Is a pulse rate in the 30s an issue for an in-shape 59 year-old?

[davidh1234]

My resting pulse rate is often in the low-to-mid 30s (lowest I have seen it is 33 but more typically 35-42).  I am 59, in reasonably good shape and have been exercising (running) regularly.   My heart rate has always been relatively low (resting in the low-to-mid 40s).  I had been a regular runner for years but took a few years off and recently (Oct) starting running again and that is when I noticed it is even lower.  I am not dizzy, light headed, etc.  Only issue I have noticed (and, this is not really new) is that my hands and feet are often cold.  I had a physical in the first week of november (before I really noticed this) and the doctor didn't say anything about any issues.  If it matters, my blood pressure is generally pretty good (perhaps, 110/74 or so).   Also, when I go running, my heart rate typically is between 128 and 140.  I don't seem to be able to really push it much above 140.  When I was running regularly a few years ago, my heart rate when running was typically in the 145 to 160 range.   I realize the lower heart rate (and slower speed) comes with age.  But, thought I would mention it in case it matters to answering this question.

[2210485]

Well. In light of your baseline from a few years and resting heart rate at that time and your lack of bradycardic symptoms; there's good reason to feel positive.

Cole, numb or painful extremities with exercise however is discouraging. It doesn't sound like this issue gets worse during or post exercise for you however, so that's good.

Additionally it sounds like all extremities are effected. If it were one extremity and not another I would say that it's actually very serious.

There are a few discouraging things though. The coldness could indeed be an indicator of poor circulation, and given your low heart rate there would be a good explanation for it!

Without any of the neurologic type of Brady symptoms I would be suprised if the situation was critical as of right now, however this could be an early warning sign that you're headed that way.

The best course of action for you would be a cardiac work up. I would say you could benefit from 3 key tests (if you haven't had them in the past 2 years):

1. Holter Monitoring

- This will help figure out exactly how low your heart rate gets, Nd will allow the doctor to see any trends or abnormalities. It is an EKG monitor you take home and wear for 24 Hours.

It's necessary because very rarely is it possible to actually see an electrical problem on a 12 lead EKG. The one's that are most often seen are fixed type of abnormalities that tend to be mord serious. The majority of folks however have problems that are transient and come and go throughout the day or under specific conditions not present in the doctors office.

2. Stress Testing

- Typically this test is used for individuals with Chest Pain and problems exercising. However it can be used for another function, 'Chronotropic Competance'.

This test monitors your EKG while you walk on a treadmill for signs that your heart is not getting enough blood. When used for Chronotropic Competance however it can be used to track the rate at which your heart rate increases with exercise. This can help identify situations in which the rise in rate doesn't keep up with demand; a key indicator of the health if your hearts default electrical system.

Of course given your age, you are reaching the point where heart attacks are a higher risk for you. Checking the blood flow during exercise out will give the cardiologist a good idea about how healthy your hearts blood vessels are too, even though this may not be your main concern.

3. Echocardiogram

- This test is an ultrasound image of your heart. Its designed to look at structural defects and other indicators of low blood flow in the heart (wall motion abnormalities).

In your case it's biggest benefit for this test is going to be simply getting a resting 'Ejection Fraction'.

This will tell doctors more information about your 'Stroke Volume', basically how much blood your heart is pushing out to the body every beat.

If the Stroke Volume multiplied by your lowest Heart Rate (recorded by the Holter) is not sufficient to sustain your body,adequately given your Age, Size and Weight the doctors may want to develop a treatment plan, or start seeing you annually/biannually for checkups.

Feel free to schedule an appointment with your primary doctor. You can jot down some of this information and simply express your concerns.

Request a referral to cardiology directly and explain your rationale. Even if you were 100% healthy/didn't have any concerns, most doctors would still want you to get your heart looked at, if only just once in your lifetime.

If we had unlimited funding and staff honestly everyone would get a cardiac workup: At 3 months of age, 13 years of age, 50 years, 65 years and 80 years. It would be like a colonoscopy or a Mammogram..

[2210485]

Probably throw age 25 in there too..

Rationalr for picking these arbitrary ages:

3 months old is early congienital structural defects.
13 is when we see the first genetic biochemical and electrical things.
25 is the time of abnormal electrical circuits
50 is coronary artery disease
65 for Bradycardic conduction disease/ fibrosis
80 is all about valves

Your issue with heart rate would fall under the age 65+ bradycardic conduction disease category. Its an age you are indeed approaching, so testing for it is certainly appropriate.

[davidh1234]

I should have added - I am not taking any medications and  my medical history is generally very good.  My cholesterol, etc. is low.  Overall good health.