Resting pulse rate of 25 for an 20 yr old athlete

My wife and our doctor has been concerned with my son.  He is in his second semester of college and we just found that he 'may be' diagnoised with bradycardia.  He just had a monitor on overnight and we found that his resting rate was 25.  Should we be concerned?  I don't know what else to give to you other than he has had NO symptoms and he feels great, there has been no indication of problems.  Please help... David

[ksig]

You did not mentioned if your son was a strong athlete.  Many professional athletes have low resting heart rates but I doubt if many of them have one at 25bpm.  I am not an athlete but i do exercise.  One day at work, I felt lightheaded and had a hard time carrying out my work (I was a middle school principal at the time.) I was totally exhausted by 9:30AM and could not walk out of my office so 911 was called.  My heart rate was 28bpm.  By the end of two day's time I had a new pacer and became a new person.  

My suggestion is for you son to see an eletrophysiologist (cardiologist with training specifically about the electrical system of the heart) soon.
ksig

[dadof3and3]

Thanks for the timely response!
My son is an athlete however not a professional athlete, he played sports in high school and continues to workout 3-5 times per week.  Our doctor did send us to a cardiologist who has become concerned and he has sent us onto a electrophysiologist, we see him on Monday (he thought it is pressing however not urgent).  The cardiologist has recommended a pacemaker which scares all of us, why would a 20 yr old male, in great health with NO symptoms need a pacemaker?  This is a tough pill to swallow however we want to do what is right.  I'm wondering if his bradycardia could be related to his eating habbits.  He recently changed his diet to better align with his blood type.  Since this episode of concern he has resorted back to eating 'normal' again, much to our (his parents) liking.  I have a few questions to ask the electrophysiologist and hopfully get straight answers and we all can get good buy-in to do whatever is right. Could his sinus rhythm be normal?  

[yarrow]

28 is pretty much outside the range even for highly trained, competitive athletes.  Lance Armstrong, for example, had a resting heart rate of 32-34 bpm in his racing prime.  Your son may have no symptoms yet, but that low heart rate probably signals that his body and brain are in danger of lack of oxygen.

It would be helpful for you to read about causes of bradycardia:

http://www.mayoclinic.com/health/bradycardia/DS00947/DSECTION=causes

Something unusual is going on, and it is extremely unlikely--extremely--that your son's eating habits have anything to do with this.  Considering his youth, it is more likely that a faulty electrical or anatomical problem is involved, unless something else listed at the above website is found in his cardiac evaluation.

[Jerry_NJ]

Not to "scare" as I am not a doctor and even if I were the information and it accuracy is too thin to be certain.  That said from what I've read a resting HR of 25 is dangerously low.  What is the HR when he is up and walking, or playing/running?  

I haven't looked it up, but recall Bradycardia is a resting HR below 50 (or something in that range) and some people by nature or by long hard physical training have a resting HR in that range. In my best fitness days my resting HR was around 60.

You mention a pacemaker, that or an ICD may be called for to protect against the heart stopping.  I hope someone who has a pacemaker will provide some facts, there are other threads on this forum and the web that will give an accurate description.  For a starter I believe a pacemaker is used to "pace" the HR, e.g., to keep it above some lower limit, much higher than 25 I'd guess.  And ICD is to restart a heart that has stopped, or not had a beat in some defined period of time.. And ICD hits the heart with a defibrillator shock, I understand which is uncomfortable.  A pacemaker I believe sends a signal to the heart timing and is usually not felt...  if this looks interesting do a search on "pacemaker" on this forum and read some of the threads.

[ksig]

Jerry and Yarrow are right on.  I am not a health professional either and I do not think food has to do with his low HR either.  There are many folks walking around with pacers and they are young... your son's age or even younger.  And they really have forgotten about having one and go on and live great, productive and active lives.  I think about mine once a month because I transmit a report to my doc.  Setting up the transmitter, etc takes all of 5 min and off I go to other activities.  I have never again had a low heart rate.  In fact it is set for 60 on the low end and 175 on the high end.  I am on my second pacer, too.  I am glad you have an appointment on Monday to get some answers to your questions.
Let us know what happens.
ksig

[is_something_wrong]

You need to clear something up for us: Is this the general resting heart rate or is it the night minimum? This can't by any means be compared.

Myself, my resting heart rate is 55 but my Holter did reveal a night minimum of 37. Not a problem at all. Athletes often get a so-called AV block occationally at night where the heart rate can be really slow. This is something a doctor should evaluate but it's most often a normal phenomenon. I remember an answer from a doctor saying night time heart rates could get as low as 20.

Anyway, clearly a doctor should evaluate this, and if the heart rate is 25 at daytime it's definitely abnormal. But heart rate at night can be amazingly low without necessarily involving a disease.

[dadof3and3]

I GREATLY appreciate all the responses everyone has given.  This has been a shock to the family and we are coping with the idea of my son having a pacemaker, hopefully Monday we will get more answers.
More information (I'm not the greatest writer): On Monday of this week, the cardiologist had him wear a Holter device and I now have all the information (hey, I'm a computer nerd, I scanned it).  When he was asleep is heart rate was as low as 25bpm, this occured @ 6 AM Tue.  Here is the narrative from the Holter device that was written...

The patient’s average heart rate was 41 BPM.  No episodes of tachycardia were noted.  Heart rates less than 50 BPM were noted 91% of the time.
6232 pauses exceeding 2.0 seconds were noted.  The longest pause of 2.5 seconds occurred at 06:55:34 AM Tue.
1 ventricular ectopics, which represented < 1% of the total beat count, were noted.  The highest ventricular ectopic frequency occurred from 09:00 AM to 10:00 AM Tue.  During this time 1VE(s) occurred.  Ventricular ectopics were observed as 1 isolated beat(s) only.  No couplets or runs were noted.
319 supraventricular ectopics, which represented 1% of the total beat count, were noted. The highest supraventricular extopic frequency occurred form 09:00 PM to 10:00 PM Mon.  During this time 49 SVE(s) occurred.
No episodes of ST depression (defined as -1.0 mm or more) were noted in channel 1.  No episodes of ST depression ((defined as -1.0 m or more) were noted in channel 2.  No episodes of ST depression ((defined as -1.0 m or more) were noted in channel 3.

If he DOES need a pacemaker, I just want to make sure that it is needed and we have very good buy-in from him, his mom, and of course me.

[Mom2four85]

I would ask alot of questions write a list to take to the dr, which it sounds like you're doing.  

I've read quite a bit on hr during sleep for myself and for the most part; it's not recommended for pacemaker therapy with asymptomatic patients, so ask about this since it sounds like he's asymptomatic.  Maybe he really does have symptoms but doesn't pay attention to them? You can look on the American Heart Association for recommendations for pacemaker therapy or look up treatment for asymptomatic Bradycardia.

I would ask him to see if he has any day time sleepiness, headaches, trouble concentrating, snoring or dozing off to see if he has a mild case of sleep apnea.

I've had Bradycardia since I was 9 which has led to fainting spells and dr's told me wasn't anything until I was 42 and my EP did a tilt table test that showed my HR went down I was fainting and my heart stopped.

If he does need a PM, it's a relatively easy procedure and after the initial period of recovery, he won't even notice it's there.

[rilesnic]

I personally don't have experience with bradycardia...mine is the opposite, but a friend of mine had to get a pacemaker about a year ago. He suddenly began having symptoms of lethargy and faintness and when they did a tilt table test (which I'm not familiar with), they determined he needed the pacemaker. I remember him being on a high salt, high caffeine diet and he was still having trouble getting his HR into the 80's during exercise. They finally determined his problem was not really a heart problem, but an Autonomic Nervous System problem that seemed to have been attacked by a virus. The ANS was not getting the correct signals to his heart. He does very well with his pacemaker. Wishing the best for your son and family!

[bbxx]

My brother was 20 when he collapsed one day. His HR was 30. The ambulance took him to the hospital and a pacemaker was put in. They said he could have died or had a stroke. We dont know what his resting hr was.
HIs normal HR was 50s and doctors always said he was in great shape, and  young etc...
He was active etc... BUT, for us looking back, after the fact,  he was always complaining about being tired, but he kept on going, so no one thought anything of it. Prior to his collapse he had some episodes of his chest hurting. He is now 30 and in EXCELLENT shape. He is very active and doing great.

[is_something_wrong]

I know this may sound surprising (and keep in mind, my opinion means NOTHING since I'm just a patient and not a physician) but even though this Holter report qualifies for Guinness Book of Records concerning heart rate, you can't completely rule out that your son is just blessed with a super-strong heart.

There are no arrhythmias noted (a few atrial premature beats, at this heart rate I would expect thousands of them and just one PVC, at this rate I would expect thousands of those too, and the one seen may also be a misregistered PAC). The pauses noted is just a consequence of a low heart rate. At rate 30, pause is 2 sec. You may translate it with 6232 beats at rate below 30. If we average them at say 28, his heart rate was below 30 for 3 hours 40 min.

Do your son have symptoms? How is the blood pressure? Does his heart rate rise appropriately with exercise.

This warrants a visit to a cardiologist, you need to do an ultrasound of the heart (to find out what monster machine this obviously is, but to check for any structural changes) and a stress test to see how heart rate changes with exercise. A resting EKG should also be evaluated by a cardiologist.

But I wouldn't begin to look for the best pacemaker yet. He has no symptoms, and no arrhythmias. Maybe his heart is just amazingly strong.

[dadof3and3]

Once again, thanks to ALL for this great discussion.
Here is some more information, my son had a stress test on Monday and here are some of the result for those of you that can read into the results...

Protocol: Bruce

Time Phase MPH Grade HR BP RPP METS
0:00 Exercise 0.0 0.0 63 100/60 63 1.0
1:00 Exercise 1.7 10.0 70 2.0
2:00 Exercise 1.7 10.0 66 4.1
3:00 Exercise 1.7 10.0 62 4.6
4:00 Exercise 2.5 11.9 90 102/68 91 5.7
5:00 Exercise 2.5 11.9 83 7.0
6:00 Exercise 2.5 11.9 82 110/68 90 7.0
7:00 Exercise 3.4 13.9 108 8.3
8:00 Exercise 3.4 13.9 115 110/70 126 9.8
9:00 Exercise 3.4 13.9 113 10.1
10:00 Exercise 4.2 16.0 136 120/78 163 11.4
11:00 Exercise 4.2 16.0 141 124/80 174 13.1
12:00 Exercise 4.2 16.0 143 13.4
13:00 Exercise 5.0 17.9 153 14.9
13:24 Max Exer. 5.0 17.9 156 15.8
1:00 Recovery 0.0 3.6 112 8.0
2:00 Recovery 0.0 3.6 90 156/88 140 2.0

I like what 'is_somthing_wrong' is saying, maybe he just has a super strong heart, on the other hand I really don't want to rule out something concerning. I'm hoping on Monday the electrophysiologist will want to perform more test or even repeat a few of them.  WE all are warming up to the idea of having a pacemaker installed. I'll keep you all posted.  Thank you all again for your time and comments.

[is_something_wrong]

The stress test results look great in my opinion. A little slow max HR, did he push himself completely to maximum? About 200 would be expected, but the heart rate sure does increase as it should. 16 MET is great. His BP is amazing. His post exercise heart rate drop indicate athlete level condition.

He has no symptoms with slow heart rate and no arrhythmias. It's good that you are seeing an EP doctor on Monday but as I said, you can't rule out that this may be a result of an extremely good working strong heart. Best wishes to you all and PLEASE keep us updated on the results.

[itdood]

The stress test is normal.  I thought Brady without symptoms is not treated.  What prompted all this study in the first place?

If anything I'd say it's a CNS issue, too much sympathetic tone.  But heck , ....if it aint broke don't fix it.

[dadof3and3]

itdood, brother!  (I'm an IT person myself)
Well, here is more information....
My son played basketball in high school and was very good (of course I would say that, he’s my son  ) He was a starter and one of the more active ones on the team, he also worked out, outside of normal basketball practice, he just enjoyed being fit.  Upon HS graduation, he weighed 175 @ 6’2”.  The summer before his first semester in college he attended a summer school program (scholarship) in chemistry, the first 8 hrs of college chemistry in 8 weeks.  He has always been in ‘kicks’ in that he wants (as he would say) optimum health.  He would only eat very healthy foods, no fast food (I know, for a 20 yr old that isn’t the norm) and has always been in good shape.  At the end of his first hear in college he had lost 20 lbs, he went from 175 to 155.   This concerned us, yet he had no concerns as he felt fine.  (he found his blood type is O+ and read about eating for your blood type).  His diet had changed and we became concerned so we told him that we would take him to a nutritionist. Well, last Friday (6/3) our family doctor suggested getting a blood test done, he was concerned about the results so he called us on Saturday.  He was anemic and was dry, he immediately started drinking more water and his eating changed over the last week.  Our doctor also suggested that we get an EKG done on Monday which after reading the results prompted the course of action as mentioned in my first posts, a visit to a cardiologist.  He wore a Holter device from Monday @ 3pm to Tuesday @ 3pm and we had out conference with the cardiologist … and we’re here today.  We’ll know more after our visit with the eletrophysiologist tomorrow morning, I’ll keep you posted.
Thank you all for your post and concern, you all have been great!

[dadof3and3]

Update ...
Well, we went to the eletrophysiologist on Monday and he did not see any reason for a pacemaker.  He mentioned that his bpm range is just skewed down a bit.  He reviewed all the data that we had, the EKG, the stress test as well as the Holter monitor and based on the signal that he saw, everything looked normal.  If my son were exhibiting symptoms such as light headedness, dizzy, or fainting then there would reason to consider a pacemaker, however since there are no symptoms, there is no reason to be alarmed.  He did tell us a story in the early days of when electrophysiology became a discipline, one student were presented with an EKG of a patient where the beats were up to 4 seconds apart, the med student suggested a pacemaker however there were no symptoms or indication on the EKG that anything was wrong.  It turned out that the EKG was from Kareem Abdul Jabbar, and we all know about him, he's just fine.  The eletrophysiologist does want to monitor him again with the Holter monitor and that will happen during his Christmas break then again during next summer.  I guess  is_something_wrong is correct, he is blessed with a strong heart.  Thank you all for your comments.
We have been blessed with this good news, now let’s all just enjoy life and do the best we can to stay healthy.  God Bless!

[is_something_wrong]

That's great news. I suspected that, but it was indeed correct to see an electrophysiologist.

Good luck to you all, I'm so happy everything was OK. Take care :)