Is Heart Rate Of 46 A Cause For Concern?

Posted on Thu, 23 Feb 2017

Question: My son is 27 and lives in TX. He runs, works out, lifts weights and surfs in addition to working a busy job. Yesterday he was at a Gen Pract for a routine check up. His heart rate was 46, so they decided to do an EKG on him. While laying down for that his heart rate was 36. The GP said she'd not seen an EKG like that....( she said...lower ventricles not active or not very active)...but she admitted she didn't read that many and for him to see a cardiologist. He admits to have "cut weight" recently and eats very healthy food. He may have been on a Zpac for an ear infection recently and had been on long term antibiotics for acne (which he stopped 1-2 months ago).He says he doesn't feel light headed or extremely tired...just a normal amount (a little light headed when he stands). He has never had a low heart rate before. My question...should he be seen by a cardio right away? My son feels fine and is going to CA this weekend to surf. The GP did not act like this was an emergency.

Answered by Dr. Ilir Sharka (36 minutes later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that low heart rate is quite normal in sportive persons, who perform regularly a lot of physical activity.

But the fact that his heart rate went 36, the fact that he has never had such heart rate and he says that he feels some lightheadedness time after time, may be indicative of different cardiac conditions (sinus bradycardia and even a cardiac conductance disorder like sino-atrial or AV block)

I would like to directly review his resting ECG (if you can upload it as an image) for a more professional opinion.

Anyway, I would not recommend going for surf this weekend, without a careful physical check up by a cardiologist and some other tests:

- a resting ECG and cardiac ultrasound
- some blood lab tests (complete blood count, blood electrolytes, blood urea, creatinin levels)

I would also recommend to closely monitor his blood pressure values (in sitting and standing up position). A decrease more than 20mm Hg in his systolic blood pressure when standing up compared to sitting position could be indicative of orthostatic hypotesion, which could partially explain the lightheadedness when standing up.

Hope you will find this answer helpful!

I remain at your disposal, whenever you have any other questions.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (18 hours later)

Based on his GP's assurances that it was nothing serious, he got on a plane and is surfing as we speak. I called him and told him to be very aware of any additional symptoms. He continues to say he feels fine.

I do not have the copy of the EKG. It is in his vehicle at the airport in TX and I am in XXXXXXX MA.

I will forward a copy of the EKG on Sunday or Monday when he returns. His standing heart rate is 46 as taken on two different occasions 3 weeks apart. 36 was when he laid down for the EKG.

I have made him promise to see a Cardio when he gets back, though I do not know how long the waiting list is. If they view his EKG perhaps they can get him sooner.

I will send the EKG when he returns from the surfing trip.

Thank you

Answered by Dr. Ilir Sharka (3 hours later)

Brief Answer:
I remain at your disposal whenever you can upload the ECG image.

Detailed Answer:
Hello again!

As he feels fine, it means that it does not seem to be a serious medical condition. It may have been just a sinus bradycardia.

I would be happy to review his ECG as soon as you will be able to upload it for a more professional opinion!

Let me know about everything!

Wishing a nice weekend,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (2 days later)

Hello, Here is a copy of his EKG. It was performed by a Gen Prac...not a professional EKG person.

He will turn 27 this month. He spent the last 4 days surfing. He said it was a great work out and he's never felt better.

I am continuing to tell him to make an appointment with a Cardiologist to do another EKG and make sure everything is okay.

I would like your opinion on his EKG. His heart rate went from46 to 36 during the test, but he is very athletic and also does Yoga/relaxing techniques. Thank you

Answered by Dr. Ilir Sharka (22 minutes later)

Brief Answer:
Please upload again your ECG reports/images.

Detailed Answer:
Hello again!

Could you please re-upload your ECG images?

I think it may be a system problem, because I can not see any reports attached to your question.

I remain at your disposal,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (3 minutes later)

I am trying to upload it by using the "upload new reports" box on the right upper screen.

Is there another way to attach the report?

Answered by Dr. Ilir Sharka (2 hours later)

Brief Answer:
My answer:

Detailed Answer:
Hello again!

I understand your concern, but this is the only way I know about uploading new reports.

I would recommend contact with customer-care service or the healthcaremagic team for this problem.

Let me know about everything!

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar