I have Bradacardia - when do I need a pacemaker?

Although my heart rate is low and drops to low 30’s
I haven’t had feelings of near passing out. Just tired feeling and some lightheaded feelings

I am working on deeper breathing through my nose (minimal mouth breathing)
And keeping active .my blood pressure is fine - Dr says I have a strong heart

May 25, 2025. I'm am new to this forum. I have not been diagnosed by a Cardiologist to have Bradycardia. I have been having a slow resting rate in the low 50s 's for several months. I'm not active do to other issues So l don't think my resting heart rate shouldn't be that low. As l'm writing this l just checked and my watch showed 52 bpm. I have been lightheaded but never falling down or passing out. I'm going to try to see a cardiologist as soon as I can. I was just wondering if someone could give some advice. Should I seek medical attention now at the ER.
Can it wait until l can see a cardiologist. At what point is the heart rate considered dangerously too low. Anyway advice would be welcomed.

I am 74 and have had resting heart rate in 40’s. Since I don’t have any negative symptoms
Dr says monitor if I have dizziness or other problems
Here is my BP and HR while watching Indy 500
BP 125 70. HR 43
See cardiologist and Dr should attach heart monitor for 14 days to check 24/7 heart activity
To determine problem and plan going forward
Dr said my HR wasn’t a problem at this time
I have a blood pressure HR device which I use to monitor my numbers. Activity is updated on my phone so I have a record of all my numbers. If they change from avg I will fwd to Dr
Take care.

Not a medical professional and can't answer your medical questions or medical advice just give you my experience.

A heart rate of 50s is not uncommon. I slow resting rate usually shows good cardiovascular system. The norm for resting heart rate is 70 bpm. However that is just a statistic and if your number is below or above in does not mean you have a problem.

My resting heart rate was in low 60s most of my life. When I was put on Entresto and Carvididol my resting heart rate went down into 30s. Now the problem with 30s for me was standing up to quick and getting dizzy. It also increased my PVCs.

From your post I would recommend you see a cardiologist and let do some test if he/she feels appropriate. Do you have a primary care doctor? Have you brought this to thier attention. They would be better able to guide you based on knowing our medical history and if feels should do a referral to cardiologist. With your present anxiety/stress over this I would suggest seeing one or the other as stress/anxiety is not good for you both mentally and physically.

If you are in doubt on and day/night you can always call your ER and speak to them about what you are feeling. I have many friends who have PR in the 50s but you mentioned lighheaded and make sure whomever you call you mentioned that.

When you said lightheaded that is something that needs an explanation of why? Does it come with sitting, standing, laying down, or when you stand up. Those are questions a ER and your cardiologist will ask. Also are you on any medications for BP or other medicines that can lower your HR? Can you see why a medical professional should give you medical advice as they are going to need your medical history and any medications and supplements you are on.

Thanks for the replies. It nice to just talk to someone about it hear others experiences. As far as medication l do take, Toprol 25 mg. which is beta blocker. But l used to take 50 mg. and never had a problem. I'm on it for heart palpations and mild hypertension. I also take Clonazepam 1 mg. for my anxiety. But up until around February of this year it never made me feel like this. I'm can't say this caused my issues but l had COVID in January 2025. Since that time l have felt fatigued, no energy, can't do a lot without getting tired. My GP put me in the hospital in February 2025. I had a lot of tests. A CT scan showed l had a borderline dilated ascending aorta 4.5 cm. So now l'm dealing with that as well. I had a Coronary CT Angiogram done this past Friday, 23rd. But waiting on the results. I am concerned about the lightheadedness. When l check my oxygen levels they are usually above 95%. Hopefully l can hold out untill Tuesday when l can speak to someone. I know reading about these things on the Internet sites will scare you to death. So is the lightheadedness something for me to be concerned about. I'm a person of faith and no many how much worrying you do it won't change anything. God a is in control l just need to have stronger faith. Thanks again for responding to me. But please let me know what you think about the lightheadedness. Thank you

Hi , good to hear back from you, re lightheaded feeling, I haven’t had too
much of that even with my low heart rate . Usually if I am sedentary
reading and get up quick I can feel a bit dizzy.
However I read a book a last month
‘Breath’ by James Nestor
His book explains that humans have lost the ability to breathe correctly.
A majority of people breathe through their mouth
And by changing our method of inhaling and exhaling by breathing through
the nose a person can make major changes in their life and health .
I now breathe deeper and exhale more slowly which allows more oxygen and
paradoxically more co2 in my blood stream.
It’s been very good for both body and mind.
I think this is helping me to feelstronger and alert.

I listen to podcasts primarily “People I Mostly Admire” which the host

@concern
Your body changes over time. My doctors say an allergy can start at any time or go away. You reaction to medications can change over time.

You mentioned you are on several medications. Look at their side affects and see if lighheadnesses is one of them. Then asked our medical doctors the same thing "Could any of my medications cause my light headiness."

If I read right you are under a lot of stress and anxiety. Have you talked to our doctors about that. Your oxygen meter at above 95 % is good but do you check it when you are light headed? When does our lightheadiness happen?

One of the worst things you can do when you are under high stress and anxiety is to go on Dr. Google. Dr. Google does not have your medical history nor your medications and supplements nor your level of anxiety and stress.

Speak to your medical professionals. If they are not patient oriented then suggest finding another who is.

I keep this on my husband’s BP chart as a reminder:
- High blood pressure: above 140 / above 90. If 180 or / 120, go to ER.
- Low Blood Pressure: below 90 / below 60.. If fainting/dizzy,, go to ER.
- Abnormal Pulse: below 60 (bradycardia) or above 100 (tachycardia), 120-140 dangerous.

Passing out, or nearly passing out ( syncope or near-syncope) at a time when the heart rate is shown to be low would be an example of correlating a symptom with the low heart rate, and would move a person into the Class I (a) category according to the guidelines for receiving a pacemaker.

You'd have to have a cardiac monitor attached to you to make this correlation, though.

I had an episode of nearly passing out. That is when I learned that my heart rate was in the 30's. I then did have a cardiac monitor for a month. When things did not improve and I passed out for several minutes (fortunately, my son caught me), I was given a pacemaker. The EP said that it would happen again, probably for longer and I may have to be resuscitated and no one around to catch me. That easily convinced me to want the pacemaker. So, I agree with marybird that having a syncope episode with the low heart rate would meet the guidelines for a pacemaker.