Low Heart Rate

Overview

A low heart rate (bradycardia) is a resting heartbeat slower than the expected range. In physically fit people and during sleep, a slow rate is healthy and a sign of good conditioning. A low rate becomes a concern when it comes with dizziness, fainting, fatigue or breathlessness, or when it occurs in someone who is not fit — as it can reflect an under-active thyroid, a medication effect, a heart-conduction problem, or an electrolyte disturbance.

Common causes

• High cardiovascular fitness — a healthy, benign cause.
• An under-active thyroid (hypothyroidism).
• Medication effects — especially beta-blockers and some heart or blood-pressure medicines.
• Heart-conduction problems — such as heart block.
• Electrolyte disturbances.
• Ageing-related conduction changes.
• Sleep and resting states.

Symptoms and associated features

A low rate in a fit, well person with no symptoms is usually benign. Features that warrant assessment are dizziness, near-fainting or fainting, fatigue, breathlessness, or a low rate in someone who is not physically fit. A low rate that develops after starting a new medication is reviewed promptly.

Evaluation and investigations

Evaluation combines a history and examination with an ECG and blood tests — thyroid function, electrolytes, and a review of current medicines. A Holter monitor is arranged when a conduction problem is intermittent. See ECG Evaluation for Symptoms, Thyroid Disorders and Abnormal Test Results.

Management overview

Management treats the cause. A benign low rate in a fit person needs no treatment; an under-active thyroid is treated; medication effects are resolved by adjusting the prescription; electrolyte disturbances are corrected; and a heart-conduction problem is managed with specialist cardiac input, sometimes with a pacemaker.

Follow-up and monitoring

Follow-up confirms the rate is appropriate and any underlying cause is controlled. Persistent symptomatic bradycardia is reviewed and referred for specialist cardiac assessment when appropriate.

Warning signs — seek urgent care

• A low heart rate with dizziness, fainting or near-fainting — urgent.
• A low rate with breathlessness or chest discomfort — urgent.
• A low rate with collapse or loss of consciousness — emergency.

How we help

Dr. Nayak evaluates a low heart rate with a structured history, examination, an ECG and targeted blood tests, treats the underlying cause or adjusts medication, and refers for specialist cardiac assessment when needed. Consultations are available in-clinic in Bhubaneswar and over teleconsultation.

Related conditions and patient concerns

• High Resting Heart Rate
• Abnormal Pulse
• ECG Evaluation for Symptoms
• Thyroid Disorders
• Feeling Faint with Palpitations