What initial investigations are recommended for a patient with symptomatic bradycardia in primary care?

For a patient presenting with symptomatic bradycardia in primary care, the initial investigations should include a 12-lead electrocardiogram (ECG) to identify any conduction abnormalities such as heart block or other arrhythmias. This is essential to detect red flags that require urgent referral. Vital signs including pulse rate and blood pressure (lying and standing) should be recorded. Blood tests should be arranged to identify reversible causes, including full blood count, urea and electrolytes, thyroid function tests, liver function tests, and HbA1c. If syncope or near syncope is present, or if the ECG shows second or third degree atrioventricular block, urgent cardiology referral is indicated. Additional investigations such as ambulatory ECG monitoring may be considered depending on symptom frequency and severity. Echocardiography should be arranged if structural heart disease is suspected clinically or on ECG. Medication review is important to identify drugs that may contribute to bradycardia. These steps help identify underlying causes and guide management or referral decisions.