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

Two case reports are presented of bradycardia in two elderly patients, which was resistant to atropine but which resolved immediately the acute bladder distension was treated. Generally, a sympathetic cardiac response is expected, and this paradoxical response may be due not only to lesions of the reflex loop involving both the vagal and the sympathetic nerves, but also to endocrinological factors. As acute urinary distension is not uncommon on geriatric wards, bradyarrhythmia due to bladder distension should be considered in elderly patients.