Heart and Vascular Care
Bradycardia
You’re in good hands with our expert heart team. We will assess your bradycardia and figure out next steps together.
Medically reviewed by Sandhya Venugopal, M.D. on May 25, 2023.
Understanding Bradycardia
Bradycardia is a slow heart rate, meaning your resting heart rate is lower than 60 beats per minute (BPM). The hearts of adults at rest usually beat between 60 and 100 times a minute.
Sometimes bradycardia is normal and doesn’t cause symptoms or complications. For instance, when you sleep or if you are an athlete, your resting heart rate may fall below 60 BPM.
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Symptoms of Bradycardia
When your heart rate is too slow, your heart may not pump enough oxygen-rich blood to the body.
Common Symptoms
Some common symptoms of bradycardia that you may experience include:
- Fatigue or weakness
- Dizziness or lightheadedness
- Mental confusion
- Fainting (syncope) or near-fainting
- Shortness of breath
- Fatigue during exercise or with physical exertion
- Chest pain
Emergency Symptoms
You should call 911 immediately if you experience symptoms of a heart attack, such as:
- Discomfort in your upper body (arms, back, stomach, neck or jaw)
- Chest pain or pressure
- Collapse and sudden cardiac arrest
- Nausea or vomiting
Causes of Bradycardia
You may have bradycardia due to several reasons. These include:
Arrhythmia
Your heart’s normal electrical pathways between the upper and lower chambers can get interrupted. This disruption causes heart rhythm problems, or arrhythmias.
Cardiomyopathy
Cardiomyopathy, or heart muscle disease, can make your heart muscle enlarged and stiff. Your heart may have a harder time pumping and thus go slower.
Electrolyte Imbalances
Abnormal potassium or calcium levels in your blood weaken the signals from your heart’s natural pacemaker (sinus node).
Hypothyroidism
Low thyroid hormone can slow down your heartbeat.
Inflammation
Inflammatory diseases, like rheumatic fever, can cause your heart tissue to become inflamed and stiff (myocarditis). A rigid heart may beat slower than normal.
Medications
Some heart medications can slow your heart rate, including beta blockers and calcium channel blockers.
Previous Heart Damage
Sometimes bradycardia stems from prior damage or injury to your heart. This may be due to heart anomalies from birth or complications from heart surgery.
Sick Sinus Syndrome
Sick sinus syndrome is a collection of problems with your heart’s natural pacemaker, the sinus node. If the sinus node tells your heart to slow down too much, you can get bradycardia.
Sleep Apnea
Sleep apnea is when your breathing stops and starts throughout the night. Your heart may slow down due to a lack of oxygen.
Bradycardia Diagnosis and Testing
Your physician will ask about your symptoms and history. They will also do a thorough physical examination, including taking your pulse and listening to your heart.
Bradycardia is usually confirmed by an electrocardiogram (EKG or ECG), which records your heart’s electrical activity.
Your physician may do an ECG in the office as well as have you wear a portable ECG, such as a Holter monitor, to record your heart rate for 24 hours.
Your physician may decide that you need additional tests like an exercise stress test which monitors your heart rate while you exercise.
Treatment of Bradycardia
Not all cases of bradycardia need treatment. Your treatment will depend on what is causing your bradycardia.
Medications
Your physician may prescribe medications to treat the underlying cause of your bradycardia. For example, if you have low thyroid hormones, you may need a medication supplement.
If your resting heart rate is so low that you’re about to go into cardiac arrest, you’ll likely need urgent treatment. Your physician may give you a medication, such as atropine, to increase the rate.
Pacemaker
If your physician feels that you will benefit from an implanted pacemaker, you will discuss that option together.
A pacemaker is a small device that helps keep your heart beating at a normal rate and rhythm. The device uses sensors that are threaded and implanted in your heart through a catheter.
The most common reasons why you might need an implanted pacemaker are either a problem with your heart’s natural pacemaker (SA node) or a block in your heart’s electrical system that controls your heartbeat, known as a heart block. There may be other reasons that your physician would discuss with you.
Treatments
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