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Slow heart rate

  • The normal heart rate is between 60 and 100 beats per minute.  Any heart rate below 60 beats per minute is called bradycardia.  Bradycardia can be normal, especially in athletes (their heart is so well conditioned it beats more efficiently) or during sleep.  It can be abnormal when there is damage to the pace-setting mechanism (the sinus node) of the heart. 
  • The sinus node is located in the upper portion of the right atrium.  After the electrical impulse is generated in the node, it travels to the ventricles and the rest of the heart through the A-V node (an area between the atria and ventricles), thus any damage to these areas will slow the rate of this electrical impulse, which may lead to bradycardia or other arrhythmias. 

    • Athletic training
    • Sinus node dysfunction
    • Other heart conduction problems
    • Medications (especially beta-blockers, digoxin, and Calcium channel blockers)
    • Bradycardia may be a consequence of other disorders such as Hypothyroidism, Hypothermia, and end stage liver disease. 

    • None (in athletes)
    • Lightheadedness
    • Weakness
    • Confusion
    • Fainting

    • Slow pulse
    • Electrocardiogram (EKG)
    • A 24 hour ambulatory portable EKG monitoring called the Holter monitor 
    • Blood tests for thyroid function, chemistries (electrolytes, liver function) may be done. 

    • Asymptomatic (especially younger individuals and athletes):
    - none
    • Symptomatic:
    1. Elimination of medications that may cause symptoms, but only if it is medically safe to do so.
    2. Pacemaker -- An implanted device that regulates the heartbeat by generating electrical impulses just as the sinus node would in a normal heart. 
    3. Correct underlying disease or disorder.


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