Low Heart Rate: Implications and When to Seek Cardiology Care

Bradycardia

Hello, doctor.
In my health check report, there is an electrocardiogram (ECG) finding suggestive of myocardial ischemia, and my hemoglobin and mean corpuscular hemoglobin concentration are low.
My smartwatch has a heart rate monitoring function, and a normal resting heart rate for healthy individuals is usually between 50-100 beats per minute; however, mine is between 43-45 beats per minute.
I would like to know if this could have any implications, and if so, should I see a cardiologist for further evaluation? Thank you.
🙏🏻

Yan Pei, 20~29 year old female. Ask Date: 2021/06/21

Dr. Hong Yuanbin reply Internal Medicine

Hello, regarding bradycardia, it should be assessed in conjunction with your symptoms.
If you have no discomfort, there may not be a need to address it.
A low hemoglobin level and mean corpuscular hemoglobin concentration indicate anemia, and the specific hemoglobin level should be evaluated.
At your age, if the hemoglobin is greater than 12 g/dL, specific treatment is usually not necessary.
As for the suspected myocardial ischemia indicated by the electrocardiogram, this result is based on the machine's interpretation of your ECG, which can have significant variability.
If you do not experience any cardiac discomfort, there should not be any major issues.
In summary, if you have any heart-related discomfort, you may want to consult a cardiologist; if you have no symptoms, monitoring is sufficient.
Thank you for your inquiry.

Reply Date: 2021/06/21

More Info

Low heart rate, or bradycardia, is defined as a resting heart rate of fewer than 60 beats per minute. While it can be normal for athletes or individuals who are very physically fit, a low heart rate in someone who is not an athlete can raise concerns, especially if accompanied by symptoms such as fatigue, dizziness, or chest pain. Your reported heart rate of 43-45 beats per minute is significantly lower than the normal range, and the presence of symptoms such as suspected myocardial ischemia and low hemoglobin levels adds complexity to your situation.

Bradycardia can have various causes, including but not limited to:
1. Intrinsic Heart Conditions: Issues with the heart's electrical system, such as sick sinus syndrome or atrioventricular (AV) block, can lead to a slower heart rate. These conditions can sometimes be serious and require medical intervention.

2. Medications: Certain medications, especially those used to treat heart conditions, high blood pressure, or anxiety, can lower heart rate. If you are taking any medications, it is essential to review them with your healthcare provider.

3. Electrolyte Imbalances: Low levels of potassium or calcium can affect heart rate and rhythm. Blood tests can help determine if this is a contributing factor.

4. Hypothyroidism: An underactive thyroid can lead to bradycardia. Thyroid function tests can help rule this out.

5. Sleep Apnea: This condition can cause intermittent drops in heart rate during sleep, leading to bradycardia during waking hours.

Given your symptoms of fatigue and the findings of your health check-up, it is advisable to seek evaluation from a cardiologist. They may recommend further tests, such as an electrocardiogram (ECG), echocardiogram, or even a Holter monitor to assess your heart's rhythm over a longer period. These tests can help determine if there are any underlying heart conditions that need to be addressed.

In addition to the heart rate concerns, the mention of low hemoglobin and average hemoglobin concentration suggests that you may also be dealing with anemia, which can contribute to feelings of fatigue and weakness. Anemia can result from various factors, including nutritional deficiencies (like iron, vitamin B12, or folate), chronic diseases, or bone marrow issues. Addressing anemia is crucial, as it can significantly impact your overall health and energy levels.

In summary, while a low heart rate can be benign in some individuals, your specific situation—with a heart rate consistently below 50 beats per minute, symptoms of fatigue, and other concerning lab findings—warrants a thorough evaluation by a cardiologist. They can provide a comprehensive assessment and determine the best course of action, which may include lifestyle modifications, medication adjustments, or further diagnostic testing. It is always better to err on the side of caution when it comes to heart health, so seeking professional advice is a prudent step.

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