For some people, it’s normal to have a slow heart rate. People who are very conditioned athletes, who exercise a lot, can have a resting slow heart rate, sometimes even in their fifties, forties and that’s perfectly okay.
For other people, it can be part of the natural aging process. The electrical wiring so to speak can slow down in the heart as we go through the aging process and that can cause the natural heartbeat to slow down.
Interestingly, it can also cause people to skip some beats or miss a beat, which are symptoms of certain types of arrhythmias. So, when you check the heart rate, it can appear to slow, either because the heart rate is too slow or because people are dropping or skipping some beats. There are different ways to figure out what’s going on and whether or not that’s important.
Usually this is something that comes with age. In general, as people go on through time, sometimes their heart rate can slow down. We do look for this and see if this as part of the natural aging process, the heart rate either slowing down or developing conduction abnormalities where the top and the bottom don’t connect.
But there are a few rare circumstances where young people under the age of 30 or even sometimes children can get this because of conditions that they can be born with and that’s a little bit less common. But most of the time we see this condition as people get older.
When you just get your heart rate checked or get an EKG, any time the heart rate comes back as less than 60 beats per minutes, that’s considered bradycardia.
However, we really only get concerned about a slow heart rate if people are symptomatic and what I mean by that is feeling unexplained fatigue, really tired, sometimes lightheaded or dizzy, in really severe cases actually fainting or passing out. Some people report difficulty exercising. They say they feel they don't have enough energy or get their heart rate up when they try to exercise. In those situations, bradycardia or a slow heart rate can actually be a problem and in some circumstances we would want to follow that up further.
We have a lot of useful tools that we use. For example, we can put an external heart monitor on. We have monitors in the office that we can send you home with that you wear for one to two weeks, up to 30 days, to let us know what is your heart rate doing over time.
We have longer term monitors. Depending on the situation, there are little ones that can get implanted under the skin and can stay in for several years and monitor the heart rate and send a notification to your doctor’s office if the heart rate is either too fast or too slow.
Nowadays, people can monitor themselves with certain things like their watches. Basically we don’t react just to a slow heart rate, but if the heart rate is slow at the time that people are also experiencing these symptoms and we can’t think of any other reason for it, then we can attribute the fatigue or the lightheadedness to the slow heart rate.
If somebody is just sitting around with a slow heart rate feeling great, we don’t necessarily worry about it.
If somebody really has a slow heart rate that’s causing not enough blood to get to the brain, often times we find that it’s not just that the heart rate is slow. They might sometimes have what we call arrhythmia, where they drop or skip a beat once in a while or not all of the heart beats get through.
In your heart, you have your natural pacemaker that’s up in the top chambers of the heart. Your heart follows these electrical pathways for the heartbeat that go from top to bottom.
Sometimes we find the beats that are starting in the top aren’t making it all the way to the bottom. Sometimes we find that your own pacemaker has slowed down and all the beats are getting through, but the heart rate is too slow. In either way, if your heart rate is so slow that you’re not pumping enough blood to get to your brain, usually those people will say, “I just don’t have the energy to do what I want through the day. I feel listless, I feel tired.”
First, we check and make sure there are no other reasons that people are feeling tired. We check their blood work. We check the heart function because you can have a slow heart rate and still have normal heart function, but then at the end of the day you’re not getting enough blood to the brain and you can feel tired.
If you’re diagnosed with bradycardia, the first important thing is to figure out what type of bradycardia it is, whether it’s just the heart rate being too slow or you’re actually dropping and skipping beats.
The first thing you would want to do is see your doctor. Depending on how poorly you feel or how good you feel, you would get one of these different types of heart monitors. If it turns out that you need a pacemaker, which a lot of people do, that can make people feel better.
There are different types of pacemakers. For example, there is one that gets implanted and goes into the heart muscle. There is a tiny one that can go into the heart itself.
Think of the pacemaker as a backup generator. Your heartbeat can still do what it needs to do, but the pacemaker is in the background and gives you a little bit oomph to your heart rate as needed. There are circumstances where people’s heart rate is slow all the time versus intermittently, and that’s where the pacemaker can kick in.
Most of the time, people spend one night in the hospital and then go home the following day.
Usually, especially if you get the pacemaker implanted under the skin which is the most common type, we ask that people don’t do any driving or heavy lifting or swimming for about two weeks to give you a chance to recover properly and then hopefully you can go about your normal business.
If you are fainting or passing out or feel like you’re going to, that’s a very good time to go to the emergency room.
If you’re just feeling a little rundown and you’re not entirely sure why, it’s reasonable to make an appointment with your doctor to get an EKG, to verify the heart rate, maybe look for other reasons you could be tired; check blood work, make sure you’re not anemic. Those are different reasons people can feel tired. You may also want to consider a monitoring device to try to tease out the cause of the fatigue.
If people are asymptomatic, meaning they don’t have any symptoms with their slow heart rate, often times they can do fine, especially if it’s one of those athletes who just has a slow heart rate from running. They can do great.
However, if it’s actually one of these types of heart block where the beat doesn’t get through from the top to the bottom, it usually progresses. People feel worse over time, more tired, more fatigued, and then unfortunately people can actually faint or pass out and really get injured in that way as well. If it is something that’s causing symptoms, it’s really worth getting checked out, just to be on the safe side.
Lightly edited for clarity.
Watch the San Diego Health video with host Susan Taylor and Dr. Uddin discussing causes and treatments for bradycardia.