Slow Pulse | Bradycardia - How Low is Too Low for our Heart Rate?

Peter balance here cardiologist now I've had several requests to do a video on the heart rate being slow or bradycardia let's find out how low is too low now the heart itself is an amazing organ as we've witnessed through many of our videos about how the heart functions and pumps the heartbeat normally ranges between 60 to 100 beats per minute anything less than 60 beats per minute we usually call bradycardia and vice versa anything more than 100 beats per minute with that pulse that is referred to as tachycardia now bradycardia is not always a worrying problem so many people young fit otherwise active people can have heart rates that are less than 60 beats per minute between 40 and 60 beats per minute when we're sleeping our heart rate is usually low 40 50 beats per minute it does not mean there's something wrong when bradycardia becomes a concern is when there are symptoms that can occur as a result of the heart not being able to efficiently pump blood and oxygen and nutrients to the rest of the body the frequent symptoms that you may have if your heart is going too slow is you might feel light-headed you might feel giddy dizzy you might feel as though you're a bit wobbly on your feet or about to to pass out a condition known as pre-syncopy or in some people they have fainting they have blackouts they have syncope so we always take it into the context of the patient and their condition their symptoms what medication they might be on what other history they might have so on its own having a slow heart rate is not a serious problem and people live active normal lives without any concerns but when the heart rate does go too slow and is causing symptoms then we need to take some action and perform some further tests now to get a better idea about the heart rate and how it works I want to just briefly go through how our wiring or electrical system of our heart functions and I like to describe an analogy that we have a power station of our heart called the sinus node and the sinus node essentially is our own natural pacemaker it's a little collection of fibers and tissue that stimulates activity from the top part of the heart called the Atria and that activity goes down through a Channel of cables I like to say to a substation so we've got the power station being the sinus node we've got the substation being a collection of tissue called The Av node and then through there there's a rather complex array of fibers and cables that pass through both the left and the right sides of the heart called the bundles and the bundles we we often you might have heard of a term called bundle branch block well these are the cables that get affected when there is this bundle branch block so the heart has a very intricate wiring Network as I said the sinus node being the pacemaker the top part of the heart beats the Atria conduction travels down to the heart to get the ventricles to contract so we get the boom boom boom boom manifestation of what our heart does and when that's working fine well we're not noticing any particular symptoms however when there are delays in the conduction or delays in how the electrical supplies actually traveling through these fibers through these cables then that is when problems may arise and commonly and I won't break it down into problems that affect the pacemaker itself of our heart the actual Power Station the sinus node and then we've got problems that can develop further Downstream in some people the sinus node or the power station just slows down as we get older there might be a history of heart disease that might have been you know heart attacks there might be some people who have blockages in their arteries and those arteries do Supply critical blood flow to these little areas of our heart called a sinus node well when that is impacted then the sinus node doesn't fire properly and that can slow the heart down to levels whereby it starts causing symptoms down you know to the 30s even in 20s and that becomes a concern because obviously you are at risk of fainting or blacking out with a lack of blood flow traveling to the body traveling to the brain so we always explore what are the possible causes and we talked about you know coronary artery disease being one of the more common conditions that leads to these conduction problems but there might be other conditions there might be endocrine conditions or hormone conditions you might have heard of a gland called the thyroid gland which is in our in our neck and that's a central gland that can controls many of our bodily functions and when that is misfiring and not functioning properly too low underactive it's sometimes even too high it can create concerns in the conduction system of our heart leading to problems with the heart rate and slowing it down there might be other conditions that you might have been born with congenital heart defects or holes in the heart or various conditions there that can actually impact the way that the electrical system is firing and working that can dramatically lower or slow down the heart rate this can be seen in other conditions that affect the heart muscle itself and anything that causes inflammation myocarditis is a condition that can be a poster virus post you know vaccine where myocarditis affects the muscle it can also affect those little networks of tissue that are essential at controlling how our heart is beating and that can also cause a very slow pulse imbalances in chemicals in our bloodstream potassium in particular these are the electrolytes that are very very important in how our heart contracts and functions well changes in those can also affect our heart and heart rate and slow it down and then there are medications and there are several medications that people might be on that equally can have an impact that actually slowing down the conduction or the the heart rate you might have heard of a classic drug called beta blockers they're a calcium channel blockers there are medications that we use to help that control the heart rhythm amiodarone fleconide there are other ones that also slow down the heart rate that you might have heard of called digoxin but all these medicines we actually use for the control of fast heartbeats well of course as a result they work on the conduction system and they slow it down causing slow Heartbeats so we always ask our patients what medications they might be on what are the conditions they might have and then we explore the symptoms and most often if the heartbeat is slow there might not be any symptoms or any concerns at all but what are the symptoms well the case symptoms are lightheadedness or dizziness sometimes it can be as simple as just feeling fatigued and no energy and particularly when you're trying to exercise or walk and do activities you might find that the heart rate doesn't appropriately increase and that's a key symptom that we ask for because having a slow heartbeat on its own when you're sleeping or when you're at rest is okay but when you get up and do an activity when you push yourself when you go up a flight of stairs when you go for a walk go for a jog we would expect that the heart rate appropriately picks up and that's what we want for the conduction system of our heart to actually respond to what's going on to respond to the rest of the body when you're exercising and the muscle wants more oxygen and blood delivered or the heart rate has to increase or when the heart rate doesn't that can be a concern and there is a condition that your doctor might have called chronotropic incompetence and what that means is that the heart rate just doesn't improve or doesn't respond to physical exertion physical activity as we would normally see and there are some further tests that can be useful in that regard and and then of course fainting and blackouts the first symptom of a slow pulse might be fainting and we do see patients who come into Hospital following a collapse they might have struck the head there might have been seizure activity and people might get confused well could this be epilepsy and in the end we find that it is in fact the heart rate that has just slowed down too much so then we've talked about the problems that occur in the top part of the heart or the sinus node but then equally there are a key group of conditions that we look for to tell us whether the wiring is actually starting to fail and these are degrees of heart block and you might have heard of heart block and we normally grade these into three classifications first degree heart block second degree heart block and third degree heart block now what does that all mean now first degree heart block is one of the mildest forms and it's often benign doesn't really signify any particular concern or worry the signals are still traveling from the top part of the heart the sinus node and still firing down to the bottom part or the substation the AV node but the signals are just taking a little longer this can be seen seen in healthy individuals and when it's not causing any symptoms there's no action that needs to be taken the next type of heart block is second degree heart block now as we start getting more into the second and third degree well then the problems start becoming a little bit more concerning because in second degree heart block we're still getting signals coming from the top part of the heart to the bottom but not all those signals are being transmitted appropriately and as quickly to the bottom part so there might be some Mist beats some skip beats and again there are different grades of second-degree heart block not all of them are pathological not all of them need anything to be to be done apart from just some reassurance and monitoring but there are various types whereby when the signals are not traveling to where they should then the heart momentarily freezes and slows down there's no beat for a few seconds and then no blood getting to the brain therefore leading to symptoms and then third degree heart block is obviously the the one that we we are always looking out for the one that we're more concerned about because in third degree heart block well really there's no coordination in terms of the signals the signals coming from the top part of the heart are not communicating appropriately to the signals at the bottom part of the heart and that lack of coordination the fact that not all the signals are traveling means that the heart is skipping beats is missing beats he's slowing down and that does need to be corrected and treated now what are the treatment options well as I said in many cases having a slow heartbeat does not mean a thing does not mean any concern whatsoever there are some simple tests that can be done including electrocardiogram and ECG we we also consider popping a monitor on the heart just to see what the pattern of your heart rate is over 24 hour period or sometimes even a bit longer a couple of days seven days even 30 day monitors and in some individuals who might have blackouts and fainting well there can be a case to consider placing a little implantable recorder and we'll have a separate video on what those implantable recorders are and and how they might be useful so in cases whereby the heart rate is slow and is causing these the second and third degree heart blocks where there is a disconnect between the signals well then in those cases we need to address underlying causes we often you know perform some simple tests including an ultrasound of the heart and that gives us an idea about how the heart is pumping and functioning how the valves are performing but then we start looking at well what other underlying causes now are there any hormonal changes any thyroid problems are there any concerns with the electrolytes for potassium levels in our body and are you on any medication they might be contributing that we may need to stop but if the answer is no to all of those then we're just left with essentially the wiring just slowing down um you know through natural causes well then we often need to act and the treatment for a slow heart rate that is causing symptoms is obviously speeding it up there's no simple medication that unfortunately we can use to put patients on to do that and the treatment is often by using these devices called pacemakers so the Pacemakers themselves are external devices that are placed under the skin and they through a connection through often two leads that go into the heart they could Monitor and they can help the pumping and the contraction of the Heart by ensuring that they stimulate electrical activity to make sure that you know we're not slowing down too much so you know that video was just a bit of an overview of the heart rate as I said it's not always a problem the concern can sometimes be that when you are a bit slow but you're not improving with exercise and that can cause symptoms can cause fatigue and cause shortness of breath and as we talked about chronotropic incompetence when the heart rate is not picking up as it should but then we look for various types of these heart blocks this sort of Disconnect between the top part of the heart and the bottom part of the heart in the end May sometimes need to be managed with these pacemaker devices hopefully you found that useful until the next video bye for now

Channel: Heart Matters

Views: 435,075

Keywords: slow pulse, bradycardia, low pulse, what does a low pulse mean?, cardiology, what is first degree heart block, what is second degree heart block, what is complete heart block, EKG, 24 hour Holter monitor, presyncope, syncope, pacemaker, beta blockers, what is bradycardia?, what is definition of slow heart rate?

Id: 5_GtgFgDBQ4

Length: 14min 30sec (870 seconds)

Published: Wed May 17 2023