Heart Rate Variability: Insights on Bradycardia and Stress

Bradycardia

Hello Doctor: My blood pressure is normal, and I feel fine while running; my heart feels normal and I don't experience any discomfort.
In October, I had a lot of work-related stress.
During that month, I noticed that on several days, at random times during the day, I felt like my heart was acting strangely, almost like it was missing a beat.
This sensation would last for a moment and then return to normal, with the next occurrence possibly happening several hours later.
It happened about five days in October, roughly 2-3 times a day, each episode lasting about a second.
I did not feel any discomfort, chest pain, tightness, or shortness of breath, but when I returned home at night, it did not occur.
I consulted a cardiologist who suggested that it might be due to stress and recommended a 24-hour Holter monitor.
During the monitoring, I felt that there were two instances that felt odd.
I pressed the button to record the times, and when I reviewed the report, the doctor said my daytime heart rate was completely normal, averaging 75 beats per minute.
The times I recorded were also normal.
However, during sleep, there were two instances where my heart rate paused for 2 seconds before resuming, but the rate was normal when it resumed.
My average heart rate during sleep was 45 beats per minute.
The doctor mentioned that the daytime readings were normal, and the two 2-second pauses during sleep were still within acceptable limits, advising me to monitor the situation.
He said if the pauses exceeded 3 seconds, we would consider implanting a pacemaker.
He did not perform an echocardiogram to check for mitral valve prolapse and asked if I wanted to do an exercise stress test, but he said it wasn't necessary given my condition, as exercise stress tests are primarily used to detect myocardial infarction, which I do not experience.
Currently, my work stress has decreased, and it seems that these episodes have not occurred during the day this past week.
However, how can I know if they still happen at night? The doctor mentioned that I would need to wait about 3 months to wear the Holter monitor again due to insurance coverage issues.
If I experience the slow heart rate during the day again, should I return for a follow-up? Thank you, Doctor, for patiently reading my account.
Thank you.

40-sui nan, 40~49 year old female. Ask Date: 2016/10/31

Dr. He Dongjin reply Cardiology

Hello, it is normal for your heart rate to slow down while you sleep.
The heart also needs to rest for more than 3 seconds.
Considering the installation of a pacemaker is not wrong, but it should be based on daytime standards.
If there are no discomforts at night, there is no immediate danger to life, so there is no need to panic.
Changhua Hospital cares about you.

Reply Date: 2016/10/31

More Info

Understanding heart rate variability (HRV) is crucial for assessing cardiovascular health, particularly in the context of bradycardia and stress. Bradycardia, defined as a resting heart rate of fewer than 60 beats per minute, can be a normal physiological response in well-trained athletes or during sleep. However, in non-athletic individuals, it may indicate underlying health issues, especially when accompanied by symptoms such as dizziness, fatigue, or fainting.

Your experience of feeling your heart "slow down" intermittently during the day, particularly under stress, is not uncommon. Stress can significantly impact heart rate and overall cardiovascular function. When under stress, the body releases hormones like adrenaline, which typically increase heart rate. However, in some cases, stress can lead to vagal responses that may slow the heart rate temporarily, causing sensations of bradycardia or irregular heartbeats.

The fact that your heart rate was recorded at an average of 75 beats per minute during the day and dropped to 45 beats per minute while sleeping is noteworthy. The two instances of your heart rate stopping for two seconds during sleep, while concerning, fall within a range that your physician deemed acceptable. It’s important to note that brief pauses in heart rhythm during sleep can occur in healthy individuals, particularly during deep sleep stages.

Your physician's recommendation to observe your symptoms and the decision not to pursue further testing, such as an echocardiogram or exercise stress test, seems reasonable given your lack of significant symptoms like chest pain or shortness of breath. However, if you experience any new symptoms or if the episodes of bradycardia increase in frequency or duration, it would be prudent to follow up with your healthcare provider sooner rather than later.

To monitor your condition further, consider keeping a daily log of your heart rate, especially during times of stress or after physical activity. This can provide valuable information for your healthcare provider during your next visit. Additionally, lifestyle modifications such as regular exercise, a balanced diet, adequate hydration, and stress management techniques (like mindfulness or yoga) can help improve your overall cardiovascular health and potentially enhance your HRV.

If you are concerned about the potential for more significant issues, such as the need for a pacemaker, it’s essential to communicate these worries with your doctor. They can provide reassurance and may suggest alternative monitoring options, such as a Holter monitor, which can be worn for an extended period to capture more data on your heart's rhythm.

In summary, while your current heart rate patterns and experiences may be influenced by stress and are not uncommon, ongoing monitoring and communication with your healthcare provider are key. If symptoms persist or worsen, do not hesitate to seek further evaluation. Your health and peace of mind are paramount, and proactive management is the best approach to maintaining cardiovascular health.

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