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Is A Heart Rate Of 42 Bpm A Cause For Concern?

Posted on Fri, 1 Jul 2016

Question: Hello Dr. Sharka,

I am looking into possibly trying beta blockers for some performance anxiety related stuff. I do not want to use benzodiazapines or alcohol and was hoping this might be a suitable alternative. I do have a fairly low resting heart rate of 42-43 bpm, should I be concerned about this while taking a BB? I have read that they slow a person's heart rate.
Thanks
XXXXXXX

Answered by Dr. Ilir Sharka (5 hours later)

Brief Answer:
I would not recommend taking beta blockers.

Detailed Answer:
Hello!

Welcome back to HCM!

Regarding your concern, I would strongly recommend avoiding beta blockers.

You should know that they can reduce your heart rate and cause possible severe bradycardia in your clinical situation.

From the other hand, they also reduce physical performance, leading to chronic fatigue.

I would recommend discussing with your attending physician other possible treatment options to help you manage anxiety ( increase the dose of your actual antidepressant if you are actually taking one, or switch to another antidepressant).

Regarding your low heart rate, I would recommend performing further tests to investigate for the possible causes:

- an ambulatory 24-48 hours ECG monitoring to examine your heart rhythm trends during a prolonged period
- a cardiac ultrasound to examine your cardiac function and structure
- some blood lab tests (complete blood count, thyroid hormone levels, blood electrolytes).

You should discuss with your doctor on the above tests.

I would be happy to review your test reports as soon as you can upload them for another second professional opinion!

Hope to have been helpful!

I am at your disposal for any other questions whenever you need!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (15 hours later)

Thanks for your response. In regards to the slow heart rate I have had ekgs and 2 echos, and thankfully you reviewed and indicated that you saw now abnormalities... So I guess I just have a slow heart and not too worry, or would you still try to figure out why it is so low?

Thanks as always
XXXXXXX

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
You don't need to perform further tests.

Detailed Answer:
Dear XXXXXXX

As all your cardiac tests have resulted normal, possible cardiac disorders have been excluded.

It seems that you have a low physiological heart rate, and as long as you feel good, there is nothing to worry about.

So, I would not recommend performing further tests to investigate for the cause.

Just focus on your anxiety management and avoid beta blockers which are not a good treatment choice in your case.

Hope to have been helpful!

Best wishes,

Dr . Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (1 hour later)

Dr.Iliri,

Thanks for your response, and is reassuring that you do not find abnormalities in my previous cardiac tests. If you recall, I have been suffering with chronic fatigue for over 2 years which started with a virus over holiday. I just wonder if a slow heart rate be the reason I am fatigued and sleepy all of the time? I should add that my heart rate is NOT low when I stand up or exercise, only when I am sitting or lying down (low 40s). Also correct me if I am wrong, but wouldn't the use of a pacemaker to increase heart rate also increase how hard the heart is working and add more stress? I already have high blood pressure and would not want to stress heart even more. All other tests, thyroid, hormone, blood tests, kidney liver have come back normal.

Thanks
XXXXXXX

Answered by Dr. Ilir Sharka (2 hours later)

Brief Answer:
I would explain:

Detailed Answer:
Dear XXXXXXX

The fact your heart rate proportionally increases during physical activity and when standing up is a strong marker that it is not responsible for your persistent fatigue.

This is also reinforced by the fact you have no low blood pressure. So you don’t have sick sinus syndrome, which is not rarely characterized by persistent bradycardia (low heart rate) and may lead to fatigue, lightheadedness, and even fainting or syncope.

Coming to this point, I just want to reassure you that as far as no abnormal cardiac conductance disturbance is confirmed by ECG you don’t have to worry about this issue.

So relax!

Regarding pacemaker implantation, I would explain that it is recommended when strong evidence of sick sinus syndrome is confirmed by Holter monitoring (24 to 48 hours ambulatory ECG monitoring), or important cardiac conductance abnormalities are detected.

As no such abnormal findings are evident, then you are not a candidate for pacemaker implantation.

You just need to relax and periodically check your heart rate by ECG and medical exam.

Hope you will find this answer helpful!

Regards,

Dr. Iliri

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar