Low heart rate - a little help please

BTDT

by AgentX86 - 2018-08-08 08:44:48

First of all, in addition to a cardiologist, you should be seeing an electrophysiologist. Cardiologists are plumbers,  EPs are heart electricians. Bradycardia is an electrical problem.

Yes, many of us have been in your shoes. It doesn't get better by itself and left untreated,  will get worse. That said mid-40s is, by definition,  Bradycardia, though given your exercise regimen,  not particularly low. The fact that you aren't feeling good and have periods where you're "fuzzy headed" says that it needs to be fixed.

The good news is that this is one of the easiest heart conditions for a pacemaker to fix. However, at your age,  many doctors will be reluctant to go here. You'll need a replacement every six to ten years, for the rest of your life. That's a big commitment and one doctors will try to avoid.

That's not to say that you shouldn't try other solutions but you're going to have to be insistent that this gets fixed. Your quality of life is on the line. If you're unhappy with your doctor's progress, don't hesitate to fire him. Let me reiterate, though, you need to see an electrophysiologist to treat this.

Thank you

by NickEdwards83 - 2018-08-08 13:03:25

Thank you for your reply.

I'm still surprised that the cardiologist didn't flag it up at the time. Or perhaps it has developed since that. On that subject, is this something that, once started, generally gets worse? And if so, does that generally happen quickly or slowly? To be honest, I don't really know how long this has been going on, as I've only been tracking my heart rate since January. I guess I have felt sluggish and ocassionally light-headed for a couple of years now. 

If the doctor advises against a pacemaker and there are no uinderlying causes for the low heart rate (which I think will be the case given that I had a full blood test earlier this year and everything came back normal), what will they realistically suggest instead? 

You said mid-to-high 40s isn't particularly low given the fact I am active, so what would be considered low? I should add that my heart rate isn't like this all the time, only when I am sedentry for a prolonged period of time.

Sorry for all the questions. I'm just a bit anxious as this has all come out of nowhere, and unfortunately I can't see a doctor for a couple of weeks as I'm going on holiday. 

Thanks again.

Bradycardia

by AgentX86 - 2018-08-08 14:44:19

Your cardiologist probably did "flag" it but didn't want to make a big deal out of it yet. As I said, mid-40s isn't all that bad and by itself isn't dangerous. The Holter likely confirmed to him that Bradycardia was all you're looking at, but 24hrs isn't a long time window. I would have expected three day, minimum, to rule out more serious problems. A seriously low Bradycardia would be in the 30s but my cardiologist wasn't even concerned about that. He changed meds a bit but that's it. The meds were, at least initially, my Bradycardia problem. The primary issue is/was Aflutter and the meds for that caused Bradycardia and eventually pauses.

Yes, it always gets worse. Never better. It's usually a slow process, which is likely why your cardiologist's hair isn't on fire yet.

The larger issue is that you're not feeling well. You have to impress upon him that your quality of life matters. Be honest but firm with him. You don't want any part in The Walking Dead. You have to be honest with yourself,  too. How bad is it? Can you manage the way you are? What are you willing to go through to feel better? Waiting is a valid choice, here. A pacemaker now will mean, maybe five or even ten more throughout your life. Yes, people here will do that. It's not a horrible outcome but is it neccessary for you to live your life as you want to live it? These are your choices. Your doctor's job is to guide you, not to tell you how you must live. Make sure he is doing that job. He is your employee.

Again, I'll say that you need an EP. Apparently you have no structural problems with your heart but apparently you do have an electrical problem. That's what electrophysiologist do. My cardiologist is a great guy and he helped me through bypass surgery but passed me off to an EP after the plumbing was made right. My EP has been much more comfortable giving me options to fix, or at least paper over, the electrical system problems.

Go on your vacation. It doesn't seem that there is any emergency here. Have fun. Forget about your heart for a couple of weeks.

What AgentX said....

by Gotrhythm - 2018-08-08 15:28:37

I agree with everything AgentX says. For someone who is very fit, a heart rate in the fourties is not in itself cause for alarm. A person can live and even thrive with a slow heartrate. The big question is how do you feel? You meantion tired, fuzzy headed and short of breath. Is there a pattern. Worse sometimes than others? How are you feeling when running and after?

I doubt if the findings of a Holter monitor test a few years ago (and only 24 hours) would be significant now, becuase rhythm or electrical problems don't stay the same, and generally get worse. You could also have other rhytym problems in addition to the low heart rate. And you might have none at all.

As for how fast rhythm problems get worse... that depends. In my case they worsened slowly for several years and then in the space of three months my HR plummeted from 60 to 34. For some, the problem seems to appear out of the blue.

The takeaway here is that you need to see an EP, like AgentX says. Don't worry about putting it off for your vacation. Realistically, if you call today you won't be seen for a month. 

My experience

by phadzip - 2018-08-08 18:27:49

Mid- to low-40s is usually fine for someone who is fit. I bottomed out at around 30. I was in the ER once on another matter and they stuck me into a resuscitation room. I was very active, so 40 was normal. I ran 27 marathons, including 8 Bostons, but a few years ago things started to turn and every run became a chore.

I did have some of the lightheadedness of which you speak as well as fatigue. That's another key symptom. To make a long story short, I had an ablation two years ago to correct atrial flutter and at that time they said I would eventually probably need a pacemaker.

I got myself back into better shape and managed a half marathon last fall. It was very slow (for me) and very difficult. Two weeks later a followup showed I still had issues. Fast forward to July 16 and I was in the OR getting a pacemaker implanted. They set my resting heart rate to 50 and within a day I had an energy that wasn't there before.

We were on vacation in Greece the month before, and walking up little hills left me feeling bagged. The day after my procedure I went for a walk and had no trouble on the little hills around my house.

I am still recuperating, but expect to hear "all systems go" at my next followup at the end of this month. I will then sign up for a 5K race and, while I won't burn up the course, I expect to do OK. And beat a bunch of people decades younger than me. Not bad for a 63-year-old guy.

So bottom line Nick, go see an electrophysiologist. There may be something going on. Pacemakers aren't just for old people. My mother had one in her 40s. Back then they were the size of a deck of cards and you could see them under the skin. I still have a bump where mine is, but I am slowly getting used to it.

Good luck!

Bradycardia

by The real Patch - 2018-08-08 18:46:53

while it is quite common for athletic people to have a low resting heart rate, that doesn't make it okay. In fact low rates  mean your heart is not pumping enough oxygen and nutrient enriched blood to your organs. Further, the fact you are exhibiting symptoms of Btadycardia indicates it is getting worse and needs to be treated.

An Electrophysiologist (EP) is just a Cardiologist who specializes in the electrical system. No matter what kind of MD they should be able to identify the fact that resting heart rates below 60bpm is abnormal and should refer you to a specialist (EP). It is not uncommon for a short term of 24 hours to miss problems with an EKG and in fact I know many people who went through the same until they were given a holter monitor for 30 days. So if they didn't detect a problem they should have gone a step further.

Still the main point, you are exhibiting symptoms of Bradycardia (slow heart rate) and it needs to be treated seriously. Don't take no for an answer, the doctors work for you.

Good luck

Thanks everyone

by NickEdwards83 - 2018-08-09 01:53:44

Thank you all for taking the time to reply. 

Just to clarify a few things about symptoms - I do often feel tired and slugish, particularly in the mornings and evenings. But then life can be tiring. I get up at 6am every day and don't always get enough sleep. As I said, I'm active. Plus I suffer with mild depression/anxiety, which by all account can leave people feeling flat. 

The last few weeks it has perhaps been worse than usual, but this has coincided with a pretty major heatwave where I live. It's around 35c in the shade most days, and the air is thick and muggy. So again, that could be a factor. 

When i look back, I could probably say I've felt this way off and on for years. I just put it down to the fact that life is tiring. When I got my fitness tracker back in January, my resting heart rate was around 54 for months. It then dropped down slowly over the last 4 month or so. The last week or so it has been around 46. I don't know if hot weather can effect this or not. But during the last 8 months, I have stepped up my running, knocking about 2 minutes off my 5k time on average, so my cardio health is obviously improving. I often feel a bit destroyed after a run, but I push myself fairly hard. 

Anyway, thanks again for your thoughts. I'm reassured to know that 46 isn't dangerously low, but I'll definitely book in with my doctor when I get back from my hols. 

Bradycardia for me

by Electric Elise - 2018-08-09 08:50:10

Hi Nick,

As usual, the folks responding so far have offered you very good and pertinent advice, and they all have way more expereince than i do, so i will just quickly tell you what it felt like in my case. Like yourself, i’m 35, almost 36 actually and i had never had heart trouble in the past. However, i’m not as sporty as yourself, but i was still able to walk briskly for miles and miles, go out and run around with the dogs and so on. However, about a year ago i started complaining about feeling more and more unfit. Climbing up stairs - my archnemesis!! But i just couldn’t put my finger on it exactly. I thought maybe a thyroid problem? Got that checked - no. Lungs perhaps? Checked - no. I even blamed the heat, so i had an AC unit installed - to no avail. As time went by, i was getting more and more aware that i simply wasn’t functioning as i used to. I was tired, sluggish, out of breath. And i thought ok, maybe it’s the anxiety/depression i’d been struggling with for the past couple of years. I read so much on the topic to get myself back to happy, eventually i even managed to do that - yet the constant tiredness was plaguing me. It really became obvious in the first few months of 2018, when i also started experiencing dizzy spells - which got worse as the months went by. Then it all went downhill from there. By may, the rare dizzy spell became a daily occurence, by june it was an almost permanent state. I went from walking for hours straight to not even being able to drag myself from one room to the other. I avoided going downstairs because the mere thought of having to climb up was more than i could deal with.

ALL the cardiologists i’d seen may-june (and there were 5 or 6 of them by the way! I was THAT worried and determined to get to the bottom of things) seemed to brush things off. That “oh she’s way too young to have this big of an issue” mentality. Luckily for me, on my second 48 hour holter monitor, it actually registered a 3rd degree heart block. And even then 2 docs were reluctant to advise me to get paced, because the block somehow miraculously went away by the time i got admitted to hospital! The EP sat me down, talked me through all the pros and cons and even HE said that at this point, going by all the tests they had run, getting a PM will be more of a preemptive measure. The heart block was gone, i was doing pretty ok.. how long for, it would’ve been hard to say. I told him i wanted to have the operation nevertheless, because the previous weeks of uninterrupted bradycaria were a nightmare (felt like my body was slowly shutting down - couldn’t walk, couldn’t breathe, kidneys starting failing me).

I’ve had the PM for one month now. A couple of days ago, i went for my check-up and innocently asked the EP if i’d been paced at all during those 4 weeks.. he gave this look “uhm.. yes, actually, 48% of the time”. Shock all around - to me, him and the cardiologist who took care of me while in hospital (to quote him, upon hearing the 48% news: “you have got to be kidding, i can’t believe it!!”). Nobody thought it would be this needed, but lo and behold.

I suppose the long and short of it is.. if you feel there’s something wrong, keep insisting until you get to the bottom of it all. Some things in life just don’t sort themselves out without outside intervention, no matter how much we will them to.. Wishing you best of luck and i hope to hear more from you.

Elise

Discounting symptoms

by Gotrhythm - 2018-08-09 14:19:25

Having read "Thanks everyone" I find myself with more to say. I was struck by the sentence "I often feel a bit destroyed after a run, but I push myself fairly hard."

It sounds to me as if you are discounting what you are experiencing because you are still able to cope. But you are able to cope, not because you feel well or have normal energy for someone your age, but because you have a strong will and are disciplined.

Another discount: "The last week or so it [my pulse] has been around 46. I don't know if hot weather can effect this or not."  Hot humid weather does not cause your heart rate to slow. If it did, everyone in the Southern US, where summers are brutal would suffer from bradycardia.

Another discount: "Plus I suffer with mild depression/anxiety, which by all account can leave people feeling flat." There is very little difference between feeling tired because you are depressed, and feeling depressed because you have been tired for so long you don't remember what feeling great feels like. If you are slogging through life, pushing yourself to do more than you really feel like doing, never bad enough to collapse, never good enough to feel vigorous, up energy--not waking up rested and ready for the day--why wouldn't you feel a little flat?

The cause of your mild depression and anxiety might not be your heart--but there's a very real chance it could be. Read the archives. It isn't uncommon for "emotional" symptoms to disappear once people have a steady heartbeat.

It really is particularly important that you see an electrophysiologist. A busy cardiologist will look at the fact that you are obviously healty, obviously able to function, not having spells of unconsiousness, and dismiss you.

When you talk to the EP, do not discount. Tell them exactly how you feel. And be ready to insist on a Holter monitor test--the longer the better.

Good luck. Let us know how you're getting along.

That’s Low and Getting Lower

by NiceNiecey - 2018-08-11 01:20:45

Hi there and welcome to our club.  We hope you don’t have to join but it sounds like you may!

Given that your resting heart rate has dropped steadily in 8 months, it’s concerning.  Furthermore, running a 5k 3 times a week isn’t like practicing for a marathon.  I was swimming for an hour 3 times a week before my PM and thought I was getting in better shape because my heart rate had always been resting at around 80 and was suddenly 70 or 65.  I patted myself on the back.  I must be entering the “elite athlete” phase, I reasoned.  Not so!!!  I was wiped out when I crawled out of the pool each day.

Through the years, I was placed on a holter monitor 2 or 3 different times.  Nothing other than PVCs were ever noted.  But, like Elise, climbing the stairway became exhausting and I had to focus hard on my breathing so I could think.  I just couldn’t concentrate.  My head was fuzzy like I drank a glass of wine really fast.  I nearly fainted.

Unfortunately, I think the chances of this “getting better” are quite slim and typically only related to an infectious process in the body clearing up.  But that’s not you since you’ve had blood work done.

Is it possible to ask your primary physician what your HR was in previous checkups before you went in about this problem?  Looking back might provide some evidence of a significant change.

In addition, do you take meds of any kind that might lower your HR?  My husband has always had a resting HR in the 50s.  But he has high BP and takes medication for it, further lowering his HR.  He is fine but he has always had a low HR.

Do let us know what happens.  We want to be of help to you!

Niecey

More data needed?

by mbcracken - 2018-08-11 10:29:09

Lots of great advice and suggestions above...

For about +20 years, I was misdiagnosed wtih elipelsy rather then bradycardia.  What helped me eventually was when a new neuroligist suggested I have my heart examined more.  I wore a external heart monitor for 2 weeks and it showed some slightly odd heart rates.  I then had a heart loop recorder installed to monitor my heart.  A heart loop recorder has about 1-2 year battery life span.  Comes with a handy small "time marker" device that you click and hold over the device to mark times you feel uncomfortable.  This helped catch my cardiac events with great detail so my EP could install a PM the day after I had my events.  

Like yourself, I too am an athete.  A bit older then you at 51yo. Prior to my PM, I would drop into the low-mid 40 BPM. My bradycardia events were causing me to faint (syncopy).  My heart rate was dropping to 3 beats over 30 seconds, then no cardiac activity for 15 seconds.  Then, it would kick back in and I would be fine.  Luckily, the cardiac loop recorder captured all this so the ER and EP could help me immediately.

Cheers, Mike