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very low pulse
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very low pulse


Posted by alicia on July 16, 1999 at 09:27:07
I periodically experience extremely low pulse/heart rates -- mid 40's.  The condition will persist for several days or weeks; severe fatigue accompanies the drop.  What can cause this condition?  Repeated visits to doctors have been of no help in diagosing.  Thank you.  

Posted by CCF CARDIO MD - CRC on July 16, 1999 at 13:20:32
Thank you for your question.  There are many different causes of bradycardia (slow heart rate).  By definition bradycardia is present when the heart rate is less than 50.  Causes may be broadly divided into physiologic and non-physiologic causes.  
Physiologic causes are due to normal adaptations of the heart.  The most common example of this type of bradycardia is in the athlete or extremely fit individual.  The heart has become so powerful in its pumping capability that very few beats per minute are needed to provide blood supply to the rest of the body.  The heart rate may be as low as the 20's to 30's in some athletes.  This type of bradycardia does not cause symptoms and the heart increases to normal rates with exercise.
Non-physiologic bradycardia is usually due to disease of the conduction system of the heart.  There are several areas in the heart that can be affected: the sinus node (natural pacemaker) and  AV node are common sites of conduction disease. The exact location can usually be determined with an EKG but sometimes a special study called an electrophysiology study is required.   The incidence of this type of bradycardia increases with age.  If this type of bradycardia is symptomatic (i.e. lightheadedness, fainting) treatment is usually recommended.  Treatment is generally with a pacemaker device.
Your cardiologist should be able to determine which type of bradycardia you have and make appropriate recommendations from there.  For asymptomatic bradycardia no treatment is usually needed.  Good luck.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by alicia on July 16, 1999 at 14:24:36
Thank you, this is helpful.  But is there nothing in between no treatment and a pacemaker?  No medication?

Posted by CCF CARDIO MD - CRC on July 19, 1999 at 10:31:19
Not for bradycardia.
CRC



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