Slow Heart Rate: When to Seek Medical Attention

Bradycardia

Mother originally had a follow-up appointment with the cardiologist every three months.
Recently, due to symptoms (chest tightness and chest pain), her medications were adjusted (previous medications included bisoprolol 1 mg once daily and Adalat 1 mg once daily).
A new prescription for coxib 0.5 mg twice daily was added.
Afterward, her heart rate dropped to 52-55 bpm, prompting an earlier follow-up.
The physician recommended reducing the bisoprolol dosage to half (from 1 mg to 0.5 mg daily), but her morning heart rate remained at 53-58 bpm and her evening heart rate at 55-61 bpm.
Her blood pressure readings were consistently between 120-134/55-70 mmHg.
However, she has not experienced any discomfort.
Is it necessary to schedule an earlier follow-up appointment, given that the next one is not due until November? If an earlier visit is needed, the physician is on leave this week.
Should we seek another doctor, or can we wait for the original physician to return? Thank you for your response.

qq, 30~39 year old female. Ask Date: 2015/10/14

Dr. Li Han reply Cardiology

Hello, based on your description, "Your mother originally had a scheduled follow-up with the cardiology department every three months.
Recently, due to symptoms (chest tightness and chest pain), her medication was adjusted (she was previously on bisoprolol 1 mg once a day and adalat 1 mg once a day).
A new prescription for coxib 0.5 mg twice a day was added.
Afterward, her heart rate dropped to 52-55 bpm, prompting an earlier follow-up.
The physician suggested reducing the bisoprolol to half a tablet (from 1 tablet per day).
However, her morning heart rate remains at 53-58 bpm, and her evening heart rate is 55-61 bpm, with blood pressure readings between 120-134/55-70.
Your mother reports no discomfort.
Is it necessary to schedule an earlier follow-up?"
The bisoprolol in your mother's medication is a sympatholytic agent that can cause a decrease in heart rate.
Generally, if there are no clinical symptoms, a resting heart rate of 50-90 bpm is considered appropriate for most individuals, as long as the heart rate increases appropriately with activity and there are no feelings of weakness or other discomfort.
Currently, her heart rate does not seem problematic.
However, addressing your question may not be entirely appropriate, as the assessment of heart rhythm should include both quality and quantity, as well as potential underlying cardiac issues and the reasons/indications for medication.
It is worth noting that your mother's symptoms of chest tightness and chest pain may warrant further investigation, as all three medications mentioned have anti-anginal effects.
If the symptoms persist, it would be advisable to determine the underlying cause.

Best regards, Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2015/10/14

More Info

When it comes to understanding a slow heart rate, or bradycardia, it is essential to consider various factors, including the patient's overall health, symptoms, and any underlying conditions. In your mother's case, her heart rate has been consistently low, ranging from 52 to 61 beats per minute, which is below the normal resting heart rate of 60 to 100 beats per minute. However, it is important to note that a low heart rate can be normal for some individuals, especially those who are physically fit or are on certain medications that affect heart rate.

Given that your mother has a history of heart issues, including chest pain and adjustments in her medication, it is prudent to monitor her condition closely. The fact that her blood pressure remains within a reasonable range (120-134/55-70) and that she does not report any symptoms of discomfort is reassuring. However, the presence of symptoms such as chest tightness or pain should not be overlooked, as they could indicate underlying cardiac issues that may require further evaluation.

In general, bradycardia can be a benign condition, particularly if the individual is asymptomatic. However, if symptoms such as dizziness, fatigue, shortness of breath, or fainting occur, it is crucial to seek medical attention promptly. In your mother's case, since she has experienced chest discomfort and has had her medication adjusted, it would be wise to consult with a healthcare provider sooner rather than later, especially if her heart rate continues to remain low or if she develops any new symptoms.

Regarding whether to wait for her regular physician or seek another doctor, it depends on the urgency of her symptoms. If her symptoms worsen or if you have concerns about her heart rate and overall health, it may be beneficial to see another healthcare provider for a second opinion or immediate assessment. On the other hand, if she remains stable and asymptomatic, waiting for her scheduled appointment in November may be acceptable.

In conclusion, while a slow heart rate can be normal for some individuals, it is essential to remain vigilant, especially in patients with a history of heart disease. Monitoring her symptoms and heart rate, along with regular follow-ups with her healthcare provider, will help ensure that any potential issues are addressed promptly. If there are any changes in her condition or if she experiences concerning symptoms, do not hesitate to seek medical attention.

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