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What Causes Slow Heart Beat Despite Having Normal ECG, Stress Test And Cardiac Ultrasound?

Posted on Mon, 25 May 2015

Question: I had a full work up done for the second time this year by a cardiologist. He performed a stress test, Echocardiogram, 48 hour holter and several ecg. Everything came up structurally normal and no significant arythmia. The holter picked up approximately 400 pacs and 15 pvcs over 48 hours. One thing that concerned me is that my resting heart rate sometimes goes into the low 50s. While sleeping it went down to 41.y cardiologist insists this is all normal as I have a healthy heart with no sign of heart disease, heart block or sick sinus syndrome. I get concerned because my heart beat feels so slow. My average heart rate on the holter read 71bpm. However it showed 26% of the team in bradycardia and 12 % in tachycardia. Is this all normal? I am worried.

Tonight I was sitting on couch watching TV after a long day at work and I had pressure in my throat and checked my pulse and it was in the low 50s.

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
You look in perfectly cardiac condition.

Detailed Answer:

Hello!

Thank you for asking on HCM!

I am glad to confirm you, that all the medical data and test results you have submitted are within the normal physiology of a healthy person.

The first enthusiastic and important conclusion is the fact you have a structurally normal heart. This is confirmed by the normal cardiac ultrasound and your satisfactory well-being.

Your stress test confirms the above statements, and leaves no doubts for any further speculations on that matter.

Regarding your 48 hours Holter data, I would like to confirm that is within normal ranges, and no any elements would raise suspicions about any underlying disorders.

Your heart rhythm is continuously normal sinus one. Your heart rate do demonstrate a physiologically normal day-night and awake-sleeping variations.
50 bpm, and even 41 bpm is frequently seen when resting and sleeping in normal subjects. So, relax! Don't worry about!

Your average heart rate is quite normal. The same are your tachycardia and bradychardia trends. Your registered PACs an PVCs are significantly irrelevant, unimportant. So, relax again!

Your unpleasant sensation while watching TV, seems a stress related phenomenon. You need to be more physically active, and relieve your anxiety and eventually increased stress.

Hope to have been helpful to you. Greetings! Dr. Iliri

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Ilir Sharka (14 hours later)

Hi doctor thank you for explaining all this to me. I just have one further question. It seems that when I get a feeling of a lump in my throat or food coming up I check my pulse and I get 5 to 7 very slow hard beats. Can this be stimulation of the vagus nerve causing this? Even if I am doing a physical activity sometimes I will feel it and I check my pulse and I'll feel the slow beats then after 5 to 7 slow beats it speeds up. This scares me because usually when you are moving heart rate increases and does not have these slow beats. It is always accompanied by a feeling like I have food in my esophagus. I know all the tests on my heart were normal but I don't understand what is causing these symptoms. Is it dangerous?

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
You should explore your digestive system.

Detailed Answer:

Hi again!

Your transitory heart beat lowering is not dangerous. You have to relax!
My answer to your question is: Yes! Vagus nerve may express such a response, regarding heart rate, when triggering factors do exist. Your indigestion, possible reflux or even esophagus hernia, etc, may stimulate such a response by vagus nerve part.
The recommendation is to explore those triggering factors (indigestion, a lump or resting food on your throat, etc).

You have to visit a gastroenterologist, in order to address these issues. Probably a fibrogastroscopy could be helpful to clarify any possible digestive disorders.

Best Regards! Dr. Iliri

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

Follow up: Dr. Ilir Sharka (38 hours later)

Hi doctor one last thing I would like to ask you. Is there a reason why sometimes the etopic happen and I get tachycardia and then sometimes they happen with bradycardia? Also is it dangerous to exercise if PACS occur with high heart rate. I did not have any etopic during stress test but I sometimes get tachycardia with pacs.

Answered by Dr. Ilir Sharka (3 hours later)

Brief Answer:
Please do follow the recommendations I gave you before!

Detailed Answer:

Hello!

The fact that those rare ectopic beats do occur despite the heart rate values, do confirm once more their extra cardiac triggering nature. Please, do follow the recommendations I gave you before.

Regarding the hazard of PACS, I would explain that nobody has died from them as far. So relax!

Remember, your PACs and PVCs are totally insignificant, and there doesn't exist any limitations regarding physical activity.

Hope to have been helpful. Greetings! Dr. Iliri

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Ilir Sharka (33 minutes later)

Hi doctor thank you for explaining that to me. It was very helpful and now I have a better understanding. I was just told in the past that bradycardia is not normal and this scared me as I experience it. When is bradycardia dangerous. I do not have heart block, heart disease or sss so does this mean it's normal?

Answered by Dr. Ilir Sharka (3 hours later)

Brief Answer:
Asymptomatic bradycardia is not abnormal, or dangerous.

Detailed Answer:

Hi!

Asymptomatic bradycardia is not considered abnormal or dangerous. As long as you do not experience such abnormalities you mentioned above (heart block, SSS, etc), there is nothing to worry about.

Wish you good health! Dr. Iliri

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj