Severe bradyarrhythmia in a patient with Alzheimer's disease and a patientwith cerebral ischaemia, both induced by acute distension of the bladder

Two case reports are presented of bradycardia in two elderly patients, whic h was resistant to atropine but which resolved immediately the acute bladde r distension was treated. Generally, a sympathetic cardiac response is expe cted, and this paradoxical response may be due not only to lesions of the r eflex loop involving both the vagal and the sympathetic nerves, but also to endocrinological factors. As acute urinary distension is not uncommon on g eriatric wards, bradyarrhythmia due to bladder distension should be conside red in elderly patients.