When Is Heart Rate “Too Slow?”

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

It can be frightening to learn that your heart isn’t beating normally, especially when it’s racing or quivering. But what about bradycardia, a heartbeat that’s slower than normal?

What’s considered “too slow” can vary from person to person, depending on age and physical condition. But generally speaking, bradycardia is defined as a resting heart rate of fewer than 60 beats per minute (BPM).

Slow heart rate is not necessarily a bad thing. Many healthy, physically active people—particularly athletes—have a resting heart rate well below 60 BPM. In these cases, a slow heart rate is a sign of good health and means that the heart is very efficient at pumping blood throughout the body. A slow heart rate is also completely normal during sleep.

Additionally, bradycardia becomes more common with age. In the absence of symptoms, though, it’s really nothing to be concerned about. For these reasons, cardiologists usually don’t worry too much about it.

In certain situations, though, bradycardia can become problematic…

Bradycardia Symptoms

When the heart rate becomes so slow that the heart isn’t able to pump enough blood to meet the body’s needs, bothersome symptoms can develop. Bradycardia symptoms that indicate insufficient blood flow include:

  • Fatigue
  • Weakness
  • Dizziness/lightheadedness (especially with exertion)
  • Fainting or near-fainting
  • Shortness of breath
  • Confusion

If left untreated, severe or abnormal bradycardia can lead to complications like heart failure, chest pain, high blood pressure, or orthostatic hypotension (severe drop in blood pressure that occurs when you stand up from sitting or lying down).

If you have any of these symptoms, you need to work with a cardiologist to determine the type and cause of your bradycardia. 

Types and Causes of Bradycardia

The two most common types are sinus bradycardia and heart block.

Despite a name that says otherwise, sinus bradycardia has nothing to do with your nasal passages. It actually refers to the sinus node (also called sino-atrial node), which is a small group of cells located at the top of the right atrium that sends out signals instructing your body to pump more blood. The sinus node is sometimes called your “intrinsic” or “natural pacemaker.”

The sinus node should send out a signal about 60 to 100 times per minute. But if it works too slowly or fails to work at all, sinus bradycardia can result.

The condition may be so mild that you never notice symptoms. But in more serious cases, you might notice the symptoms mentioned above.

A number of conditions can injure or incapacitate your sinus node, thus resulting in bradycardia. Some of them include:

Additionally, certain drugs can cause bradycardia. Some of the usual suspects are medications used to control arrhythmias and high blood pressure. Slow heart rate is a common side effect of beta blockers, for example, and sometimes the dosage will need to be reduced or discontinued if bradycardia symptoms develop.

With a heart block (also called atrioventricular, or AV, block), the flow of signals from the sinus node down to another group of cells, called the AV node, is compromised.

Mild forms of this type of bradycardia cause no symptoms, but more serious forms may require emergency care.

Heart blocks may be caused by congenital heart defects, but most often they are the result of heart attack, inflammation of the heart muscle, and/or heart disease.

Bradycardia Treatment

Bradycardia treatment depends on the type, cause, and severity of symptoms.

If you have no symptoms, treatment usually isn’t necessary.

If you have an underlying problem that is causing the bradycardia—such as sleep apnea or a thyroid disorder—your doctor will likely address that. Often, resolving those issues restores your resting heart rate into the normal range.

If you’re taking a medication that could be affecting your heart rate, finding an alternative or adjusting dosage may correct the problem.

To see if the slow heart rate is indeed the cause of your bradycardia symptoms, your doctor may have you wear a 24-hour monitor for a week or so. 

And finally, if all else fails and your doctor believes your bradycardia needs to be treated, s/he may recommend a pacemaker. This small device gets implanted under your collarbone, and wires are threaded through your veins and hooked up to your heart. A pacemaker monitors your heart rate and, when necessary, sends electrical impulses so that you maintain an appropriate number of beats per minute.

The Bottom Line on Bradycardia

In healthy young people, and even in older people who are in good physical shape, a slow heart rate—even as low as 40 or 50 BPM—is pretty typical.  Bradycardia is only considered a real issue if your heart rate is too slow to meet your body’s needs and you start developing symptoms. If that’s the case, your cardiologist can come up with a treatment plan that’s appropriate for you.

Otherwise, he/she will simply monitor your heart rate and follow up with you periodically to make sure your bradycardia is not starting to affect or bother you in any way.

© 2019 Stephen Sinatra, MD. All rights reserved.

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9 Comments

  1. Maurice S

    on July 13, 2019 at 12:27 pm

    I have been using your formulations and a few I have added via antioxidants, and one product, SloNiacin ; 500 mg. 3 X’s per day which over time lowered my Lp (a) when discovered @ 130 and last check now 6. For a good number of years I have survived more TIA’s attacks which my attending doctors have offered any meaningful input . Also, upon my retirement at age 65 I have suffered constant changing degrees of Tinnitus in both ears. I have demanded and finally underwent varying test to determine if I have , (minute particles of temporary plaque blockage within my brains blood supply) with no definitive exclamation for these numerous past TIA’s. 26 December 2019 I will turn 86. I sincerely thank you for your knowledge and dedication to actually realize that much of your early medical training was seriously lacking and embarked on using your medical training to fill in the real gaps as to why conventional medicine did not adequately address heart and blood flow problems by conventional means of risky surgery supplemented with prescribing the usual toxic prescription drugs. I am completely convinced had my years of researching my conditions I would never have found you and your new knowledge that we truly are what we eat. Currently, I am confronted with irregular heart beat and or arrhythmia. Currently my systolic pressure is 110 to 120; Diastolic in the 60’s with a few 50’s ; pulse at low of 53 a high of 70 to 80’s. I stand 5 feet 8 1/2 ” and my weight now steady at 156 to 158 pounds. I have zero head aces, my sense of balance is becoming a problem and I move with a slight staggering gait. Your commencements will be sincerely appreciated.

  2. Tony

    on July 23, 2019 at 12:27 pm

    I’m interesting about slow heartbeat.

  3. Carl

    on August 6, 2019 at 10:28 pm

    Hi My age is 91 years old
    My heart rate has dropped as low as 28 beats a minute, but if I take a natural supplement called (Ventricore) my resting HB rate stays up around 60 beats a minute. I take a natural supplement called VENTRICORE anytime my resting HB drops below 60 beats a minute. My doctor had me wear a device to record my HB several days at a time. I check my Blood Pressure daily and my resting HB stays around 60 beats a minute. when resting without taking Ventricore .
    I do take BP lowering prescribed Cardevilil to keep my BP down to an acceptable level.
    Thanks

  4. roger

    on January 20, 2020 at 9:32 am

    I have bradycardia, and this article is one of the best. My heart beat is low 50’s/high 40’s when not active. When exercising, I can go up to 90’s. I have been on a heart monitor for a week and take a blood thinner. The cardiologist said that if I do not have symptoms, no need for a pacemaker—yet. Any thoughts? Also, I had a stroke about a year ago in Haiti, but have gotten back to normal, luckily.

  5. Jaunita W

    on January 21, 2020 at 3:03 pm

    I read an article about how Peptace Fish Peptides could take away A-fib as long as one takes it… I ordered the product for my 91 year old sister inlaw. She is concerned that she may have a problem taking it since she is on Multag, Eliquis, and Metoprol. Please tell me if you think she would have any concerns taking it along with the drugs mentioned. Thank You..

  6. Martha Dancy

    on January 24, 2020 at 11:38 pm

    I have had a low relaxing heart rate for a long time, about 49 and then it goes up to 50 or 51 when I sit up and then hangs around the late fifties and then goes to sixties,etc when I get active or go walking. I have no symptoms but I can’t take blood pressure meds that lower heart rate. I have high blood pressure and control it with 80mgs of micardis, an arb, and three small vasodialators called hydralazine. They work well but sometimes, if I take a hydralazine near a meal of regular size, I get loose stools. If I take it long after a meal, I am OK. I am 82, a former skier for forty five years and am still active in hiking. However, I have trouble with side effects if I take higher doses of meds. I hate calcium channel blockers because of bad side effects with stomach issues. I take a lot of natural supplements and am on your list for some. I have osteo arthritis which two anacin a day take care of very well. My doctor believes in real low blood pressure but I am happy with the 130s on top. I do not have bad symptoms except high systolic blood pressure which I am working on. It fluctuates a lot. Otherwise, I do quite well for my age. Any suggestions on medicines that might be better?

  7. Martha Dancy

    on January 24, 2020 at 11:48 pm

    Short note to Maurice. My tinnitus is caused by medicines, especially aspirin and amoxicillin. It may not be your brain or ears, but a side effect from a prescription drug. My tinnitus is so high frequency and airy that I ignore it. It does not bother me and my anacin does so well for my arthritis, I would rather not have pain so I continue one or two anacin a day. The other pain killers cause calcification of the arteries so I do not take them. Just a hint to help out. I am sure the doctor can explain better about things than I.

  8. Carolyn T.

    on June 27, 2020 at 4:48 pm

    Hi I am 63 years young and had a mitral valve repair a year ago and now I’m in conjunctive rhythm, which is causing some shortness of breath and tiredness. I also have hypertension and hypothyroidism. One EP said I need a pacemaker, I sought a second opinion and he wants more information….Halter monitor strips. Also the first EP’s notes. In the mean time I started looking around on net and found your site. My question is….should I start taking Magnesium and what else?
    Thank you,
    Carolyn T.

  9. Sandi bergeron

    on July 1, 2020 at 1:45 pm

    Hello Carolyn,
    Thank you for reaching out! This is what Dr. Sinatra had to say: “I would NOT recommend magnesium if you are in what is called a “junctional” rhythm, as it could slow your heart rate too much. You are symptomatic with shortness of breath and fatigue, which means your heart rate may be too slow for you. The atrial-ventricular or AV node, the generator or source of a junctional rhythm—fires at a rate of 40 to 60 beats per minute (BPM). The AV node is the back up pacemaker for the sinus or SA node, which initiates heart beats in the 60 to 100 beat per minute range. If your SA node is not functioning properly, a pacemaker may be your safest preventive course. Consult with your physicians.:

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