emergency

Sinus Bradycardia (Symptomatic)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ESC Guidelines on cardiac pacing and cardiac resynchronization therapy 2021 · Atropine - StatPearls - NCBI Bookshelf (NBK470551), Administration and Dosing: "Bradycardia: 1 mg every 3 to 5 minutes (3 mg max), repeat until obtaining desired heart rate" and "Pediatric: 0.01 to 0.03 mg/kg every 3 to 5 minutes. The pediatric minimum dose is 0.1 mg, the maximum dose is 0.5 mg (child)". The 500 microgram lower bound is from Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201): "the patient can be treated with intravenous (IV) atropine 0.5 mg push every 3 to 5 minutes up to 3 mg total". · Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201), Treatment / Management

Verified against2 documents

Atropine - StatPearls - NCBI Bookshelf (NBK470551), Administration and Dosing: "Bradycardia: 1 mg every 3 to 5 minutes (3 mg max), repeat until obtaining desired heart rate" and "Pediatric: 0.01 to 0.03 mg/kg every 3 to 5 minutes. The pediatric minimum dose is 0.1 mg, the maximum dose is 0.5 mg (child)". The 500 microgram lower bound is from Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201): "the patient can be treated with intravenous (IV) atropine 0.5 mg push every 3 to 5 minutes up to 3 mg total".
Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201), Treatment / Management

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

When symptomatic, patients report tiredness, poor exercise tolerance, lightheadedness, dizziness, or fainting spells [dizziness · fatigue · syncope]
Worsening chest pain, worsening heart-failure symptoms, or slowed thinking can also signal a symptomatic slow heart rate [bradycardia · chest pain]

Signs — what you find (3)

Bluish skin discoloration and swelling in the legs can appear on exam in a symptomatic patient
Confusion or a change in alertness can be found on exam [confusion]
Breathlessness with crackling lung sounds can be heard on exam [breathlessness]

Tests (4)

A 12-lead tracing of the heart's electrical activity is required to make the diagnosis
Blood work should cover sugar, salts, calcium and magnesium, thyroid function, a cardiac enzyme, and a drug screen
When there is no sign of a heart attack, the next step is to look for an infection or thyroid problem as the cause
A long-term recording device can be used later if the slow rate and symptoms persist once other causes are treated

If not this — what else fits (3)

When the P wave cannot be identified on the tracing, the rhythm is instead coming from the AV node or ventricle
More than one P wave for every QRS complex points to a second- or third-degree block rather than this condition
A wandering pacemaker within the atrium is on the differential for a slow, irregular rhythm

SourceStatPearls "Sinus Bradycardia" - disease-level clinical article

Presentation findings are traced to the source above.

ATROPINE SULPHATE

1st line

Strength1 mg

Forminjection

Adult dose and duration

500 mcg to 1 mg IV, repeated every 3-5 minutes PRN up to maximum 3 mg for acute symptomatic hemodynamically unstable bradycardia while arranging immediate emergency hospital transfer - acute emergency single course

Paediatric dose

0.02 mg/kg/dose [child max 0.5 mg]

(Minimum dose 0.1 mg to avoid paradoxical bradycardia; emergency pediatric referral)

Dose by weight
3kg	0.06 mg/dose
4kg	0.08 mg/dose
5kg	0.1 mg/dose
6kg	0.12 mg/dose
7kg	0.14 mg/dose
8kg	0.16 mg/dose
9kg	0.18 mg/dose
10kg	0.2 mg/dose
11kg	0.22 mg/dose
12kg	0.24 mg/dose
13kg	0.26 mg/dose
14kg	0.28 mg/dose
15kg	0.3 mg/dose
16kg	0.32 mg/dose
17kg	0.34 mg/dose
18kg	0.36 mg/dose
19kg	0.38 mg/dose
20kg	0.4 mg/dose
21kg	0.42 mg/dose
22kg	0.44 mg/dose
23kg	0.46 mg/dose
24kg	0.48 mg/dose
25kg	0.5 mg/dose
26kg	0.5 mg/dose (capped)
27kg	0.5 mg/dose (capped)
28kg	0.5 mg/dose (capped)
29kg	0.5 mg/dose (capped)
30kg	0.5 mg/dose (capped)
31kg	0.5 mg/dose (capped)
32kg	0.5 mg/dose (capped)
33kg	0.5 mg/dose (capped)
34kg	0.5 mg/dose (capped)
35kg	0.5 mg/dose (capped)
36kg	0.5 mg/dose (capped)
37kg	0.5 mg/dose (capped)
38kg	0.5 mg/dose (capped)
39kg	0.5 mg/dose (capped)
40kg	0.5 mg/dose (capped)
41kg	0.5 mg/dose (capped)
42kg	0.5 mg/dose (capped)
43kg	0.5 mg/dose (capped)
44kg	0.5 mg/dose (capped)
45kg	0.5 mg/dose (capped)
46kg	0.5 mg/dose (capped)
47kg	0.5 mg/dose (capped)
48kg	0.5 mg/dose (capped)
49kg	0.5 mg/dose (capped)
50kg	0.5 mg/dose (capped)

Dose source

Atropine - StatPearls - NCBI Bookshelf (NBK470551), Administration and Dosing: "Bradycardia: 1 mg every 3 to 5 minutes (3 mg max), repeat until obtaining desired heart rate" and "Pediatric: 0.01 to 0.03 mg/kg every 3 to 5 minutes. The pediatric minimum dose is 0.1 mg, the maximum dose is 0.5 mg (child)". The 500 microgram lower bound is from Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201): "the patient can be treated with intravenous (IV) atropine 0.5 mg push every 3 to 5 minutes up to 3 mg total".

Why

Atropine is an antimuscarinic that blocks vagal inhibition of the sinoatrial node, raising heart rate in acute hemodynamically unstable bradycardia while emergency transfer is arranged; it treats the acute rhythm, not the underlying cause.

Cautions

Urgent cardiology referral is required if bradycardia is persistent or symptomatic (syncope, dizziness).
Causes tachycardia, dry mouth, urinary retention, and blurred vision.
Identify and treat underlying causes (medications like beta-blockers/diltiazem, hypothyroidism, ischemia).
Children: 0.01 to 0.03 mg/kg.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ATROPINE SULPHATE 1MG/ML 25 AMP. (MISR)	MISR	162.50 EGP
ATROPINE SULPHATE 1MG/ML 100 AMP. (CID)	CID	500.00 EGP
ATROPINE SULFATE 1MG/ML 100 I.V./I.M. AMP. (EL-NILE)	EL NILE.	650.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.