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Suggest Treatment For Sinus Bradycardia

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Posted on Wed, 19 Nov 2014
Question: My son is 17 years old and has a very poor diet. He has been an unusual eater since he was a toddler, very sensitive to textures. I thought he would outgrow it . He didn't . No meats, very few vegetables, will only eat fruits, breads, dairy, and peanut butter. He has supplemented with Ensure or Muscle Milk drinks occasionally. He is active with swim team and basketball and has grown to 6'6! My ten-year-old son is not picky and eats very well, in fact he eats more than my 6'6 17 year old! Family and friends have been concerned about how little my oldest son eats for some time, but family doctor says he is growing so he is fine. He weighs almost 200 pounds. This last year he has been getting tired more easily, sweats heavily with any exertion, for example after swim team practice will feel light headed and will need to sleep for 2 or 3 hours, if he mows the grass will need to sleep for a couple hours. One day after playing basketball and then sleeping, he felt lightheaded and just not right when he woke up so i checked his pulse and it was in the 30s. I began monitoring for about a month and it was often 30s, 40s, and 50s, occasionally in 60s or 70s. I spoke to family doctor and he ordered Holter Monitor 24hr. He was noted to have a marked sinus bradycardia with lowest being 26-27 bpm during sleep around 6 am and his average rate was 50. Otherwise unremarkable and he had normal sinus rhythm with no evidence of blockage. Family doctor thinks he just has a very efficient, athletic heart. No bloodwork or other labs were ran, as family dr didn't feel necessary. I trusted him, but don't think he realizes how little my son eats because of his tall height just kind of brushed it off by telling me no teenager has a great diet. I do worry though about the nutrition aspect of this in relation to the health of his heart but don't want to pester or question our family dr. I would really appreciate your medical opinion. Also, I am writing today because my son has begun to have another issue that is more of a GI problem. He has started having blood in his stools for two weeks now. When he first told me he had bleeding I asked him the color and he said bright red. I told him not to worry it was probably just some irritation or from straining. Today however he called me to look at the toilet after he had a bowel movement and there was quite a bit of blood! It is bright red so that confuses me as I thought bright red would be hemmorrhoids or straining and very small amounts. Again, this was quite a bit of bleeding, enough that the toilet bowel water was quite bloody. Any relation between the bradycardia and GI blood loss? Any tests you would recommend? What kind of dr would be recommended to see? He is having no pain.
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Answered by Dr. Panagiotis Zografakis (2 hours later)
Brief Answer:
Please read on

Detailed Answer:
Hello,

I've read your text and I understand your concerns. A low pulse rate is common among good athletes but a rate lower than 40 is too low. Keep in mind that some professional athletes like NBA players were reported to have also very low heart rates (35/minute) without any problems in their life.
A consultation with a cardiologist would be more appropriate in his case since he had an unusually low heart rate.
Despite that, I do not believe that his heart rate is the source of this exhaustion. Perhaps he's just too active and training all the time!
His eating behavior can be easily assessed with blood tests. You haven't mentioned how many calories he eats per day. But if he's not eating meat and he has a problem with that, he should have a low ferritin or vitamin B12 for example. If his blood tests are normal then you shouldn't worry too much about it. As your doctor pointed out, he's grown so tall and he's so active and trained. It would be a XXXXXXX if he'd developed any nutrient deficiency.
Regarding the blood in his stool: bright red blood is usually caused by a bleeding site close to the anus (hemorrhoids, anal fissure, bleeding site inside the intestine). Judging from your description, is seems like a bleeding internal hemorrhoid which is painless but can bleed a lot! An endoscopic assessment by a gastroenterologist would be appropriate. The gastroenterologist will be able to identify the bleeding site and rule out more serious diagnoses.
I hope I've helped you understand his situation!
If you have more questions, please ask. I'll be glad to answer.

Kind Regards!
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3814 Questions

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Suggest Treatment For Sinus Bradycardia

Brief Answer: Please read on Detailed Answer: Hello, I've read your text and I understand your concerns. A low pulse rate is common among good athletes but a rate lower than 40 is too low. Keep in mind that some professional athletes like NBA players were reported to have also very low heart rates (35/minute) without any problems in their life. A consultation with a cardiologist would be more appropriate in his case since he had an unusually low heart rate. Despite that, I do not believe that his heart rate is the source of this exhaustion. Perhaps he's just too active and training all the time! His eating behavior can be easily assessed with blood tests. You haven't mentioned how many calories he eats per day. But if he's not eating meat and he has a problem with that, he should have a low ferritin or vitamin B12 for example. If his blood tests are normal then you shouldn't worry too much about it. As your doctor pointed out, he's grown so tall and he's so active and trained. It would be a XXXXXXX if he'd developed any nutrient deficiency. Regarding the blood in his stool: bright red blood is usually caused by a bleeding site close to the anus (hemorrhoids, anal fissure, bleeding site inside the intestine). Judging from your description, is seems like a bleeding internal hemorrhoid which is painless but can bleed a lot! An endoscopic assessment by a gastroenterologist would be appropriate. The gastroenterologist will be able to identify the bleeding site and rule out more serious diagnoses. I hope I've helped you understand his situation! If you have more questions, please ask. I'll be glad to answer. Kind Regards!