17841 Bradycardia

Overview

Bradycardia is a condition where the heart beats slower than normal. For most adults, a resting heart rate of fewer than 60 beats per minute is considered bradycardia. However, some people, such as athletes, can have a slow heart rate and still be perfectly healthy. Bradycardia only becomes a problem when the heart is too slow to pump enough oxygen-rich blood to the body.

Bradycardia is relatively common, especially in older adults. Many people with bradycardia have no symptoms and do not need treatment.

It can affect people of all ages, but it becomes more common as we get older. It can also affect athletes and people taking certain heart medications.

Symptoms

Common symptoms

• Dizziness or lightheadedness
• Fatigue or weakness
• Shortness of breath
• Chest pain (angina)
• Confusion or memory problems
• Fainting or near-fainting (syncope)

Symptoms in children

• Poor feeding in infants
• Unusual tiredness or sleepiness
• Being less active than usual
• Rapid breathing (as a sign of distress)

Symptoms in older adults

• Confusion or memory lapses
• Balance problems or unexplained falls
• Feeling weak or unsteady on your feet
• Reduced ability to do daily activities

Causes

Main causes

• Problems with the heart's sinus node (the natural pacemaker)
• Damage to the heart from heart disease, heart attack, or heart surgery
• Underactive thyroid (hypothyroidism)
• Electrolyte imbalances, such as low potassium or calcium
• Sleep apnea (pauses in breathing during sleep)
• Certain medications that can slow the heart rate

Risk factors

• Older age
• A history of heart disease
• High blood pressure
• Diabetes
• Being a high-intensity athlete (physically conditioned)
• Smoking or heavy alcohol use

When to see a doctor

See a doctor urgently if:

• If you faint, have chest pain, or feel short of breath, seek medical help right away. If these symptoms are severe, call your local emergency number.

Book a routine appointment if:

• Make an appointment with your healthcare provider if you notice a consistently slow pulse (under 60 beats per minute) and you feel dizzy, weak, or tired, even if the symptoms are mild.

Diagnosis

To diagnose bradycardia, your healthcare provider will ask about your symptoms, medical history, and medications. They will listen to your heart and check your pulse. The key is to see whether the slow heart rate is causing symptoms and whether it is constant or comes and goes.

Tests that may be done

• Electrocardiogram (ECG or EKG) — a quick, painless test that records the heart's electrical activity.
• Holter monitor — a portable ECG worn for 24 hours or more to capture intermittent slow rhythms.
• Event recorder — a device you wear for weeks to record your heart when you press a button during symptoms.
• Blood tests — to check for thyroid problems, electrolyte imbalances, or signs of a heart attack.
• Exercise stress test — to see how your heart rate responds to activity.

What to expect at your appointment

Most diagnostic tests are simple and painless. You can usually go home the same day. If your bradycardia is intermittent, you may need to wear a monitor for a few days. Your healthcare provider will explain the results and what they mean for you.

Treatment

Treatment for bradycardia depends on the cause, your symptoms, and your overall health. If the slow heart rate does not cause symptoms, or if it is due to a reversible cause like a medication, treatment may not be needed or may be adjusted. Your healthcare provider will tailor the approach to you.

Self-care at home

• Keep a record of your pulse and any symptoms to share with your provider.
• Avoid using substances that can slow the heart, such as tobacco and excessive alcohol.
• Stay well hydrated.
• Follow your provider's advice about managing any underlying conditions, such as thyroid problems or sleep apnea.

Medical treatments

Medical treatment focuses on the underlying cause. For example, adjusting a medication that may be causing bradycardia, or treating a thyroid condition. If the heart is not able to keep the rate high enough on its own, a pacemaker may be recommended. A pacemaker is a small implanted device that helps regulate the heart rate. Always discuss any concerns about treatment options with your healthcare provider.

When is surgery considered?

Surgery is generally not needed for bradycardia itself. The main non-surgical procedure is pacemaker implantation, which is done under local anaesthetic and is not open-heart surgery. In rare cases, if there is an underlying heart problem needing correction, surgery may be considered, but this is decided on an individual basis.

Living with this condition

Living with bradycardia often means becoming more aware of your body. Carry a written record of your pulse readings and symptoms to your appointments. If you have a pacemaker, you will need to follow some simple precautions, such as avoiding strong magnetic fields. Your healthcare team will give you clear advice.

Lifestyle tips

• Get regular, moderate exercise as recommended by your provider.
• Eat a heart-healthy diet rich in vegetables, fruits, whole grains, and lean proteins.
• Manage stress with relaxation techniques such as deep breathing or mindfulness.
• Avoid smoking and limit alcohol.
• Get enough sleep and treat any underlying sleep apnea.

Diet and exercise

A balanced diet and regular physical activity help keep your heart strong. Ask your provider about the safe level of exercise for you. In general, gentle activities like walking, swimming, or cycling are good choices, but you should avoid sudden intense exertion unless your provider says it is safe.

Mental health and emotional wellbeing

Living with a heart condition can cause anxiety or worry, especially if you have had fainting spells. It is important to talk about how you feel. Consider speaking to a counsellor or joining a support group. If you are struggling with mental health, please reach out to a healthcare professional or a local crisis support line.

Prevention

Not all cases of bradycardia can be prevented, especially those caused by ageing or certain heart diseases. However, you can reduce your risk by keeping your heart healthy: control blood pressure, manage diabetes, avoid smoking, and stay physically active.

Vaccines

It is a good idea to stay up to date with recommended vaccines, such as the flu vaccine, because infections can sometimes affect the heart. Ask your healthcare provider or pharmacist for advice.

Screening programmes

Routine check-ups that include measuring your pulse and blood pressure can help detect a slow heart rate early. If you have risk factors, your provider may recommend an ECG. There is no specific screening test for bradycardia, but being aware of your symptoms and getting regular health checks is important.

Complications

If left untreated

• Fainting and injuries from falls
• Heart failure (the heart does not pump enough blood to the body)
• Cardiac arrest, which is a medical emergency where the heart stops beating properly

Long-term outlook

For most people, bradycardia is manageable and not life-threatening. If treatment is needed, a pacemaker can effectively control symptoms and allow you to live a full, active life. With the right care, many people with bradycardia feel much better once their heart rate is stable.

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