Symptomatic Bradycardia in a Patient with Meningoencephalitis

The National Institutes of Health defines bradycardia as a heart rate less than60 bpm in adults other than well trained athletes. However, population studies frequently use a lower cutoff of 50 bpm. In physiological cases, bradycardia is asymptomatic. When bradycardia becomes severe or is associated with other pathologies, it may manifest as lightheadedness, presyncope, and syncope, chest pain on exertion, symptoms of heart failure, cognitive slowing, and exercise intolerance. Sinus bradycardia is caused by intrinsic cardiac disorders like sick sinus syndrome or inferiormyocardial infarction, metabolic and environmental causes (such as hypothyroidism and electrolyte disorders), medications (such as beta-blockers and amiodarone), infection (such as myocarditis), increased intracranial pressure, and toxic exposure, while it can sometimes be a normal phenomenon, especially during sleep, in athletes, and during pregnancy. Symptomatic sinus bradycardia should warrant a thorough work-up in order to identify any reversible causes; otherwise, placement of a permanent pacemaker could be needed. We reported a patient where the patient complained of frequent fainting with a pulse rate of 50 beats per minute, there were also complaints of pain in the back of the head, fever accompanied by decreased consciousness and had seizures. On physical examination, there was positive neck stiffness and electrocardiographic examination with the impression of sinus bradycardia. So that the patient was diagnosed with meningoencephalitis with symptomatic bradycardia, atropine sulfate was chosen as therapy for the management of bradycardia in these patients.