Bradycardia

[uniured]

Good day!

Height 173 cm, weight 70 kg, age 30 years.

complaints:
There is a constant feeling of weakness, tiredness.
Noticed that the low pulse affects other organs. It is worth to me at the time of the next pain in the stomach to do physical exercises (pull-ups, push-ups) for 15 minutes, as all the symptoms of the disorder disappear (often tormented discomfort, gastrointestinal disorders).
I feel myself well, and head works fast only when the pulse of 80-85 beats / min. (pressure 115/70).

research:
The results of the ECG:
30.06.1999 (15 years) - 55 beats / min; Diagnosis: Sinus bradycardia. Signs vagotomy.
30.05.2007 - 51 beats / min; Diagnosis: Sinus bradycardia. Signs vagotonia.
08/05/2013 - 49 beats / min; Diagnosis: Sinus rhythm. Bradycardia. Violation of intraventricular conduction in all decree. holes V1 V2 RS with serrated. Early repolarization syndrome
09/30/2014 - 44 beats / min; Diagnosis: Sinus bradycardia

Holter test results:
During the daily monitoring of ECG Holter registered 84,654 complex. The basic sinus rhythm with episodes of sinus arrhythmia with an average heart rate of 69 beats / min. Max. Heart rate of 141 beats / min. at 19:38 (when walking), Min heart rate of 36 beats / min. at 6:19 (sleep).
Against this background, recorded: 1 ventricular parasystole 1 supraventricular arrhythmias. Paroxysmal ectopic rhythms, long pauses and accurate ST segment depression was not revealed. Patient complaints from the heart does not show.

As you see i have been having the diagnosis bradycardia since childhood. In recent years, the pulse rate on the ECG became lower.
Please, what research needs to be done?
Which reaso of bradycardia should be sought?

Yours faithfully,
Alexander

[uniured]

The results of the latest Holter monitor:

Duration of monitoring 23:26. Recorded leads: V2, V5, aVF
Sleep from 23:10 to 6:20.
During the study analyzed 84,930 complexes QRST.
Of these to artifacts attributed 1.6%
RHYTHM
Basic rhythm - sinus
HEARTH RATE
min avg max
sleep 34 46 80 3:53:41 3:00:19
awake 40 67129 in 6:20:51 22:33:10
day 34 in 3:53:41 to 22:33:10 60129

Duration of bradycardia 6:51:40 :
• 30 to 40 beats / min 00:21:25
• 40 to 50 beats / min 6:30:15
Duration of tachycardia 00:20:10 :
• 90 to 100 beats / min 00:17:20
• 100 to 120 beats / min 00:02:25
• 120 to 150 beats / min 00:00:25
Circadian index is equal to 1.46 (normal 1.24-1.44)
BREACH ATRIOVENTRICULAR CONDUCTION
Episodes conduction abnormalities not registered
ECTOPIC SUPRAVENTRICULAR ACTIVITY
Total for the day found 3 supraventricular extrasystoles 2 during wakefulness and 1 at bedtime. Interval of coupling from 0.51 sek. (at 17:06:49) to 0.73 sek. (in 3:56:11). 3 of them are single.
VENTRICULAR ECTOPIC ACTIVITY
Ventricular extrasystoles are not identified
PAUSE (FALL-OUT QRS)
Blockade were not identified.
Total found 124 (73 during sleep) an apparent sinus arrhythmia. Duration RR: 1.8-2.0 sec - 3 (during sleep); <1.8 sec - 121 (70 during sleep); Maximum arrhythmias RR 1.90 sec. in 2:37:54
Maximum RR 1.90 seconds . in 2:37:54
DYNAMICS PQ INTERVAL
Episodes of increasing and shortening of PQ interval are not registered.
DYNAMICS OF ST-T
ST-segment deviations are not registered
DYNAMICS OF QT INTERVAL
Periods of increasing and shortening of the QT interval are not revealed. The average daily duration of intervals: QT = 0.40 sec., QTc = 0.40 sec.
RATE VARIABILITY
HRV analysis for all time monitoring:
time analysis HRV:
Description Value Norm
Mean | Average value of all RR intervals | 995 |  795 (583-1090)
SDNN | Standard deviation of the study | 229 | 143 ± 32
SDNNi | Average SDNN in 5-minute sections | 78 | 64 ± 15
SDANNi | Standard deviation of averaged over a 5-minute values of RR intervals | 231 | 130 ± 33
rMSSD | RMS difference of adjacent RR 44 35 ± 11
PNN50 | % of adjacent intervals differing more than 50 ms 16 13 ± 9

Additional rate variability analysis was performed on short sections, consisting of 33 intervals RR
All worked up plots in 2304 (88% of the time study).
Heart rate variability: increased
SIGNS OF FEELING SICK
signs of feeling sick are not available.
CONCLUSION OF DOCTOR
Throughout the study, recorded sinus rhythm with a predominance of sinus bradycardia in the passive period with min. averaging. heart rate of 34 bpm. min. at 03:53 (sleep) and max. averaging. heart rate 129 bpm. min. at 22:33 (walking). Episodes of bradycardia less than 34 bpm. min. have been identified.
The daily average heart rate of 60 beats per min. The daylight hours average heart rate of 67 beats per minute. The night average heart rate 46 beats per min.
Throughout the study, with a predominance during sleep episodes were recorded marked sinus arrhythmia, max RR 1,9 sec.
During the study, 3 registered supraventricular arrhythmias.
Diagnostically significant ST-segment changes haven't been identified. Submaximal heart rate of age is not reached.
Increased heart rate variability and increased circadian indexes are detected.

[uniured]

Hello!

I've read article, that bradycardia can be caused by:

1. Changes in the heart that are the result of aging.
2. Diseases that damage the heart's electrical system. These include coronary artery disease, heart attack, and infections such as endocarditis and myocarditis.
3. Conditions that can slow electrical impulses through the heart. Examples include having a low thyroid level (hypothyroidism) or an electrolyte imbalance, such as too much potassium in the blood.
4. Some medicines for treating heart problems or high blood pressure, such as beta-blockers, antiarrhythmics, and digoxin.


I've checked electrolyte imbalance already by blood tests (as i understand it):
Ca++, Free Calcium, Calcium ionized - 1.14 mmol/l refer:(1.03 - 1.23)
Ca, Calcium total - 2.31 mmol/l refer:(2.10 - 2.55)
К+, Potassium - 4.3 mmol/l refer:(3.5 - 5.1)
Na+, Sodium - 140 mmol/l refer:(136 - 145)
Сl-, Chloride - 103 mmol/l refer:(98 - 107)
Мg, Magnesium - 0.86 mmol/l refer:(0.66 - 1.07)

It's looks good.
What also i can check according the described symptoms?

[uniured]

Hello.

You and I are not doctors. So I am only reacting to my health and tests according to knowledge i have. And i'm trying to describe them.
Also you are reacting to my description according to knowledge you have. But neither you nor I can not say what it is. This is doctor's work to find in med-history a significant symptoms.
You and I can only speculate about subjectively or objectively what I wrote, but we will not come to any conclusion.
As an example: One day I was took a holiday with my ex girlfriend. She did not want to go to the depth of the sea, because she was afraid that bad swims. I persuaded her, and took in my arms, went into the depths. Suddenly she started to cry sharply in the first second I didn't think anything serious, but it turned out that it stung by a jellyfish. I was started worried, because it's my responsibility.
There immediately was a first aid for her (not sure: alcohol or antiseptic), the pain began to subside. We were at the doctor, and bought a special cream, but since it was a different country and an unknown language, there was no full of confidence. Stories of my girlfriend that pain migrated from foot on her back, weren't encouraging :).  In the following days I worried internally, but seeing my care she was happy and wasn't remembering about the pain.

[kcolly32]

Hi, I'm no doctor but I work as a RN on a cardiac floor. Idk what could be causing your problems but I can give you some suggestions. A slow HR can make you feel tired and sluggish but so can many other things. It's best to get a complete physical to rule it out. Are you on any heart medications for blood pressure? Many can slow down the HR and make you feel tired. OR if you work out alot, it can cause a low HR. Most Drs aren't concerned if you aren't having episodes of syncope. Sluggish thinking and trouble concentrating aren't usually caused from having a low HR. Might need some vitamin B supplements or some iron, this can also help with feeling cold. People that are anemic often complain of being cold and feeling sluggish. Have you ever gotten your hemoglobin checked? Also with the gestational tract, slow HR doesn't usually make it an issue. However, if you have an issue with anxiety, have stress, or a high HR that could give you diarrhea, just from all the stimulation. But constipation is trouble with your diet or certain meds, never heard a low HR cause these problems. Have you noticed that these symptoms go away under stress because you are focused on something besides your low HR? Like I said I'm not a doctor just thought I give you examples of other things causing your problems, it's hard to link a low HR to causing all your issues. Best bet is to get a physical done. Good Luck!

[uniured]

Thank for your answer.

I found key of this problem - it's increasing average heart rate.

I understand the complexity of the processes of the body, so i try to consider all sides.

Am I right in thinking that bradycardia may be as induced vagal tone and as other reasons?
Do I understand correctly that bradycardia by itself (without delving into the cause) may cause the other symptoms I described?

Are there any comprehensive studies on the identification of vagal tone or tone of the  parasympathetic nervous system?

I've read an article about autonomic nervous system.

As I understood the mediator for the parasympathetic nervous system is acetylcholine. For sympathetic - adrenaline.

If the activity of the parasympathetic system is large, it can be used an  anticholinergics, isn't it?

"When the amount of acetylcholine is increased, the excitatory receptors of the adrenal medulla, and therefore, a large amount of adrenaline"
Therefore it's protective mechanism against high activity of the parasympathetic nervous system. How to check that it works well?


Two more my ECG are below :

03/05/2014 - 49 beats / min; Diagnosis: Sinus rhythm. Bradycardia. Violation of intraventricular conduction on the right bundle branch block in all decree. V1 V2 RS with serrated. Early repolarization syndrome
07/25/2014 - 44 beats / min; Diagnosis: Sinus bradycardia. Violation of intraventricular conduction on the right bundle branch block

[uniured]

I have checked, though some parameters already outdated.
Thyroid Stimulating Hormone, TSH - 3.510 µIU/ml refer:(0.350 - 4.200) 07/17/2014
Free Triiodthyronine, FT3 - 4.1 pmol/l refer:(2.6 - 5.7) 09/29/2014
Free Thyroxine, FT4 - 14.3 pmol/l refer:(10.300 - 24.450) 07/16/2013
anti-thyroglobulin autoantibobies 0,65 U/ml refer:(0.00 - 65.00) 07/16/2013

[Carston4]

Check your thyroid levels. Those are symptoms.

[itdood]

You're thinking that your heart beating slow is causing those 5 issues.  

Perhaps something else is causing all those issue above, including your heart to beat slower?  Meaning, the slower heart rate is also a symptom with all those other issues.

I really don't see a problem though, your heart rate increases appropriately with activity.

It could be some sort of Dysautonomia.  All the issues you are reporting, including the slow heart, are related to vagal tone and activity on the parasympathetic/sympathetic nerve branches of the central nervous systems.

[uniured]

I apologize that I could not explain clearly what worries me.

1. Almost every day I feel tired and weak.
2. Sluggish thinking.
3. Periodically, it hard to concentrate.
4. I'm cold, where other people do not complain of the cold.
5. There are problems of the gastrointestinal tract.
If I am under stress, all the above problems are disappear.
As stress bring body to produce adrenaline, the heart begins to NMS need quickly. That is why I tried to connect all of this symptoms with bradycardia.
Also I made the measurement of pulse and pressure and found that both at 85 beats / m and 115/70 I have no complaints.

[itdood]

If it's not symptomatic, why worry about it?  If your doc isn't worried, why are you not trusting their advise?  (Go to a new doc if you can't accept their advice).   Your heart is responding with appropriate increase in rate when you exert yourself, this is normal.   Brady is a problem when you have it inappropriately, which you do not.