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Low heart rate, or bradycardia, is when your heart beats less than 60 times in one minute while you’re at rest. For some people, it’s not a health concern, but for others, it can be a serious issue.
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Some symptoms of low heart rate require immediate medical care. These include chest pain, dizziness or lightheadedness, fainting or near fainting, and shortness of breath. If you have these symptoms, go to your nearest emergency room.
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Treatment for bradycardia depends on what’s causing it. It can include taking medicine to increase your heart rate, changing medications that are slowing your heart rate, wearing a pacemaker to support your heart’s rhythm or addressing underlying issues that are causing low heart rate.
Low heart rate (bradycardia): Causes, symptoms and when to seek care
Your pulse rate, or heart rate, is the number of times your heart beats in one minute to pump blood to your body. It varies based on your age, fitness level, activity, medications and health conditions. Doctors measure your resting heart rate – your pulse when you’re at rest – as one indicator of heart health.
Bradycardia is a heart rate that’s consistently lower than the normal range. It’s an abnormal heart rhythm, or arrhythmia.
What is considered a low heart rate
According to Jason S. Bensch, M.D., a cardiologist at Providence Heart Clinic – Willamette Falls, a normal resting heart rate is between 60 to 100 beats per minute (bpm). A low heart rate, or what some mistakenly call a low heartbeat, is less than 60 bpm.
Bradycardia can be a serious health problem if your heart can’t pump enough oxygen-filled blood to your body and brain. But sometimes, low heart rate isn’t a health concern.
When a low heart rate is normal
Athletes and people who are very physically active can have a low heart rate of 40 to 60 bpm. Because their heart is so strong, it pumps more blood with each beat.
Low heart rate can also happen when we sleep. Because we’re completely at rest and most muscles aren’t working, the heart slows down.
People over 65 are more likely to have low heart rate. “Aging can lead to bradycardia as your heart conduction system gets older,” Dr. Bensch says. “While it’s not inevitable, it is typical.”
Causes of low heart rate
Some of the most common causes of low heart rate are heart conditions, medications and other health issues.
Heart conditions
Heart conditions that can lead to bradycardia include:
- Congenital heart defects: Can cause heart malfunction
- Heart attack: Can damage tissue
- Heart block: Interrupts your heart’s electrical system
- Heart surgery: Can upset your heart’s natural rhythm
- Infiltration of heart muscle with amyloid: Thickens your heart and reduces function
- Myocarditis, pericarditis or endocarditis: Indicates inflammation of your heart, the sac surrounding your heart or the inner lining of your heart
- Sinus node dysfunction: Disrupts the area of your heart that controls heartbeat
“The most common cause of bradycardia is sinus node dysfunction, where your heart’s natural pacemaker slows down,” Dr. Bensch says. “Also common is an atrioventricular (AV) block, when the heart’s electrical signals don’t travel correctly through the heart.”
Medications that slow heart rate
Types of medications and drugs that can slow a normal heart rate include:
- Anti-arrhythmics
- Beta blockers and calcium channel blockers
- Lithium and depressants
- Marijuana
- Narcotics
Other medical conditions
Some medical conditions can lead to bradycardia (or what people may search online as “low heart pulse rate”). These include:
- Anorexia nervosa
- Deficiencies of calcium, magnesium and/or potassium
- Hypothyroidism
- Inflammatory diseases like rheumatic fever or lupus
- Lyme disease
- Obstructive sleep apnea
Symptoms of bradycardia
Some people have no signs of bradycardia. But others can have symptoms that may include:
- Chest pain
- Confusion, difficulty concentrating or memory problems
- Dizziness or lightheadedness
- Fainting or near fainting
- Fatigue
- Heart palpitations
- Shortness of breath
When to worry about low heart rate
Wearables like the Apple Watch can send notifications if your heart rate drops to a low level. “If you have a low heart rate and feel fine, you probably don’t need to go to the doctor right away,” Dr. Bensch says. “If you have no other symptoms, this typically isn’t something to worry about.”
But, he adds, “If you’re wondering about your symptoms, or if they’re a dramatic or sudden change for you, then visit your doctor.”
Symptoms that require immediate medical care include:
- Chest pain
- Fainting or near fainting
- Lightheadedness or dizziness
- Shortness of breath
- Sudden weakness
If you have any of these symptoms, go to the emergency department (ER) at the nearest hospital.
Diagnosis and testing for low heart rate
Schedule an appointment with your doctor if you’re concerned about bradycardia. To diagnose low heart rate, your doctor will review your medical history and symptoms. They’ll do a physical exam, listen to your heart and measure your pulse rate.
You may also have other tests. These can include:
- Blood tests to assess electrolyte levels and thyroid function
- Electrocardiogram (ECG or EKG) to measure your heart’s electrical activity
- Holter monitor or event recorder to analyze your heart rate over time
- Sleep study if your doctor suspects sleep apnea is causing bradycardia
- Stress test to check your heart’s performance during exercise
- Tilt table test if you’re fainting often
Treatment options for low heart rate
If you have bradycardia but don’t have any symptoms, you likely won’t need treatment, Dr. Bensch says. If you have symptoms, however, treatment options include:
- Medication: Injectable or IV medicine can increase your heart rate. If a medicine you’re currently taking is causing low heart rate, your doctor may adjust the dosage or change medicines.
- Pacemaker: Doctors implant a small device in your chest that sends electrical pulses to your heart to regulate your heart rhythm.
- Underlying conditions: Treating the cause of your bradycardia, like sleep apnea or hypothyroidism, can address low heart rate.
Living with bradycardia
Follow your doctor’s recommendations for your treatment and get regular check-ups if you have low heart rate. Make lifestyle changes if necessary to eat a nutritious diet, exercise regularly, and avoid smoking, tobacco and drugs.
“Pay attention to your body and how you feel, and always tell your doctor if you have new symptoms,” Dr. Bensch says. “Bradycardia can be intermittent or sometimes go away on its own, and many of the causes are reversible.”
Get your heart checked at Providence
Bradycardia is typically treatable, and the Providence Heart Institute has an expert cardiology team that provides integrated care and all subspecialties.
“For 90% of patients, bradycardia is relatively straightforward,” Dr. Bensch says. “We are fortunate to have a ton of tools to diagnose it. And we also can provide a thorough, advanced evaluation and treatment for rare conditions.”
If you’re concerned about a slow heartbeat or your heart health, schedule a consultation with a cardiologist at a Providence location near you.
Contributing caregiver
Jason S. Bensch, M.D., is a cardiologist at Providence Heart Clinic – Willamette Falls in Oregon City, Oregon.
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Related resources
Your comprehensive guide to heart health
Five things you can tell about your health by your heart rate
Ways to monitor your heart health throughout the year
This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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