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v Confusion or difficulty focusing. v Heart palpitations or flutters. v Limited ability to exercise. v Chest pain, which may signal reduced blood flow to the heart.
WHEN TO CALL 911
Call 911 if you experience any of the following: v Shortness of breath. v Pain or pressure in the chest. v Lightheadedness, dizziness or fainting.
It’s very important to tell your provider how you’re feeling — even if your symptoms are mild. The way a slow heart rate affects your ability to function will help determine if and when you need a pacemaker or other advanced treatment. These symptoms could also be caused by aging or other medical conditions such as anemia or hypothyroidism (when your thyroid doesn’t produce enough thyroid hormone). If untreated, bradycardia can lead to complications — including congestive heart failure, stroke and, in some cases, sudden death. So if you have concerns, speak up.
What Increases Your Risk
Many factors can affect how fast or slow your heart beats, including your age, activity level and your sleep (your heart beats slowly during sleep). An imbalance of electrolytes, such as low potassium levels, also can play a role. Minerals must be at the right levels for your body to work properly. You are at greater risk for developing bradycardia if you:
v Are 65 or older. The heart’s electrical system can become damaged as we age, making older people especially prone to slower heart rates.
v Have some heart disease or heart damage. Examples include coronary artery disease, having had a previous heart attack, or problems with your heart’s electrical system (left bundle branch block causes a delay in how electrical signals are sent from the upper to lower chambers of the heart). In addition, congenital heart disease (for example, being born with a hole in the heart), infection (myocarditis) or an inflammatory disease that affects cells (sarcoidosis) can make it more likely for you to have a slow heart rate.
v Have had heart surgery. It can be a complication of some heart procedures (for example, bypass, valve replacement, TAVR and others).
v Have untreated high blood pressure. v Take medications such as beta-blockers, calcium channel blockers, certain antidepressants.
v Have other medical conditions such as sleep apnea,
low thyroid function (hypothyroidism), certain neurologic disorders (epilepsy) or use excessive alcohol or recreational drugs.
v Have a family history of a slow heart rate. Research shows that Lyme disease can also affect the heart’s electrical system and cause heart block, which may make bradycardia more likely.
WHEN TO CALL YOUR PROVIDER Talk with your provider if you: v Are over age 65. v Have someone in your family with heart rhythm problems. v Notice any of these symptoms, even if mild. v Have noticed a change in your heart rate. v Suspect you had a tick bite and may have Lyme disease.
Diagnosing Bradycardia
Bradycardia is most often suspected based on a report of symptoms, by taking your pulse, or both.
Your provider may recommend additional tests to confirm that you, in fact, have bradycardia and to determine its cause. These tests may include: v Electrocardiogram to measure and produce tracings of your heart’s electrical activity. However, this test is limited in that you’d have to be having an episode of a slow heart rate while the test is being done.
v Holter monitor — a portable, wearable monitor — to record your activity level and heart rhythm, usually for 24 to 72 hours.
v Heart rate monitors on certain wearable smart watches, but talk with your provider first.
Your healthcare team will also consider and try to rule out other conditions that might be contributing to a slower heart rate. For example, sleep apnea — a sleep disorder that results in shallow or pauses in breathing — can cause bradycardia due to a lack of oxygen.
Treatment
Treatment will depend on how slow your heart rate is, what might be causing it and any complications. In some cases, bradycardia can result in fainting episodes, dangerous falls or even seizures and sudden death due to long pauses between heartbeats.
Some people may not need to do anything for their slow heart rate. For others, treatment may include treating an underlying condition, adjusting or changing medications that may be causing dips in heart rate, or a pacemaker (usually if there is irreversible damage to the heart’s electrical system and in older people).
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