Bradycardia

What is bradycardia?

Bradycardia (pronounced brad-e-KAHR-dee-uh) is the medical term used for a heart rate which is lower than normal. Where a normal resting heart rate for adults is typically between 60 and 100 BPM, a bradycardia heart rhythm is below 60 BPM. 

Some people, such as athletes who are very fit, have a naturally low heart rate but don't experience any symptoms or need treatment. 

However, sometimes bradycardia is the result of a problem with the electrical impulses in your heart which prevents it from pumping enough blood around your body. This can lead to symptoms including tiredness, dizziness, shortness of breath or palpitations, requiring swift diagnosis and treatment as available through our private network. 

Bradycardia vs tachycardia

Bradycardia is a type of arrhythmia, a category of conditions that involve an abnormal heart rhythm. Tachycardia is the opposite type, describing an abnormally fast heart rate. 

Types of bradycardia (bradyarrhythmias)

There are several types of bradycardia and not all of them are dangerous. Although your doctor may diagnose bradycardia if you have a resting heart rate below 60 beats per minute, this doesn't necessarily mean you need any treatment.

For most people, there are times when your heart beats slower without any cause for concern (for example, when you’re relaxed or asleep). However, bradycardia sometimes has an underlying cause which requires treatment. 

Your cardiologist will carry out a full assessment to diagnose which type of bradycardia you have. The most common include:

• Sinus bradycardia: Most common in older adults and athletes, some people with sinus bradycardia don't have any symptoms. It occurs when the sinus node (your heart's natural pacemaker) doesn't work properly, resulting in a slow heartbeat. It’s also commonly seen in people on some types of heart medication, particularly beta-blockers. 

When sinus bradycardia does cause symptoms, it’s known as sick sinus syndrome, a common type of cardiac arrhythmia in which the heart rate can alternate between very fast (tachycardia) and very slow (bradycardia).

• Heart block (also known as atrioventricular/AV block): Occurs when electrical impulses through the heart are blocked, causing it to beat more slowly or with an irregular rhythm. It’s common in older people as the heart ages or after a heart attack.

Other types of bradycardia include:

• Junctional bradycardia: Usually caused by an absence of the electrical impulse from the sinus node. As a result, the heartbeat is generated by a different part of your heart, the AV (atrioventricular) node, and is slower than normal. Commonly seen in young people and often normal, it can cause symptoms and need treatment if persistent, particularly in older people.

Rest assured we see more cases than any other private provider, from common to complex. If you’re diagnosed with one of these types or another arrhythmia, we offer the best available care to improve your condition. 

Causes of bradycardia

Bradycardia can be caused by many factors including:

• Damage to the heart tissue from heart disease, a heart attack or complications from heart surgery 
• Congenital heart defects (heart problems which are present at birth) 
• Myocarditis (inflammation of the heart tissue)
• An underactive thyroid gland (hypothyroidism)
• A chemical imbalance in the blood
• Sleep apnoea, a condition which causes repeated pauses in breathing during sleep
• Other rare medical conditions including rheumatic fever, lupus and Lyme disease 
• Certain medications such as beta-blockers, or drugs to treat other heart rhythm disorders

Bradycardia risk factors

Bradycardia is sometimes caused by congenital heart problems which can't be avoided, as well as being more common in people over the age of 65. Other factors which increase your risk of developing heart disease also increase the risk of a bradycardia heart rhythm, including:  

• High blood pressure
• Being very overweight
• Smoking
• Drinking too much alcohol
• Taking illegal drugs
• Stress and anxiety 
• Not getting enough physical activity (though high levels of athleticism can also cause bradycardia)

If you’re worried about your personal risk or want to know more, we can help you understand and manage it effectively through our private diagnostics network.  

Bradycardia treatment options

There are various treatments for a low heart rate including monitoring, medication management, pacemakers and ablations. If you're diagnosed with bradycardia, your treatment will depend on the cause and severity of your condition as recommended by your consultant.  

It may involve stopping or changing certain medications or making changes to your lifestyle. If your bradycardia is related to an underlying condition such as hypothyroidism (an underactive thyroid) or congenital heart disease, your treatment will usually focus on managing that condition.

If you don't have any symptoms or your condition is mild or infrequent, you may be recommended monitoring rather than immediate bradycardia arrhythmia treatment. Your cardiologist will work with you to determine the most effective treatment options – all of which are available through our private cardiac network. 

Monitoring and/or lifestyle changes

For mild or symptom-free bradycardia, especially in young, healthy individuals, reassurance may be all that’s necessary. Sometimes regular check-ups may be suggested to monitor symptoms over a longer period of time. 

Sometimes certain activities can trigger or worsen symptoms, meaning simple lifestyle changes such as staying hydrated could help improve your condition.  

Medication management for bradycardia

Some medications such as beta-blockers and those used for other heart conditions can cause bradycardia, so it's important to let your consultant know about anything you're taking. They may recommend changing the dose or type of medication if it's found to be causing your slow heart rate. 

In emergencies, you may also be given medication for a low heart rate intravenously to improve how your heart functions, such as atropine or isprenaline.

Bradycardia surgery (pacemaker)

In some cases, especially if the cause of your bradycardia is a problem with the heart's electrical system, you may need to have a pacemaker fitted. 

A pacemaker is a small electrical device which is fitted under the skin, typically through a surgical procedure at the left shoulder. This device then monitors your heart's rhythm and sends tiny electrical impulses to restore your heart rate to normal. At HCA we also offer patients the new leadless pacemakers. These are miniaturised pacemakers that are implanted through a tube in the leg. 

Your doctor will recommend the best type of pacemaker for you. 

Can you prevent bradycardia? 

In many cases, bradycardia isn't preventable. But there may be steps you can take to reduce your risk. Leading a healthy lifestyle is one way to prevent bradycardia (as well as other symptoms of heart disease). Ways to improve your heart health include:

• Getting regular exercise
• Maintaining a healthy weight
• Eating a healthy diet which is rich in fibre, fruit and vegetables and low in salt, sugar and saturated fats
• Giving up smoking
• Drinking alcohol in moderation
• Reducing your blood cholesterol level 
• Managing your blood pressure
• Managing stress and anxiety

If appropriate, our consultants will advise on the most relevant and impactful lifestyle changes for you.  

Possible bradycardia complications

If left undiagnosed or without treatment, severe bradycardia can lead to complications including:

• Frequent fainting
• Heart failure
• Sudden cardiac arrest