Bradycardia is seen with:
**Core Concept**
Bradycardia is a slowing of heart rate, often due to vagal stimulation or direct cardiac depression. Among the listed drugs, succinyl choline can cause transient bradycardia via vagal reflex activation, particularly in susceptible individuals.
**Why the Correct Answer is Right**
Succinyl choline, a depolarizing neuromuscular blocker, induces a brief, profound vagal reflex when injected intravenously. This reflex leads to parasympathetic overactivity, resulting in bradycardia. The mechanism involves stimulation of the vagus nerve, which activates the parasympathetic pathway in the heart, decreasing sinoatrial node discharge. This effect is most pronounced in patients with preexisting vagal tone or during early administration.
**Why Each Wrong Option is Incorrect**
Option A: Midazolam, a benzodiazepine, causes sedation and hypotension but not significant bradycardia; it may even cause tachycardia in some cases due to sympathetic stimulation.
Option B: Epinephrine is a sympathomimetic agent that increases heart rate and contractility, thus causing tachycardia, not bradycardia.
Option D: Dopamine acts primarily as a vasopressor and increases heart rate at higher doses, leading to tachycardia, not bradycardia.
**Clinical Pearl / High-Yield Fact**
Succinyl choline-induced bradycardia is a known side effect, especially in elderly patients or those with cardiac disease. Always monitor heart rate closely during administration and be prepared to manage with atropine if needed.
β Correct Answer: C. Succinyl choline