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Bradycardia is characterized by a slower-than-normal heart rate. The heart of an adult, while at rest usually beat between 60 to 85 times a minute, whereas, in the case of individuals with bradycardia, the heart beats fewer than 60 times a minute.
Bradycardia can be a complex issue if the heart rate is very slow and the heart cannot pump sufficient oxygen-rich blood to the body. If this occurs, individuals may feel dizzy, weak or very tired, and at times short of breath. Sometimes bradycardia does not present with any symptoms or complications.
A slow heartbeat is not always a sign of concern. A heart rate of around 40 and 60 beats a minute is very commonly noticed during sleep and in some people, mainly healthy young adults and trained athletes. If bradycardia is severe, an artificial pacemaker may be required to help the heart maintain an appropriate rate.
Electrical signals travel via the heart's four chambers, starting from the right upper chamber and then going through the upper to lower chambers of the heart. These signals regulate it to beat in a normal and steady rhythm. However, at times, electric pulses do not always fire off, as they should. This gives rise to abnormal heartbeats or arrhythmias. Some conditions make the heartbeat too quickly or flutter. With bradycardia, it's just the reverse. The electrical impulses slow down the time between heartbeats.
Bradycardia Symptoms
Bradycardia can halt the brain and other organs from receiving enough oxygen, possibly causing these signs and symptoms:
- Chest pain
- Confusion or memory problems
- Dizziness or light-headedness
- Feeling lethargic during any physical activity
- Fatigue
- Fainting or syncope
- Dyspnoea
Bradycardia Causes
Bradycardia can be caused by the following factors:
- Damage to the tissues of the heart related to ageing
- Damage to heart tissues resulting from heart disease or heart attack
- Congenital heart defect
- Inflammation of heart tissue, Myocarditis
- A complication of heart surgery
- Hypothyroidism
- Imbalance of certain chemicals in the blood, such as calcium or potassium
- Repeated interruptions in breathing patterns during sleep are called obstructive sleep apnoea.
- Inflammatory diseases, like rheumatic fever or lupus
- Medications like sedatives, opioids, and drugs are used to treat high blood pressure, heart rhythm disorders, and some mental health disorders.
Bradycardia can also happen if the heart's electrical signals don't travel correctly from the upper chambers of the atria to the lower chambers of the ventricles. If this happens, the condition is called a heart block or atrioventricular (AV) block.
Heart blocks are categorized into three main groups, namely.
- First-degree heart block. It is the mildest form of heart block. All electrical signals flow from the atria to the ventricles, but the signal is slowed. This rarely causes any symptoms and usually doesn't require treatment.
- Second-degree heart block. Not all electrical signals end up reaching the ventricles. Some beats get dropped, resulting in a slower and irregular heartbeat.
- Third-degree (complete) heart block. None of the electrical signals generated from the atria approaches the ventricles. When this occurs, the ventricles will usually beat on their own but at a very slow rate.
Bradycardia Diagnosis
To diagnose bradycardia, the doctor usually performs a physical examination and listens to the heartbeat with the help of a stethoscope. The doctor recommends certain tests to check the heart rate and examine if the person has a heart problem that can result in bradycardia. Blood tests may be carried out to look for various other conditions that can cause slower heartbeats, like an infection, electrolyte imbalance or an underactive thyroid (hypothyroidism).
An electrocardiogram (ECG or EKG) is the primary test conducted to diagnose bradycardia. An ECG measures the amount of electrical activity of the heart and can depict whether the heartbeat is too slow, too fast or not at all.
A simple EKG can highlight the rhythm that is responsible for causing the slow heart rate, but individuals are required to put on an ambulatory monitor, which keeps track of the heart rate as well as a rhythm for a longer period. The doctor will check up on the symptoms with the activity on the monitor to check whether a problem in the heart rhythm is the cause and if the heart rate is related to the symptoms.
Bradycardia Treatment
Treatment for bradycardia entirely depends on the cause of the slow heart rate and the severity of the symptoms. If the individuals don't have any symptoms, treatment might not be necessary.
If the cause responsible is hypothyroidism or low thyroid functioning, focusing on that may resolve the heart rate issue. If there is no clear physical cause, the doctor may alter the medications that might slow the heart rhythm.
When other treatments aren't yielding desired results, and bradycardia symptoms are severe, then a device called a pacemaker is vital to monitor as well as control the heart rhythm. Pacemakers work only when required. When the heart beats very slowly, the pacemaker sends electrical signals to the heart to speed up the beat.Risk Factors of Bradycardia
Bradycardia is often linked with damage to the heart tissue from certain types of heart disease. Factors that increase the risk of heart problems can surely increase the risk of bradycardia as well. Risk factors for heart disease include:
- Older age
- High blood pressure
- Smoking
- Heavy alcohol use
- Illegal drug use
- Stress and anxiety
Complications of Bradycardia
Possible complications of bradycardia can include:
- Constant fainting
- Loss of consciousness or syncope
- Heart failure
- Sudden cardiac arrest or sudden death
Prognosis
Prognosis is generally good when the rhythm is promptly identified and corrected by a healthcare provider.
Review
Reviewed by Dr. Anupam Goel, Director - Interventional Cardiology on 12-Dec-2022.
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