Low Pulse Rate and Fatigue in Heart Disease Patients

excuse me?

Dear Doctor, my father has high blood pressure and was recently discharged from the hospital.
He was diagnosed with an acute stroke and cardiovascular disease.
Currently, his blood pressure is within the normal range, but his pulse is 48-55 beats per minute.
Is this considered normal? Additionally, my father tends to feel very sleepy and speaks very softly.
What could be the reason for this? I would appreciate your response.
Thank you.

Xiao Gui, 10~19 year old female. Ask Date: 2004/07/30

Dr. Lin Changqi reply Cardiology

A consultation with the cardiology outpatient clinic is necessary to evaluate the need for medication, including beta-blockers.
If medication is required, adjustments will need to be made; if not, further investigation into the underlying cause is needed.

Reply Date: 2004/07/30

More Info

When evaluating a low pulse rate, particularly in the context of heart disease patients, it is essential to consider several factors that could contribute to this condition. A pulse rate of 48-55 beats per minute (bpm) is considered bradycardia, which is defined as a heart rate that is slower than normal. In adults, a normal resting heart rate typically ranges from 60 to 100 bpm. Bradycardia can be benign in some individuals, especially in athletes or those who are physically fit, but in patients with underlying heart conditions, it can be a cause for concern.

In your father's case, the combination of high blood pressure, recent hospitalization for a stroke, and cardiovascular disease raises the stakes. Bradycardia in patients with heart disease can be indicative of several issues, including:
1. Heart Block: This is a condition where the electrical signals in the heart are delayed or blocked. It can lead to a slower heart rate and may require further evaluation, such as an electrocardiogram (ECG) or even a pacemaker if the block is significant.

2. Medications: Certain medications used to manage heart disease, such as beta-blockers or calcium channel blockers, can lower the heart rate. If your father is on such medications, it would be prudent to discuss this with his healthcare provider.

3. Autonomic Nervous System Dysfunction: The autonomic nervous system regulates heart rate. Conditions affecting this system can lead to bradycardia.
4. Electrolyte Imbalances: Abnormal levels of potassium, calcium, or magnesium can affect heart rhythm and rate.

5. Hypothyroidism: An underactive thyroid can lead to a lower heart rate and fatigue.

The symptoms your father is experiencing, such as excessive sleepiness and a soft voice, could be related to several factors, including:
- Fatigue from the underlying heart condition: Heart disease can lead to decreased cardiac output, which may cause fatigue and weakness.

- Neurological effects from the stroke: Depending on the area of the brain affected, a stroke can impact speech and energy levels.

- Medication side effects: If he is on medications for his heart condition or to manage blood pressure, these could contribute to fatigue and low energy.

Given these considerations, it is crucial to have a thorough evaluation by a healthcare professional. Monitoring his heart rate and symptoms closely is essential. If the bradycardia persists or worsens, or if he experiences additional symptoms such as dizziness, fainting, or chest pain, it would be advisable to seek immediate medical attention.

In summary, while a pulse rate of 48-55 bpm is not typical and warrants further investigation, the context of your father's overall health, including his recent stroke and heart disease, makes it even more critical to address these symptoms with his healthcare provider. They may recommend further tests, adjustments to his medications, or other interventions to ensure his safety and well-being.

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