Help on alternate method to cure bradycardia

My son is teenager, recently he fainted and got injury, when consulted the Doctor, after Holter mapping, they advised to go for a Pacemaker. His lowest pulse rate is at 40 during night. I am deeply worried and in deep sorrow to hear this. Please advise if any alternate methods to cure bradycardia without Pacemaker. Pls help.

7 Comments

Low Heart Rate

by SMITTY - 2013-03-17 06:03:00

Hello,

I suggest another dr before going the PM route. Inga covered one reason for the low heart rate in the last paragraph of hr comment. Our family saw another reason. Our #2 son was the athletic type and playing football. Each day he seemed to be unduly tired after practice so we carried him to the family dr. After a through exam we learned that he had a low thyroid and this was causing his low heart rate. His problem was solved with one pill a day.

Turns out that his two brthers as well as his old man had a low thyroid. The dr knew about mine and the oldest son's low thyroid and our low HR at the time and that was one reason for checking him and son #3. It was the cause of his low HR and son #3 developed the low HR a few years later.

Why everyone but my wife had a low thyroid at the time we never learned, but she did develop the problem several years later. So today the three sons, their mother and father all take synthroid each day.

Of course I'm not suggesting that is the cause of your son's bradycardia, but it may be worth checking before having him get a PM.

Good luck to your son,

Smitty

40bpm at night...

by golden_snitch - 2013-03-17 12:03:30

Hi!

40bpm at night in an otherwise healthy teenager is in my opinion not a definite indication for a pacemaker. As long as his heart rate at daytime is in the normal range, 40bpm at night is no reason for a pacemaker (that's what guidelines by American Heart Association etc. say).

So, it would be interesting to know what his average heart rate at daytime is, and if his heart rate increases when he exercises. Yes, the fainting could have been caused by a bradycardia, BUT at least I don't know anyone who fainted with a heart rate of 40bpm. And since you said this 40bpm happened at night, it's definitely not said that this is what caused him to faint at daytime. Did he get the holter monitor for 24h only? And if so, did he have any symptoms during these 24 hours? If not, I'd try to get him monitored for a couple of days with the aim to correlate symptoms with heart rates/arrhythmias. For people who pass out every now and then, sometimes weeks or months between those episodes, there are implantable event recorders which can be very helpful to make a diagnosis. Your son is young, and so I'd really not rush into something like a pacemaker as long as the indication for it isn't 100% clear.

My first holter monitor that I had at the age of 16 showed rates of around 40bpm at night, too, but neither my GP, nor the cardio, nor the heart rhythm specialist ever mentioned a pacemaker just because of these rates. I was very well trained at that time, playing basketball three times per week. People who are very athletic often have slower heart rates than the normal population.

Hope this helps a bit.

Best wishes
Inga

Low Heart Rate

by INFANTJS - 2013-03-18 03:03:06

Thank you so much Inga and Smitty for your great advises, these are definitely useful and I will follow the same.
You are the GOD's messangers giving us comfort. Sorry for writing big note...

Want to give some more inputs for your expert guidance. A year and half back my son's weight was ~60 Kgs and height 4.5 Ft. Now he is 5.5 Ft and weight is ~ 52 Kgs. He was very thin due indigestion problems and intake also reduced significantly. Later on treated(albendazole for 1-2 doses) for worms in stomach and then indigestion problems solved but still he is thin at this point.

On 10-March he slept in the afternoon for 1-2 Hrs and woke up around 2 PM. After 30 minutes he was going to get a glass of water and fainted. Not sure about the pulse rate at that point in time. We helped him to get up and took him to bed room, then he got consiousness and started talking. On same day we consulted General Physician and he suggested to see Neuro Physician and Cardiologist. A day after that Holter meter was fixed and recorded the pulse rate.

Average Heart rate at day time 74 bpm.(Avg Min 53 and Avg Max 111). Yes, his heart rate increases when he plays/exercises. Daily(except 1-2 days in a week) he plays soccer football for 1 hour. Below is the info from Holter Meter. I am also worried about the Pauses.

Time Min HR Max HR Avg HR Pauses
11:00 56 95 69 0
12:00 54 118 74 0
13:00 52 99 68 0
14:00 48 110 73 0
15:00 56 109 72 0
16:00 54 114 74 0
17:00 55 126 79 0
18:00 60 125 81 0
19:00 56 105 74 0
20:00 53 110 71 0
21:00 54 116 72 0
22:00 52 93 69 0
23:00 45 87 57 0
00:00 47 97 60 0
01:00 43 94 60 1
02:00 44 92 62 0
03:00 45 95 61 0
04:00 40 93 57 3
05:00 42 93 60 2
06:00 40 101 57 5
07:00 41 108 60 1
08:00 46 121 83 1
09:00 61 109 82 0
10:00 63 114 88 1

Holter results

by golden_snitch - 2013-03-18 05:03:02

Hi!

From these heart rates I'd not jump to the conclusion that bradycardia is what made him faint. His average heart rates are normal, his heart rate increases when he exercises, he's never below 40bpm and at daytime hardly ever below 50bpm. Don't know how the pauses were defined, but at night pauses of around 2 seconds are no problem. Sometimes pauses are caused by extrabeat (premature ventricular contractions) as those extrabeats are often followed by a so called compensatory pause. He's an active teenager, and in my opinion the holter results reflect just that.

You said that on the day when he fainted he had slept, and then got up to get a glass of water. Maybe his blood pressure didn't increase quickly enough when he got up? That's something quite a lot of people deal with when getting up, and it often causes a blurred vision for a moment, or a headache, or feeling dizzy. Some people even faint, if the blood pressure is very low.

Also, indigestion problems can lead to an imbalance in electrolytes, and those can in turn lead to arrhythmias. His potassium, magnesium etc. levels should be checked.

I'd go for a second opinion, if the cardio he's seeing at the moment insists on a pacemaker. I'd not trust someone who rushes into a pacemaker implant in a teenager that quickly. Sounds like he's looking for an easy solution, and doesn't want to do any further testing.

Best
Inga

Low Heart Rate - Questions to Electrophysiologist

by INFANTJS - 2013-03-18 07:03:09

Thanks for your great suggestoins Inga !

Soon I am going to meet a different Cardiologist and Electrophysiologist and check on the followinng points :

1) As indigestion issues were in the history, can we look at potassium, magnesium etc levels.
2) Check for underactive thyroid gland (hypothyroidism)
3) Check for infection of heart tissue (myocarditis)
4) Check for Hemochromatosis, the buildup of iron in organs
5) If he puts up weigth, will it improve HR
6) Is there any risk to life if the Low HR ~40 continues apart from fainting
7) Heard that coffee etc. will increase the pulse rate, what are the options to increase pulse rate other than medicines
8) Investigate from scratch after couple of weeks and see whether the same situataion continues

Once again thanks for your time and support. God bless you !!

Electrophysiologist Recommendations

by INFANTJS - 2013-03-21 02:03:01


Inga - You are awesome !!

Consulted Electrophysiologist below are his comments and recommendations:

- Holter reports looks fine
- cause of the faining was common syncope, during teen age transformation some people would get this kind of problems and will settle down in 1 or 2 years. This kind of problems are predominent in girls compared to boys
- recommended to go thru TMT, Stress Test and Holter(one more time) tests

Thanks once again for all your help.

Electrophysiologist Recommendations

by INFANTJS - 2013-03-25 02:03:45

Thanks all !!

Holter and Tilt Table tests conducted. Tilt Table Test simulated the fainting at BP 70/40 and HR 44 BPM. At this stage if a person can withstand for 5 minutes, he/she will be treated as normal, in our case after 3 minutes my son felt giddyness. Electrophysiologist mentioned that in teen age group they have seen this kind of issues and will get corrected in 1-2 years. EP suggested : (1) Increase fluid intake + Sodium + Potassium (2) Go thru isometric exercises

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