Bradycardia accompanying hypotension can be found in spinal cord injury (loss of autonomic reflex), beta blocker and calcium channel blocker overdose, intrinsic cardiac electrophysiologic derangement, and, often forgotten, intrabdominal hemorrhage. In the appropriate setting (blunt trauma, ruptured ectopic pregnancy), bradycardic hypotensive patients should be considered the same as tachycardic hypotensive patients and get a work up and treatment focused on Hemoperitoneum.
Howard S. Snyder, Stephen J. Dresnick, Lack of a tachycardic response to hypotension in penetrating abdominal injuries, The Journal of Emergency Medicine, Volume 7, Issue 4, 1989, Pages 335-339, ISSN 0736-4679, https://doi.org/10.1016/0736-4679(89)90294-1.
Howard S. Snyder, Lack of a tachycardic response to hypotension with ruptured ectopic pregnancy,
The American Journal of Emergency Medicine, Volume 8, Issue 1,1990,Pages 23-26, ISSN 0735-6757, https://doi.org/10.1016/0735-6757(90)90288-B.
Rana MS, Khalid U, Law S. Paradoxical bradycardia in a patient with haemorrhagic shock secondary to blunt abdominal trauma. BMJ Case Rep. 2010 Oct 6;2010:bcr0420102872. doi: 10.1136/bcr.04.2010.2872. PMID: 22778107; PMCID: PMC3027800
Jansen RP. Relative bradycardia: a sign of acute intraperitoneal bleeding. Aust N Z J Obstet Gynaecol. 1978 Aug;18(3):206-8. doi: 10.1111/j.1479-828x.1978.tb00051.x. PMID: 283785
