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DiscussionBradycardia how low is too low
Heart Rhythm Conditions | Last Active: Jun 20 4:27pm | Replies (48)Comment receiving replies
Replies to "@marybird Thank you for sharing that. I am happy to have a pacemaker if needed. I..."
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@isadora2021 There are additional steps that can be taken to determine the significance, and what can be done about your bradycardia, and tachycardia if that's a problem as well.
Might your GP refer you to a cardiologist, preferably a cardiac electrophysiologist (EP)? These docs are experts in the heart's electrical system, cardiac arrhythmias ( ack, they might even know how to spell that word right) and treatment of these conditions.
Your next steps might be getting another cardiac monitor, possibly one you wear for 2 weeks to 30 days, the longer you wear it the more likely it is to catch and record arrhythmias that may be infrequent. These monitors include instructions and a way to document any symptoms you may feel at the time you're feeling them.
A cardiologist ( especially an EP) can look at those monitor EKG readings and determine the type, time and duration of any abnormal arrhythmias that have occurred. They can even often tell the mechanism of some of those arrhythmias from looking at the EKGs, for instance, with bradycardia, those readings may show it's due to sinus bradycardia, pauses of varying lengths of time, heart block, or even an AV node junctional rhythm. Correlating these findings with symptoms recorded at the time of the bradycardia ( such as dizziness, shortness of breath, near-syncope or syncope) is presumptive evidence that the bradycardia is the cause of these symptoms. Symptomatic bradycardia is one of the justifications for a pacemaker.
An EP can also look at tachycardia episodes on those EKG readings and differentiate between
types, such as A-fib, A-flutter, sinus tachycardia, one of the AV node re-entry types atrial tachycardia, or ventricular tachycardia. Based on the type, frequency and duration of these, the doc determines whether a finding is benign, or needs treatment. They'll go from there to determine the best treatment for the arrhythmia, hopefully in consultation and input from the patient.
This of course, is predicated on the patients' arrhythmias showing up on that monitor report. They don't always rear their ugly heads while a patient is wearing a monitor, in that case, the findings will essentially be normal and the doc can't evaluate arrhythmias that aren't there. Doesn't mean you don't have those issues, and the docs know this, if you have ongoing issues the only thing you can do is to repeat the monitor testing again, although these days if you have a Smart Watch or Kardia mobile or other device that record EKGs you can get one when you're symptomatic and send it to your doctor for evaluation.
The other test that can be done to document another form of bradycardia- chronotropic incompetence ( inability of the heart rate to reach levels needed for activity by the patient) is to have a stress test. In a patient with chonotropic incompetence, the heart rate will fail to reach appropriate levels as the patients' exercise levels increase on a treadmill. Documented chronotropic incompetence is another indication for a pacemaker.
So I mentioned symptomatic bradycardia and chronotropic incompetence as conditions under which pacemakers may be recommended. Another indication is when the symptomatic bradycardia may be caused by a medication the patient is taking, for which there is no alternative medication or treatment for that condition. For example, many of the beta blockers cause lowering of the heart rate, sometimes significantly. But the patient needs that medication to control the arrhythmia and there are no other good options to do so. So a pacemaker can be implanted to control the bradycardia from this medication, and the patient can continue to take it with no fear that it will drive the heart rate down too much.
I hope this helps. Fingers crossed that you can get your issues investigated fully and end up with good answers, and the best treatment for those issues!