Need Advice Bradycardia

Your numbers are normal ?????

by IAN MC - 2018-04-15 13:36:10

Hi Marla    I am very surprised by the comment from your E.R. especially as you seem to be experiencing typical bradycardia symptoms.  As you know, if your heart-rate is too low for you then you are not getting enough oxygen pumped around your body and this can lead to lightheadedness and exhaustion.   Vertigo may be a symptom of the bradycardia rather than the cause.

The good news is that your numbers are not life-threatening , many athletes have resting heart-rates in the thirties but as you have symptoms it does need medical action especially as your bradycardia appears to be progressive.

The fact that you can't get your heart-rate up on exercising is further evidence that you may have cardiac electrical problems.

I suspect that you may be  a candidate for a pacemaker at some time in the future . You haven't filled in your bio so I am assuming that you don't already have one ??

In my opinion, as a matter of urgency,  you need to  seek medical advice even if it means getting  a second opinion ...... but I am not a doctor and doctor knows best !

 Best of luck

Ian

Normal heart rate

by Gotrhythm - 2018-04-15 14:00:17

Unless you are an athelete in superb condition, a heart rate in the 40's is not normal. For sure a heart rate that doesn't make it above 82 when climbing stairs--again, unless you are an athelete, is not normal. It's no surprise that you feel terrible.

I too had a heart rate that fell over a couple of months--and interestingly, it was a pulmonologist who noted that I didn't look like an athelete, LOL, and thought a heart rate of 50 probably wasn't good. I had been seeing cardiologists but it was he who ordered the Holter monitior.

Here's what you need to know. A heart rate in the 50's and 40's is only "normal" if you feel well. A certain heart rate doesn't mean anything unless you feel good enough to do what you need to do. Advocate for yourself. You know that your heart rate has been falling for the last few weeks. Keep track of your numbers so that you have something to show a doctor and find someone who will listen.

If you heart rate goes into the 30's get someone else to drive you to an ER.

My experience is when a doctor can't see your problem, there's no point in going back.

From your description your condition is serious. Enlist a family member or friend to go with you. Find another EP. Travel if you must. But find a doctor who will listen and take your condition seriously.

Follow-up Question

by Marla - 2018-04-15 15:07:30

What sort of tests should I be advocating for? 

Tests

by LondonAndy - 2018-04-15 15:39:20

Hi Marla.  I agree with Ian anf Gotrhythm.  You shouldn't really need any more tests - the results you already have should have given sufficient information to a doctor.  However, personally I keep a good quality blood pressure meter at home (the type that has a cuff around the arm, and costs about £30 to £40 / $50 - $70) so that you can take additional readings, particularly when feeling bad.  Keep a log of time, date and pulse/pressure readings to take with you with a friend as suggested.

Time for a pacemaker

by zawodniak2 - 2018-04-15 16:23:56

At the rate you are going you may be risking an unexpected and dangerous situation when you pass out.  Not to scare you, but only warn you.  I passed out even without having all the warning signs you are having and was lucky enough to sustain only a broken rib and spent several days in hospital. I later had an electrophysiologist perform a tilt table test which indicated brackycardia and a heart rate which did not respond sufficiently to exercise, had a pacemaker put in ten years ago and feel great. DO IT!!

              Rodger

Tests

by Gotrhythm - 2018-04-15 16:39:49

LondonAndy is right. You don't need any more tests. You have had the ones that are appropriate. You need a doctor who looks at the patient as well as the test results.

There is a natural wide variation in heart rates, but "normal" is considered to be between 60 and 100.

It's not clear from your post whether you did or are doing the 30 day monitor. If you haven't done it, that's the only thing I would suggest. But really, a Holter monitor is enough. Since your heart rate appears to be falling, it might be worthwhile to repeat it--just for comparison.

Mainly you need a doctor who will look at the test results you already have.

Tests

by IAN MC - 2018-04-15 16:50:06

An underactive thyroid can cause bradycardia so thyroid tests are usually done before going down the pacemaker route

Ian

Follow-up

by Marla - 2018-04-15 17:27:09

Thank you for the responses and information. I have had my thyroid tested and all other blood work. No medications that would affect the hr. I am scheduled to wear a 30 day monitor but I am confused if I am having almost constant lightheadedness and feeling of passing out every time I get up and move how will that help? My understanding is that it records when you press the button, I would need to press the button all the time. Did anyone wear one of those before the PM? When did you press the button? I agree about needing a second opinion. The EP started the conversation by saying he is hesitant to commit a 40 year old to 40 or 50 years with a PM but then moved on to maybe it is vertigo. Like I said I am unable to do much besides sit on the couch.

Tests and perhaps a different EP

by jcb - 2018-04-15 18:10:10

As they already did  the bloodwork the only other test i can think of is a stress test. That would show if your heart responds to exercise.

Other than that, it's unclear if they did anything with the information you provided about the sudden drop in HR and your constant lightheadedness.  If the symptoms are always present, a 24 hr holter should be enough.

There's nothing wrong with being hesitant and wanting to rule out other causes, but your age shouldn't be a factor. If you feel your EP is not listening  to you or is hesitant to advise a pacemaker simply because of your age, then you should see a different EP.

You said it all!

by donr - 2018-04-15 18:30:23

Get a new EP who completed his/her fellowship in the late 20th Century.  That line about your age & PM's is as out of date as the concept that PM's are an "Old Folks" device.  You can require a PM at ANY age.  We have all sorts of members who got PM's very close to their BIRTH. 

What more is another 30 days of Brady symptom data going to do or prove/confirm?  It has already demonstrated that it is there ALL the time.  This sounds more like CYA medicine than conservative medicine.  The final blow for me was nearly falling asleep in a restaurant & doing a face plant in a plate of pasta. 

Donr

slow heart rate

by islandgirl - 2018-04-16 12:19:02

The monitor.....you press a button when you are symptomatic.  It will automatically record, within the parameters the dr sets/specifies.  Press it often so they will know what's going on. Hopefully after a few days they will see it's not something else.  The monitor company was sending my EP faxes constantly with concerns, and they even called me to find out what I was doing, etc.  That was an unsavory feeling, especially in the middle of the night.  

Switch to another ep.  Make sure they are a member of the heart rhythm society.  You can go to that heart rhythm society's website to check.  My ep says those are the only eps you want to deal with, as they are the most up-to-date in their profession.

My resting rate was always 54 and I was very athletic.  When it started dropping and I began passing out a few times, a monitor showed it was dropping to the upper teens at night.  When I got my PM, I had a resting rate during the daytime in the low 30s.  I felt awful and was in a permanent junctional rhythm due to SSS.  It was an emergency implant.  I had only been wearing my monitor a few days when the EP called me and told me to get to the ER.  

What Islandgirl said

by Gotrhythm - 2018-04-16 13:30:29

I'm really glad you are being monitored. Hopefully, there will be some warning if your heart rate starts to dip dangerously low. I'd like to reiterate Islandgirl's comment. Push the button every time you feel something--no matter how frequently. And push the button to record what you are doing when the feelings hit. It will help the doctor to see how your symptoms are reflecting what your heart is doing. 

I remember also having waves of tiredness. Be sure to record those too. Don't worry about getting it right. No matter how frequent, anytime you push the button is the right time.

About being too young at 40. So what if you have to have a pacemaker for the next 50 years. The question is, do you need one now? That EP's reasoning is antiquated.

More bradycardia questions...

by Marla - 2018-04-29 16:37:50

Thank you for all your comments and feedback. My heart rate has declined a bit more since I first wrote. I have seen an EP who is considered one of the best in the city where I live. He spent a lot of time talking to me and thinks I have some form of dysautonomia, like POTS but not tachycardic, bradycardic. Anyway, I cannot find much online about dysautonomia and bradycardia and I want to know if bradycardia makes you feel awful 24/7 with worse times than others or only when you are experiencing low heart rates? If he said I want to put a pacemaker in I would not hesitate, he did not mentioned pacemaker in this visit. I could use any advice or expereinces that would help me. I am super sick and not getting better after a month. 

Thank you.