Atropine: Cardiac Medication Mini Series, Part Two

Do you want to enhance your understanding and effectively use atropine in the treatment of bradycardia? Starting with atropine’s mechanism of action, we will explore its proper use for symptomatic bradycardia, including it’s important contraindications.  We’ll also cover some of atropine’s other fascinating roles beyond the heart. You’ll walk away with greater confidence in both the appropriate applications and limitations of atropine for bradycardia.

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What is Atropine?

Atropine is a parasympathetic blocking agent.

It is the first line medication in the ACLS algorithm for symptomatic bradycardia (i.e. bradycardia with poor perfusion).

Mechanism of Action

  • Atropine blocks the acetylcholine, the primary neurotransmitter of the parasympathetic nervous system
  • When atropine antagonizes acetylcholine in the SA and AV nodes, the heart rate increases due to a decrease in parasympathetic stimulation


  • Bradycardia with poor perfusion
  • Preanesthetic medication to reduce secretions
  • Antidote for organophosphate poisoning
  • Reduce secretions in comfort care patients
  • Eye drops for pupil dilation
  • Treat excessive sweating
  • Prevent GI spasms in IBS


  • Avoid Atropine in 2nd degree type 2 or 3rd degree hearts blocks
    • Always check and EKG before administering Atropine
    • Because these blocks are in the bundle of His or the bundle branches, Atropine will not work as it works primarily on the SA and AV nodes
  • Avoid if ischemia is cause of bradycardia
    • Check troponin levels prior to administering Atropine