Health

Low Heart Rate (Bradycardia): When to Worry


You expect your body to slow down a bit as you age, but if the same slowing happens with your heart, is that a good or a bad thing?

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A slow heart rate (or a low heart rate) is known as bradycardia, and occurs frequently in older adults. “As people get older, there is occasional normal wear and tear on the electrical system of the heart,” says cardiologist Jose Baez-Escudero, MD. “As a result, the normal rhythm tends to slow down.”

Dr. Baez-Escudero shares when to worry about low heart rate — and the signs and symptoms to watch for.

What is a low heart rate?

Doctors consider a low heart rate to be 60 beats per minute (bpm) and below. In fact, if you have bradycardia, you’ll have a low resting heart rate below 60, even when you’re awake and active. In contrast, a normal range is 60 to 100 bpm while awake.

Can what’s considered a low heart rate change depending on the activity?

For most young people, highly trained athletes, and people who work out regularly, a low heart rate while exercising — defined as below 60 bpm — is normal and healthy.

The same goes for your nightly snooze. When you’re asleep, your heart rate normally slows down to 40 to 60 beats a minute.

What causes a low heart rate?

Many things can bring on a slow heart rate.


A heart malfunction

The most common cause for bradycardia is a malfunction in the heart’s natural pacemaker, the sinus node. It controls how quickly the top and bottom heart chambers pump blood through the body.

AV Block

Another cause of bradycardia is atrioventricular block (AV Block), in which the top and bottom chambers don’t communicate well and your heart rate drops as a result.

“It’s like having virtual electrical cables and wires inside the heart,” Dr. Baez-Escudero says. “These deteriorate as we age. Common medications used in older populations can also often make bradycardia more significant.”

Age

Age is the most common risk factor for developing bradycardia. The condition is most common among men and women over age 65.

Having certain illnesses or conditions

Illness or other conditions may also cause bradycardia. These include:

  • Heart attacks due to coronary artery disease.
  • A bacterial infection in the blood that attacks your heart.
  • Inflammation of your heart muscle.
  • Low thyroid function.
  • An electrolyte imbalance.
  • Too much potassium in your blood.
  • Certain medications, including beta blockers and antiarrhythmics.

Congenital heart defects, diabetes or long-standing high blood pressure all may make bradycardia more likely, says Dr. Baez-Escudero.

What are the symptoms of a low heart rate?

It is very possible to have a slow heart rate and experience no symptoms. However, if you have symptoms but ignore them, it can sometimes cause more serious problems.

Consult your doctor if you are experiencing some of these symptoms and you have an associated slow heart rate:

  • Lack of energy.
  • Low stamina.
  • Dizziness.
  • Weakness.
  • Chest pains.
  • Confusion/memory problems.
  • Heart palpitations or flutters.

Does bradycardia require treatment?

If your heart rate is slow, but you don’t have symptoms, there’s no reason to worry. However, it’s a good idea to know the signs of trouble because bradycardia in some cases does require treatment.

For example, if your heart rate drops into the 30s, you might not get enough oxygen to your brain, making fainting, lightheadedness, and shortness of breath possible. Blood can also pool in your heart chambers, causing congestive heart failure.

The importance of monitoring your heart rate

If you are concerned about a low heart rate, visiting your physician can help determine the causes. Your doctor will first ask about your usual activities and conduct a physical exam.

They may use an electrocardiogram (EKG) to measure the electrical signals in your heart, in order to see whether they’re firing correctly. Wearing a 24-hour monitor can also help your doctor see how your heart performs over time.

Once your doctor decides you might need treatment, they will try to rule out medications or other pre-existing conditions as causes. Sometimes changing medications or similar strategies can solve the problem.

If not, implanting a pacemaker via minimally invasive surgery is the only option to speed up your heart rate, Dr. Baez-Escudero says.

However, he notes that bradycardia isn’t often an emergency, so doctors have time to choose the right treatment.

“In general, bradycardia allows time for us to evaluate the condition and rule out if any other condition is responsible,” Dr. Baez-Escudero says. “Then, we can adjust medications or take other steps if we need to.”

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