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Bradycardia

Bradycardia is a slower than normal heart rate. The heart usually beats between 60 and 100 times a minute in an adult at rest. If you have bradycardia, your heart beats fewer than 60 times a minute.

Bradycardia can be a serious problem if the heart doesn't pump enough oxygen-rich blood to the body. For some people, however, bradycardia doesn't cause symptoms or complications.

An implanted pacemaker and other treatments may correct bradycardia and help your heart maintain an appropriate rate.

Symptoms Causes Complications Risk factors Prevention

If you have bradycardia, your brain and other organs may not get the supply of oxygen they need. As a result, you may experience these bradycardia symptoms: 

  • Near-fainting or fainting (syncope)
  • Dizziness
  • Weakness
  • Fatigue
  • Shortness of breath
  • Chest pains
  • Confusion or memory problems
  • Easily tiring during physical activity

When a slow heart rate is normal

A resting heart rate slower than 60 beats a minute may be normal for some people, particularly for healthy young adults and trained athletes. For these people, bradycardia isn't considered a health problem.

When to see a doctor

A number of conditions can cause signs and symptoms of bradycardia. It's important to get a prompt, accurate diagnosis and appropriate care. See your doctor if you or your child experiences any symptoms of bradycardia.

If you faint, have difficulty breathing or have chest pain lasting more than a few minutes, get emergency care or call your local emergency number. Seek emergency care for anyone experiencing these symptoms.

Bradycardia is caused by something that disrupts the normal electrical impulses controlling the rate of your heart's pumping action. Many things can cause or contribute to problems with your heart's electrical system, including:

  • Heart tissue damage related to aging
  • Damage to heart tissues from heart disease or heart attack
  • High blood pressure (hypertension)
  • Heart disorder present at birth (congenital heart defect)
  • Infection of heart tissue (myocarditis)
  • A complication of heart surgery
  • Underactive thyroid gland (hypothyroidism)
  • Imbalance of mineral-related substances necessary for conducting electrical impulses (electrolytes)
  • Repeated disruption of breathing during sleep (obstructive sleep apnea)
  • Inflammatory disease, such as rheumatic fever or lupus
  • The buildup of iron in organs (hemochromatosis)
  • Medications, including some drugs for other heart rhythm disorders, high blood pressure and psychosis

Electrical circuitry of the heart

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by a natural pacemaker (the sinus node) located in the right atrium. The sinus node produces electrical impulses that initiate each heartbeat.
From the sinus node, electrical impulses travel across the atria, causing the atria to contract and pump blood into the ventricles.

The electrical impulses then arrive at a cluster of cells called the atrioventricular (AV) node.The AV node transmits the signal to a specialized collection of cells called the bundle of His. These cells transmit the signal down a left branch serving the left ventricle and a right branch serving the right ventricle.

When the electrical impulse travels down these branches, the ventricles contract and pump blood — the right ventricle sending oxygen-poor blood to the lungs and the left ventricle sending oxygen-rich blood to the body.

Bradycardia occurs when electrical signals slow down or are blocked.

Sinus node problems

Bradycardia often starts in the sinus node. A slow heart rate may occur because the sinus node:

  • Discharges electrical impulses at a slower than normal rate
  • Pauses or fails to discharge at a regular rate
  • Discharges an electrical impulse that's blocked before causing the atria to contract

In some people, the sinus node problems may result in alternating slow and fast heart rates (bradycardia-tachycardia syndrome).

Heart block (atrioventricular block)

Bradycardia may also occur because electrical signals transmitted through the atria aren't transmitted to the ventricles (heart block, or atrioventricular block).

The disruption of the electrical signal may occur in the AV node, the bundle of His, or somewhere along the left and right branches that transmit electrical signals to the ventricles. Heart blocks are classified based on the degree to which signals from the atria reach your heart's main pumping chambers (ventricles).

  • First-degree heart block. In the mildest form of heart block, all electrical signals from the atria reach the ventricles, but the signal is slowed down slightly. First-degree heart block rarely causes symptoms and usually needs no treatment if there's no other abnormality in electrical signal conduction.
  • Second-degree heart block. In second-degree heart block, not all electrical signals reach the ventricles. Some beats are "dropped," resulting in a slower and sometimes irregular rhythm.
  • Third-degree (complete) heart block. In third-degree heart block, none of the electrical impulses from the atria reaches the ventricles. When this happens, the bundle of His or other tissues of the ventricles function as a substitute pacemaker for the ventricles.
    These substitutes result in slow and sometimes unreliable electrical impulses to control the beat of the ventricles.
  • Bundle branch block. The interruption of an electrical signal somewhere in the right or left bundle branches, near the end of the pathway for electrical impulses, is called a bundle branch block.
    The seriousness of bundle branch block depends on whether both branches are affected, the presence of other types of heart block and the degree of damage to heart tissue.

Complications of untreated bradycardia vary depending on how slow the heart rate is, where the electrical conduction problem occurs and what kind of damage may be present in heart tissue.

If bradycardia is significant enough to cause symptoms, possible complications of the slow heart rate may include:

  • Frequent fainting spells
  • Inability of the heart to pump enough blood (heart failure)
  • Sudden cardiac arrest or sudden death

Age

A key risk factor for bradycardia is age. Heart problems, which are often associated with bradycardia, are more common in older adults.

Risk factors related to heart disease

Bradycardia is often associated with damage to heart tissue from some type of heart disease.

Therefore, factors that increase your risk of heart disease may also increase the risk of bradycardia. Lifestyle changes or medical treatment may decrease the risk of heart disease associated with the following factors:

  • High blood pressure
  • Smoking
  • Heavy alcohol use
  • Use of recreational drugs
  • Psychological stress or anxiety

The most effective way to prevent bradycardia is to reduce your risk of developing heart disease. If you already have heart disease, monitor it and follow your treatment plan to lower your risk of bradycardia.

Prevent heart disease

Treat or eliminate risk factors that may lead to heart disease. Take the following steps:

  • Exercise and eat a healthy diet. Live a heart-healthy lifestyle by exercising regularly and eating a healthy, low-fat diet that's rich in fruits, vegetables and whole grains.

  • Maintain a healthy weight. Being overweight increases your risk of developing heart disease.

  • Keep blood pressure and cholesterol under control. Make lifestyle changes and take medications as prescribed to correct high blood pressure (hypertension) or high cholesterol.

  • Don't smoke. If you smoke and can't quit on your own, talk to your doctor about strategies or programs to help you break a smoking habit.

  • If you drink, do so in moderation. If you drink alcohol, drink in moderation. For some conditions, it's recommended that you completely avoid alcohol. Ask your doctor for advice specific to your condition. If you can't control your alcohol use, talk to your doctor about a program to quit drinking and manage other behaviors related to alcohol abuse.

  • Don't use recreational drugs. Talk to your doctor about an appropriate program for you if you need help ending recreational drug use.

  • Control stress. Avoid unnecessary stress and learn coping techniques to handle normal stress in a healthy way.

  • Go to scheduled checkups. Have regular physical exams and report any signs or symptoms to your doctor.

Monitor and treat existing heart disease

If you already have heart disease, there are steps you can take to lower your risk of developing bradycardia or another heart rhythm disorder:

  • Follow the plan. Be sure you understand your treatment plan, and take all medications as prescribed.
  • Report changes immediately. If your symptoms change or get worse or you develop new symptoms, tell your doctor immediately.
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