When I See A Patient With A Low Heart Rate I Ask Myself The Following
Is the low heart rate a physiologic finding or a pathologic finding? An example of a physiologic low heart rate would be an athlete with a low resting heart rate from being trained, which is absolutely fine. An example of a pathologic heart rate would be a disorder of the internal pacemaker system of the heart such as heart block that would often need a pacemaker inserted as treatment.
Is the low heart rate the likely cause of symptoms? Symptoms of a low heart rate may include dizziness and fatigue. In order to be attributed to a low heart rate the symptoms should occur at the same time the heart rate is low.
Are there any reversible causes for the low heart rate? Medicines such as beta-blockers or disorders such as hypothyroidism may lead to low heart rate and if the heart rate is dangerously low and causing symptoms as a result of this, stopping the medication or treating the underlying conditions will likely reverse the symptoms.
Vital Signs Abnormalities In Newborn Babies
When a baby has any problem , such a baby would be placed in a NICU or observation nursery. Once this occurs, we will closely follow various parameters for each baby. Some of those parameters are called vital signs. Body temperature, respiratory rate, heart rate, and blood pressure are all part of vital signs.
To help us follow and observe babies continuously, most newborns with health issues will be placed on cardiorespiratory monitors.
Cardiorespiratory monitors provide information on the babys respiratory rate, heart rate, blood pressure, and oxygenation levels . Most monitors record all those parameters for at least 24 hrs allowing us to look back and analyze any events that occurred in the past. Specific abnormalities found while observing a baby or due to alarms going off on the monitors may be cause for concern, especially when correlated with the babys clinical condition.
To learn which findings may concern clinicians, lets talk about some definitions used to describe vital signs abnormalities. Even though the topic of my article is heart rate dips in newborn babies, please familiarize yourself with all the terms described below because many times, different vital signs abnormalities are associated with each other and that association may help us with the diagnostic process.
A babys average body temperature should be around the same as in an adult: 36.6 degrees of Celsius.
Normal Resting Heart Rate For Kids
Childrens heart rates are normally faster than those of adults. According to Cleveland Clinic, the normal resting heart rate for a child aged six to 15 is between 70 to 100 beats per minute.
Many factors can affect your resting heart rate, including your level of physical activity. In fact, highly trained athletes can have a resting heart rate of around 40 beats per minute!
Other factors that can affect resting heart rate include:
- Age. You may find that your resting heart rate decreases as you get older.
- Temperature. Your heart rate may increase slightly when youre exposed to hot temperatures.
- Medication side effects. For example, medications such as beta-blockers can lower your resting heart rate.
- Emotions. If youre anxious or excited, your heart rate may increase.
- Weight. People who are obese may have a higher resting heart rate. This is because the heart has to work harder to supply the body with blood.
- Body positioning. Heart rate can increase temporarily when you move from a sitting to a standing position
- Smoking. Smokers tend to have a higher resting heart rate. Quitting smoking can help bring it back down.
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Things You Can Do To Help With Supraventricular Tachycardia
If your episodes of SVT only last a few minutes and do not bother you, you may not need treatment.
You can make changes to your lifestyle to reduce your chances of having episodes, such as:
- cutting down on the amount of caffeine or alcohol you drink
- stopping or cutting back on smoking
- making sure you get enough rest
Your doctor may also be able to recommend some simple techniques to help stop episodes when they happen.
Causes Of A Slow Heart Rate
Its normal for your heart rate to change throughout the day. It speeds up when you exercise, slows down as you recover from exercising, and is usually at its lowest while you sleep.
Sometimes people have a slower heart rate than normal. This is called bradycardia, and it isnt necessarily a problem. Its diagnosed when your heart beats less than 60 beats per minute.
There are several causes of a slow heart rate. The most common are being young or physically fit. The heart is a muscle, and just like the other muscles in your body, it responds positively to exercise. When youre in good shape, your heart doesnt need to beat as often to supply your body with enough oxygen.
But a slow heart rate can also be a sign of a medical problem, such as a heart condition. If your resting heart rate is slow and you have other symptoms of bradycardia such as lightheadedness, call your doctor or go to the ER.
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What’s A Normal Heart Rate
Heart rate is measured by counting the number of beats per minute. Someone’s normal heart rate depends on things like the person’s age and whether he or she leads an active lifestyle.
The resting heart rate decreases as people get older. Typical normal resting heart rate ranges are:
- babies : 100150 beats per minute
- kids 13 years old: 70110 beats per minute
- kids by age 12: 5585 beats per minute
A doctor can determine whether a heart rate is too fast or slow, since the significance of an abnormal heart rate depends on the situation. For example, a teen or adult with a slow heart rate might begin to show symptoms when the heart rate drops below 50 beats per minute. But trained athletes have a lower resting heart rate, so a slow heart rate in them isn’t considered abnormal if it causes no symptoms.
What To Expect At Your Office Visit
Your provider will examine you and ask questions about your medical history and symptoms.
You may be asked:
- Do you feel skipped or stopped beats?
- Does your heart rate feel slow or fast when you have the palpitations?
- Do you feel a racing, pounding, or fluttering?
- Is there a regular or irregular pattern to the unusual heartbeat sensations?
- Did the palpitations begin or end suddenly?
- When do the palpitations occur? In response to reminders of a traumatic event? When you are lying down and resting? When you change your body position? When you feel emotional?
- Do you have any other symptoms?
An electrocardiogram may be done.
If you go to an emergency room, you will be connected to a heart monitor. However, most people with palpitations do not need to go to an emergency room for treatment.
If your provider finds you have an abnormal heart rhythm, other tests may be done. This may include:
- Holter monitor for 24 hours, or another heart monitor for 2 weeks or longer
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What Your Heartbeat Says About Your Heart
Palpitations are basically a heightened awareness of your own heartbeat, explains Swadia. Your heart might beat faster, slower or differently than usual for a few reasons.
- Rapid, fast heartbeat at rest could be caused by stress, caffeine, alcohol, tobacco, thyroid pills, cold medication, asthma drugs or diet pills.
- Sometimes low blood pressure , heart disease and some heart rhythm conditions can cause rapid heartbeat, too.
- A slow, forceful heartbeat might be a sign of heart rhythm problems such as bradycardia, in which your heart beats less than 60 times a minute.
- An irregular or fluttering heartbeat could be caused by atrial fibrillation , the most common type of irregular or abnormal heartbeat. Another heart problem, called premature ventricular contractions, can create this irregular beat.
It might be difficult for patients to describe how exactly their heart is feeling. And likewise, doctors sometimes have a hard time understanding what the patient is feeling.
Causes Of Supraventricular Tachycardia
An episode of supraventricular tachycardia occurs when abnormal electrical impulses suddenly start in the upper chambers of the heart, and override the hearts natural rhythm.
SVT is sometimes called paroxysmal supraventricular tachycardia . Paroxysm means a sudden temporary disturbance of heart rhythm.
PSVT is usually caused by a short circuit in the electrical system of the heart, which causes an electrical signal to travel rapidly and continuously around in a circle, forcing the heart to beat each time it completes the circuit.
Another type of SVT is called Wolff-Parkinson-White syndrome, where an abnormal electrical connection occurs between the atria and ventricles . People with Wolff-Parkinson-White syndrome are born with a strand of extra muscle tissue between these chambers. This produces a short circuit, which causes the fast heartbeat.
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How To Measure Your Heart Rate
You can take your own heart rate easily by putting a finger over your pulse at the wrist, inside of your elbow, side of your neck or top of your foot. Simply count the number of beats in 60 seconds .
To get the most accurate measure of your resting heart rate, follow these tips from Harvard Health Publishing:
- Wait at least two hours after exercise or a stressful event
- Wait at least an hour after having caffeine
- Dont measure when youve been sitting or standing for a long period of time
You can also monitor your heart rate throughout the day by wearing a fitness tracker, which may help you identify a fluctuating heart rate. But keep in mind that accuracy can vary in these products.
If youre concerned that you might have an arrhythmia, the best way to know for sure is by visiting a cardiologist, who can use more sophisticated heart monitors and tools like an electrocardiogram to track of your hearts activity.
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What Are The Treatment Options
Vagal Maneuvers
Your heartbeat is regulated by the vagal nerve. Maneuvers, which affect vagal nerve are heaving , coughing and putting an ice pack on your face.
Medicine
You can take antiarrhythmic drugs either orally or get them injected. They make the heartbeat normal. The drugs are given in a hospital. The drugs that are available control heart rate restore normal rhythm of heart or do both. Sometimes, you may need more than one drug to control your tachycardia.
Cardioversion
An electric shock is given to heart using patches or paddles. The electrical impulses of the heart are affected by this and this helps in restoring normal rhythm. This is done in hospital.
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How Is It Diagnosed
To diagnose bradycardia, your doctor may take your pulse, do a physical examination, ask questions about your health, and do an electrocardiogram . An EKG measures the electrical signals that control heart rhythm.
Bradycardia often comes and goes, so a standard EKG done in the doctor’s office may not find it. An EKG can identify bradycardia only if you have it during the test.
You may need to wear or carry a device called a portable, or ambulatory, electrocardiogram. Examples include a Holter monitor and a cardiac event monitor. You might use it for a day or more. It records your heart rhythm while you go about your daily routine.
You may have blood tests to find out if another problem is causing your slow heart rate.
When Should I See My Healthcare Provider Or When Should I Seek Care
You should see your healthcare provider at least once a year for an annual physical, regardless of whether or not you have bradycardia. This yearly visit is a key way for your healthcare provider to catch a wide range of healthcare problems early, especially ones that dont have symptoms you can feel.
If you do have bradycardia but dont have symptoms, you should see your provider if you notice any new symptoms or any changes in your overall health. If you do have symptoms, you should also see your provider if you notice your symptoms changing, especially in ways that are affecting your daily life and routine.
When should I go to the hospital emergency room?
You should go to the hospital if you develop symptoms of bradycardia quickly or if you have symptoms that get worse or change suddenly.
You should also go to the hospital right away if you have any of the following symptoms :
- Dizziness, lightheadedness and fainting .
A note from Cleveland Clinic
Bradycardia is a condition where you may not have symptoms or a problem, especially if it happens for certain reasons. Still, its normal to feel nervous or worried if you have unanswered questions now or the potential for future problems. Fortunately, bradycardia is a condition thats almost always treatable. Your healthcare provider can also give you guidance and advice that will help prepare you for what youre facing and whats to come.
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Heart Rate Reveals Risk Of Sudden Death
Test May Show Heart-Rate Abnormalities in Seemingly Healthy Men
May 11, 2005 — A man’s risk of sudden death may show up in a simple exercise test, say French doctors.
Ten minutes or less of pedaling on a stationary bike was all it took, they report in The New England Journal of Medicine.
The danger signs were clear in hindsight. When the test was done, the men were apparently healthy, say Xavier Jouven, MD, and colleagues.
All the more reason not to take your heart for granted. Heart disease is a leading cause of death for men and women in the U.S.
What Is A Normal Resting Heart Rate
For a well-trained athlete, their resting heart rate will usually be around 40 beats per minute.
For adults, a normal RHR ranges from 60 to 100 beats per minute, although most people who are relaxed and healthy should be below 90. For a well-trained athlete, their RHR will usually be below this, around 40 beats per minute. This is because a lower RHR is often a sign of good cardiovascular fitness and efficient heart function.
However, you shouldnt compare your RHR with someone elses. Youre unique and beautiful and thats how it should be. While your neighbors RHR might be lower than yours, it might be for a dozen different reasons.
Instead of comparing yourself to others, youre better off monitoring how your RHR is changing over time. When your resting heart rate decreases as a result of training, its a sign that your aerobic fitness has improved.
Take that, neighbor.
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Diagnostic Approach To Heart Rate Drops In A Baby
Any baby with significant heart rate drops should be placed on a cardiorespiratory monitor to assess the severity of episodes and their correlation with respiratory rate and oxygenation levels.
In addition, if we want to consider other causes of heart rate dips than just prematurity, immature feeding pattern, or physiologic reflux, we may need to run some additional tests described below.
We perform blood cultures and CBC if we suspect an infection.
For abnormalities in the central nervous system, we can order EEG and imaging studies of the brain such as ultrasound, CT, or MRI.
Suppose the baby is suspected of having an abnormality in the heart. In that case, we can do ECG and Echo .
For babies with severe choking episodes, while feeding not explained by their immaturity, we may need to rule out anatomic abnormalities in their respiratory and digestive systems. For example, abnormal anatomy of the throat, stomach, esophagus, trachea, or lungs may contribute to such severe episodes. When we suspect that, doing CTs or X-rays with or without contrast would make a lot of sense.
I want to emphasize that most newborn babies with heart rate drops do not need any additional tests beyond just careful clinical observation. However, all these babies need to be monitored frequently or continuously, so we do not miss clues about potential etiologies that would require additional testing and our attention.
Can I Prevent Bradycardia Or Reduce My Risk Of Developing It
For many people, preventing bradycardia isn’t possible. This is especially true when it comes to bradycardia which happens because you’re in very good physical shape or bradycardia which happens naturally as you age.
Bradycardia is only preventable in cases where it happens because of the following:
- Recreational drug use. These drugs arent prescribed and you dont take them for any medical reason. Avoiding recreational drug use, especially narcotics and cannabis-based drugs, can help you avoid developing bradycardia.
- Infections. Getting infections treated promptly, even infections that seem minor, can make a big difference in preventing long-term heart problems.
- Anorexia nervosa. Receiving treatment for anorexia nervosa can help you prevent long-term problems like bradycardia.
In all other situations, bradycardia happens unpredictably. Because you cant predict when it will happen, you cant prevent it. However, many people will still develop bradycardia because of aging regardless of what they do to reduce their risk.
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What Other Conditions Cause A Low Heart Rate
Many of the medical conditions that cause bradycardia are more common in people who are older or have underlying heart conditions. Some examples of medical problems that can cause bradycardia include:
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Problems with the hearts electrical pathways: There is a special electrical circuit in our heart that controls each heart beat. Problems with this conduction system can cause the signal to go awry. This is called an arrhythmia.
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An abnormal shape or structure of the heart: The shape and size of the heart can begin to change in response to other medical problems. Examples include high blood pressure, coronary artery disease, or heavy alcohol use. Some people are born with certain defects, too. All of these conditions can affect the conduction system we just mentioned.
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Metabolic abnormalities: The heart requires the right balance of electrolytes and hormones to pump correctly. Conditions like hypothyroidism or low potassium levels can cause the heart to beat too slowly.