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What Causes Slow Heart Rate?
Question: Hi doctor please help. I have been seeing 2 cardiologists who both say I have a healthy heart and have rare PVC 15 in 48 hours and rare PACS 129 in 48 hours. I have a question. I have certain times where ill be standing working ( I am a chef) and I check my pulse and it is beating regularly and then I will get 5 or 6 beats that are very slow in between. I don't get a feeling like a pvc I only notice it by checking my pulse or like I have food in my throat. I do not understand what this is. I get a feeling like I have a lump in my throat and then I feel my pulse and it is slower than normal. Then after 5, 6 or 7 beats it speeds up again. My holter said normal sinus rhythm. what is this? My doctor says it could be related to acid reflux. Is that possible? Maybe through the vagus nerve?
Brief Answer:
please see details below
Detailed Answer:
Dear Sir
1. Approximately two-third of population have APCs and VPCs on a given day. They are considered to be benign phenomenon if there is no structural heart disease, patient is not severely symptomatic because of them and they do not initiate other significant arrhythmias.
2. At times VPCs are symptomatic and can produce different kind of feelings like transient dizziness, mild nausea and lightheadedness. The exact mechanism behind this is contraction of posterior or receiving chambers (atria) against a closed AV valve (like a closed door) rather than passage of blood through normally open valve. Once it contracts against the closed door the blood surges back and goes into neck veins on right side. The stimulates the receptors in neck vessels and produce these symptoms.
3. I hope you never had loss of consciousness, unexplained fall or black out. If there is no structural heart disease and no significant symptom as mentioned in last line, these are benign phenomenon. The feeling of lump in the throat may be one the symptoms or may be totally unrelated. Anxiety or over concern about the condition is more likely. Acid reflux causes a burning sensation behind your breastbone and is more common on lying down rather than standing and it will not go away in few seconds.
Hope this provide some insight into the issue.
Feel free to discuss further.
Sincerely
Sukhvinder
please see details below
Detailed Answer:
Dear Sir
1. Approximately two-third of population have APCs and VPCs on a given day. They are considered to be benign phenomenon if there is no structural heart disease, patient is not severely symptomatic because of them and they do not initiate other significant arrhythmias.
2. At times VPCs are symptomatic and can produce different kind of feelings like transient dizziness, mild nausea and lightheadedness. The exact mechanism behind this is contraction of posterior or receiving chambers (atria) against a closed AV valve (like a closed door) rather than passage of blood through normally open valve. Once it contracts against the closed door the blood surges back and goes into neck veins on right side. The stimulates the receptors in neck vessels and produce these symptoms.
3. I hope you never had loss of consciousness, unexplained fall or black out. If there is no structural heart disease and no significant symptom as mentioned in last line, these are benign phenomenon. The feeling of lump in the throat may be one the symptoms or may be totally unrelated. Anxiety or over concern about the condition is more likely. Acid reflux causes a burning sensation behind your breastbone and is more common on lying down rather than standing and it will not go away in few seconds.
Hope this provide some insight into the issue.
Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor Thank you for your response. My holter monitor showed some bradycardia. It said 26 % in 48 hours. My lowest heart rate was 41 during sleep. My resting heart rate is around 56 - 60. The verge heart rate was 70. The slow heart rate concerns me but both my cardiologist say not to worry. The feeling I'm explaining is when I'm standing I will sometimes feel a pressure in my throat and chest and stomach area and I check my pulse and I can feel slow beats and then after 6 or 7 it goes back to normal. These are not pacs or pvcs because the holter is only picking up single unifocal PVCS or pacs. I get worried because sometimes my heart beat feels very irregular. Not so much fast but uneven. Although the holter says sinus rhythm. I don't understand this. I have never fainted. I hope I do not . Doctor says I have too few etopic beats to treat
Brief Answer:
Not likely to be due to low heart rate.
Detailed Answer:
Dear sir
1. Every individual has unique heart rate and your heart rate is not slow by any standards unless there is a proven correlation of severe symptoms and low heart rate, which is seemingly not there in your case. Heart rate of 41 during sleep and average of 56-60 is fine. However peak heart rate can only be established by subjecting you to a stress test like Exercise ECG by treadmill or bicycle. Hence peak heart rate during holter monitoring is of not much value.
2. As I told you in last answer, likelihood of these symptoms due to over concern is high. They do not confirm to cardiac symptoms as per your description and details. Transient duration of symptoms makes likelihood of a gastric problem low, however a gastroenterologist may be consulted if symptoms persist.
sincerely
Sukhvinder
Not likely to be due to low heart rate.
Detailed Answer:
Dear sir
1. Every individual has unique heart rate and your heart rate is not slow by any standards unless there is a proven correlation of severe symptoms and low heart rate, which is seemingly not there in your case. Heart rate of 41 during sleep and average of 56-60 is fine. However peak heart rate can only be established by subjecting you to a stress test like Exercise ECG by treadmill or bicycle. Hence peak heart rate during holter monitoring is of not much value.
2. As I told you in last answer, likelihood of these symptoms due to over concern is high. They do not confirm to cardiac symptoms as per your description and details. Transient duration of symptoms makes likelihood of a gastric problem low, however a gastroenterologist may be consulted if symptoms persist.
sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor Thank you so much for your detailed response. My stress test was normal. My heart rate reached 170 bpm and slowed down appropriately after the test was stopped. Am I just over thinking this? Can anxiety be causing all the symptoms
Brief Answer:
please see details
Detailed Answer:
Dear Sir
1. Since you achieved 90% of your Age predicted Maximum heart rate during stress test your heart rate response is appropriate and not slow.
2. Yes, anxiety can be a cause for these symptoms. Discuss with your psychologist. if symptoms persist, do see a gastroenterologist.
Sincerely
Sukhvinder
please see details
Detailed Answer:
Dear Sir
1. Since you achieved 90% of your Age predicted Maximum heart rate during stress test your heart rate response is appropriate and not slow.
2. Yes, anxiety can be a cause for these symptoms. Discuss with your psychologist. if symptoms persist, do see a gastroenterologist.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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