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Slow Heart Rate: Is This Normal or a Cause for Concern?

For most adults, a heart rate of about 60 to 100 beats a minute while at rest is considered normal. But like with many things that slow down as we age so can our hearts.

If your heart beats less than 60 times a minute, it’s considered slower (or lower) than normal and is called bradycardia. If you’re an elite athlete or healthy young adult, a slower resting heart rate right might not be a big deal, but in older adults, it could indicate a problem with your heart.

Along with atrial fibrillation and tachycardia, bradycardia is one of the most common arrhythmias. If you’re experiencing a lower-than-normal heart rate, read on to learn more about potential causes, symptoms and treatment options.

What are the causes of bradycardia in older adults?

In young adults and pro athletes, bradycardia can be caused by significant athleticism or a high vagal tone, which means that your body can relax faster after stress. High vagal tone is most commonly benign. However, the vagus nerve in the stem of the brain can become overactive and slow down the heart which can prevent your heart from pumping blood to the brain, often referred to as vasovagal syncope (or fainting).

Typically, in older adults, however, bradycardia is due to an issue with the natural pacemaker of the heart or electrical system of the heart.

“Bradycardia occurs when the electrical system of the heart in the upper chambers of the heart is not working properly,” said Michael Zawaneh, MD, a cardiologist and electrophysiologist with Banner – University Medicine Heart Institute in Phoenix, AZ. “However, it can also be caused by direct damage to the heart tissue with conditions such as heart attacks or inflammation of the heart muscle known as myocarditis.”

Secondary causes of bradycardia are also seen in those with obstructive sleep apnea and hormonal imbalances such as hypothyroidism. Slowing of the heart rate can also be caused by medications used to treat high blood pressure, such as beta-blockers and calcium channel blockers, as well as sedatives, painkillers and antianxiety medications.

“Depending on the cause, bradycardia in middle-aged and older adults may be no cause for concern, or it could indicate a problem,” Dr. Zawaneh said. “It can be a serious concern when you develop symptoms."

Because bradycardia can prevent your body from getting oxygen-rich blood, you may be at an increased risk for heart failure and cardiac arrest, fainting (vasovagal syncope) and seizures.

What are the symptoms of bradycardia?

“Although many people may not experience any symptoms, there are significant symptoms associated with bradycardia,” Dr. Zawaneh noted. “Most often these symptoms are caused by the heart not being able to effectively pump enough oxygen-rich blood into the body because the pulse rate has slowed.”

Common symptoms can vary, but consult your health care provider if you’re experiencing some of these symptoms:

  • Low energy
  • Decreased physical activity or stamina
  • Exhaustion or increased sleepiness
  • Confusion or memory problems
  • Shortness of breath
  • Chest pain

More severe symptoms may include dizziness, lightheadedness or passing out with loss of consciousness.

How is bradycardia diagnosed?

A diagnosis of bradycardia is most commonly made when you share symptoms with your health care provider. It is usually diagnosed on an electrocardiogram (EKG or ECG), which measures the electrical impulses that control heart rhythm, and cardiac monitors such as continuous Holter monitors or cardiac event monitors.

Even with excellent diagnostic tests, bradycardia can often go unnoticed—especially when associated with symptoms of loss of consciousness or passing out. “If these diagnostic tests fail, sometimes a doctor will implant a heart monitor just under the skin of the chest for long-term heart monitoring,” Dr. Zawaneh said.

How is bradycardia treated?

Treatment for bradycardia can depend on the degree of your symptoms and what is causing it to occur. If bradycardia doesn’t cause symptoms, it may not need to be treated.

“It is often the case that no therapy is needed and only careful long-term observation,” Dr. Zawaneh said.

You and your health care provider can decide what treatment is right for you. Some treatment options may include the following:

  • Stopping or reducing the dose of your medications, which could potentially slow your pulse rate down. Often reducing the medication dose or stopping the medication can resolve issues of bradycardia.
  • If damage to the heart’s electrical system causes a slower heart rate, you will probably need a pacemaker, an implanted device that helps correct your heart rate. Pacemakers are a lifelong commitment, but they can successfully allow patients to return to a normal quality of life with very little, if any, limitations.

“Unfortunately, there’s not a great medication option to treat bradycardia that can be taken orally on a daily basis,” Dr. Zawaneh said. “Only medications which can improve a person’s heart rate and overcome bradycardia are available via an IV used in the cardiac intensive care unit.”

Is there anything I can do to prevent bradycardia?

You may not be able to control all of your risk factors for bradycardia, but taking steps to live a heart-healthy lifestyle may help lower your risk. These steps include:

  • Eating a heart-healthy diet
  • Maintaining a healthy weight
  • Exercising regularly
  • Limiting alcohol
  • Avoiding smoking and recreational drugs
  • Managing chronic conditions, such as high blood pressure and diabetes
  • Having regular physical exams

If you’re experiencing symptoms of bradycardia or believe you may have an underlying heart condition, schedule an appointment with your health care provider. To find a Banner Health specialist near you, visit bannerhealth.com.

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