Question posted for a friend: bradycardia

Urge your friend to a cardiologist

by Gotrhythm - 2023-05-05 16:27:25

Bradycardia is something that can happen at any age, and yes to people who have otherwise health hearts. I have bradycardia from SSS, Sick Sinus Syndrome, in the absense of any heart disease. SSS is most common in older people (65+) but it can happen in much younger people.

But to rush to talking about pacemakers before your friend has even seen a cardiologist is premature. The term bradycardia doesn't say anything about what is causing the bradycardia. There could be many causes.If she has bradycardia she needs medical attention.

Urge your friend to follow up with a specialist. A heart rate that's too slow, even when there are no obvious symtoms, slowly drains the pleasure and savor out of life. And if you're young and otherwise healthy, you can keep on, and keep up, and not really comprehend what a too slow heartrate is costing you.

In a way, I think your friend is lucky to have discovered the bradycardia. With 20/20 hindsight I think I had slowly increasing bradycardia for at least 15 years before I was diagnosed. I knew something was wrong. Went to different doctors who gave me antidepressants. But since I had no "heart" symptoms, I never once wondered if it was my heart.

Even after I was diagnosed I didn't grasp what it was doing to me, because it's so subtle. It had been so long, I had totally forgotten what life is like if you wake up rested, looking forward to the day.

Bradycardia

by Gemita - 2023-05-05 17:27:13

Hello ASully, hope you and the little one are doing well.  Bradycardia on its own can be difficult to assess and patients who are healthy and not experiencing any symptoms may go untreated for years until things start to deteriorate.  I agree with Gotrhythm that your friend needs an appointment with a Cardiologist/EP who can give her a proper diagnosis.  In the meantime, this has been my experience. 

As you know I am in the UK.  I had to prove that I was highly symptomatic before a pacemaker was recommended for bradycardia/tachycardia syndrome.  My heart rates were falling to around -29 bpm during the night and often struggling to stay around 35-40 bpm during the day (eventually confirmed by long term Reveal Linq implant monitor).  I felt cold all the time, lethargic, often close to collapse through weakness, felt intermittently breathless with chest pain and had the most awful arrhythmias that occasionally caused syncope and this was all triggered by bradycardia.  Even so the only reason why my doctors decided to implant a pacemaker was so that they could treat my AF (with a rapid ventricular response) with rate lowering meds that would otherwise reduce my heart rate to even lower levels without the benefit of a pacemaker.

A number of members here have confirmed a similar story that only when they received their pacemakers were they able to feel the difference the pacemaker had made to their quality of life.  They felt instantly better.

In your friend’s case, I note that she did not follow up with an EP, perhaps because she is asymptomatic?  Before she sees an EP, I would suggest she may want to have a look at her lifestyle and to think about any symptoms she might be getting, symptoms that might be preventing her from leading a normal life?  If she goes to any appointment and tells doctors she feels fine, with no symptoms, they may not suggest any treatment based on a one off heart rate in the low 40s.  She may need longer term monitoring to capture what is going on and I urge her to request this.  A heart rate in the 40s seen on the Holter Monitor without any other events, like arrhythmias, might not be significant and doctors need to see this happening more frequently before they are prepared to confirm bradycardia and a possible need for a pacemaker.  

I hope this helps

simple bradycardia

by ourswimmer - 2023-05-05 18:12:09

Resting HR is pretty variable from person to person, but well-conditioned endurance athletes often have RHRs in the 50s or 40s. Mine was in the high 30s for years when I was in peak condition, and never over 45 even when I was comparatively out of shape. BUT: a lifetime of endurance sport raises one's risk of later sinus node dysfunction (which I now have) and of atrial fibrillation (which I do not have). I don't think endurance training has any known relationship with any kind of conduction block.

If I were your friend, and if I had health coverage for it, I'd do the follow-ups. They would want to do a treadmill stress test and an echocardiogram. Both of those tests are really interesting for a fit person who's curious about her body. Plus, even if they confirm that her heart function is totally normal and healthy right now, they will give a baseline if she comes back in 10 years and complains that she is performing poorly at workout and feels as if her heart rate won't rise with effort the way it should.

Edit: To echo Gotrhythm's point, when my overnight HR fell to 30-ish, before I got my pacemaker, I did experience fatigue and a sort of blah feeling, both from the low RHR and from the poor sleep. I didn't relate those problems to the super-slow heart rate until after my pacemaker had fixed them, though. But even now, my pacemaker lower limit is 40, which for my heart and body is fine to keep me alert and active and comfortable.

Addendum

by Gotrhythm - 2023-05-06 15:57:01

One thing I wondered as I read your post. How did the Holtor monitor test come about? It's an expensive test and not  ordered unless a doctor has a discreet reason to suspect arrythymia. What symptoms led her to consult a doctor in the first place?

One thing about arrythmias like SSS is that, until it gets very bad, the symptoms can come and go in a fashion that seems so random, it's easy to forget about them or to attribute them to any of a million things. If they come on gradually with long periods of normal rhythm between it can be even harder to grasp the meaning of exhausted feelings, brain fog, memory lapses, trouble concentrating, headaches, and general dullness.

It feels safe, rational even, to just shrug them off as "just one of those things." Someone like me will just try harder to conquer low periods with "mind over matter."

Your friend is lucky to have you, willing seek understanding on her behalf. We agree so often around Pacemaker Club about how important it is to advocate for yourself. I don't think I've spoken often enough about the contribution of my friend who like you has advocated for me, insisted I go back to the doctor, or to a different doctor, when I wasn't thinking clearly enough to do it for myself.

Follow up

by BradyJohn - 2023-05-06 16:28:47

Hi ASully,

I'm another life long endurance athlete, I was proud to have a resting HR of 29 at one point.  One of the problems though that can happen is postural hypotension, getting light headed or even fainting when standing up quickly and especially from a squatting position.  I wrote off for years that if someone would come to my office door, everything would go black before I got from my chair to the door.  Not cool.  That, plus some fainting episodes led to the treadmill test.  I thought I crushed it because my HR didn't jump up.  Wrong answer.  Life has been much improved since I received a pacemaker three years ago.  I wish I had it years ago.

All the best to your friend, but yes, definitely follow up.

Peace,

John

Bradycardia

by AgentX86 - 2023-05-07 00:19:45

A resting heart rate of 29 is dangerous, I don't care how conditioned you are.  It is not normal.

Symptomatic

by Penguin - 2023-05-07 07:12:44

I agree with Gemita re: how symptoms are an important factor.  Some people manage fine with a low heart rate and are symptom free, fit and healthy whilst others are breathless, exhausted and feel ready to keel over. 

If she's had a holter monitor test the rhythm of her heart will have been looked at e.g. whether it is regular / normal or whether there are pauses, arrhythmia etc. 

A holter monitor test prompts a file of ECG readings and a report. The report summarises findings. Your friend could ask for a copy of the report and the ECGs and take them to her GP for an initial discussion. Her GP could better help her make an informed decision as to whether or not she needs further investigation and may even have the report already. 

We (and you) can only register a concerned, rather than knowledgeable, interest in what may be going on!  I don't know about you but I find it difficult not to 'deflect' my own experiences onto others although I know that this isn't necessarily helpful.  Independent, professional advice is best for something like this IMHO. 

Best Wishes