Bradycardia how low is too low

Well, as you've all showed, there's bradycardia and there's bradycardia, brought on by a myriad of causes. Some bradycardia is physiologic and may represent normal cardiac function in some individuals, other bradycardia may be pathologic and cause physiological havoc and lousy quality of life in the poor schmucks inflicted with this ( ask me how I know this). To sort all this out, guidelines to differentiate among the causes of bradycardia( and tachycardia in applicable cases) and determination of appropriate treatment methods have been put forth to aid diagnosticians in their best treatment of patients with these conditions. I don't think anyone would be happy just to throw pacemakers/CRT/defibrillators at everyone who visits a cardiologist with a complaint of bradycardia!

The table shown in this link ( Merck Manual) summarizes the 2019/2021 American College of Cardiology, American Heart Association, and the Heart Rhythm Society Guidelines for pacemaker placement.
https://www.msdmanuals.com/professional/multimedia/table/indications-for-permanent-pacemakers
And here's a second article that basically covers take home points in those guidelines:
https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/08/31/18/37/2021-esc-guidelines-on-cardiac-pacing-esc-2021

Am 62 and get chest pain discomfort at 80 bpm try telling anyone around this place and get brushed off.

@marybird Very interesting. I was very fit in my past and an average resting heart rate of around 43 was normal.

It’s been many years since I’ve been that fit. My average resting heart rate moved to around 55 - 60.

Suddenly last year my average resting heart rate at times dropped as low as 35 and averaged 44. I’m walking daily with my young dogs for a hour and a half but certainly no elite athlete any more!!

I’ve had numerous tests including an MRI and a 48 hour Holter monitor. No apparent reason for the very low results 🤷‍♀️

The cardiologist says not to worry but just keep an eye on my smart watch monitoring and how I feel. So that’s what I’m doing. No pace maker for me!

@isadora2021 Wow, a resting HR average between 35 and 44 seems pretty darn low to me, though maybe with your athletic history with a HR average of 43, this is still ok for you. Though I agree with your cardiologist it's something to watch, and if you develop symptoms with that bradycardia it might be time to do something about that bradycardia.

I was told the same thing by my cardiologist when my bradycardia set in- to keep an eye on it, but it was generally ok if: 1) the low heart rates were asymptomatic, and 2) the heart rate rose appropriately with activity. This happened with me for a while, but as the heart rate went lower and stayed there for longer times, I became symptomatic, nearly passed out several times. Then it got to where no matter what I did, moderate to vigorous activity, my heart rate would not go past the low 50's- unless, of course, it went into tachycardia, and it seemed as though it was one or the other, no happy mediums. I didn't want a pacemaker either, but I consented to it and it wasn't till I had it for a while and realized I felt much better, that I had to admit I needed one.
Maybe you'll get lucky and will never progress to the point where you need that pacemaker, but if you do, it won't be the worst thing in the world!