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Is low resting heart rate a cause for concern?

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Posted on Mon, 18 Feb 2019
Question: I am seeking counsel from a bona fide cardiologist.
I'm in pretty good shape - a little overweight - male, age 67, 225 lbs., and 6 ft. 2 inches.
I have been a regularly active exercise walker for more than 30 years. Generally walk 3-4 miles at a 15-16 minute pace.Probably average 4-5 days a week over the 30 plus years.
Here's my question.....often my resting heart rate is in the 48-52 rate per minute. My rate if I'm standing or moving around (household chores etc.) rises to around 60. Rate while exercise walking (not gasping for breath and not winded), but breathing a little deeply is around 80. If walking up a hill, rises to around 100, but quickly declines.
Absolutely no symptoms like being out of breadth or chest pressure or dizziness.
Moderate high blood pressure, but well controlled (125/70) with Ramipril and amlodipine). (Would otherwise probably be in the 145 range.)
Excellent cholesterol - Total 130, Ldl 55.

Is the low resting heart rate concerning? Any concern of sinus dysfunction?
Thanks.
XXXX
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows.

Detailed Answer:

Hello,

I carefully reviewed your medical history and would like to explain that being in a good physical condition; that is following a physically active daily profile is quite important for your cardiovascular well being and endurance.

It is true that you are overweight with a BMI of around 29, but from the other side you demonstrate a satisfactory physical conditioning as shown by successfully performing all the various daily physical tasks.

Being generally in a relatively low heart rate is a thing, but it could not be correctly adjudicated without considering the underlying clinical symptomatology.

In fact, your heart rate increases progressively in an escalating manner, and this sounds quite correct and normal. This is demonstrated also by the fact that it surpasses 90 bpm while trying intensive exertion.

On the other hand, you don't experience any obvious clinical symptomatology (like dizziness, excessive breathlessness, chest pain, or syncope, etc.)

Bradycardia is the most common finding in sinus node dysfunction, but your relatively low heart rate could not be considered clear evidence of such a supposition.

First, your heart rate exhibits a normally escalating increase and this is important.

Second, you have no suggestive clinical symptomatology.

And third, it is important to investigate any other clinical evidence that may be related to a slightly low heart rate fashion.

A metabolic cause, such as endocrine (thyroid gland dysfunction, adrenal, etc.), an electrolyte imbalance, etc. should be sought and excluded.

In additionto that, good physical conditioning could underlie your heart rate profile.

Besides the above mentioned investigations, in order to correctly answer your concern, it is advisable to explore your heart rate and rhythm trend by means of an ambulatory 24 to 48 hours ECG monitoring (Holter) test.

An exercise cardiopulmonary test would be valuable to investigate your cardiovascular endurance and physical conditioning.

You need to discuss with your attending physician (cardiologist) on the above mentioned issues.

Hope you will find this answer helpful! In case of any further questions, I would be glad to discuss with your again.

Regards,
Dr. Iliri Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Thanks, Doctor.
Just a quick follow up if I may.

Is it fair to say that based on my description, you think sick sinus is unlikely and the need for a pacemaker seems unlikely?

Also, I have read amlodipine is not supposed to decrease heart rate but I've read cases where it seems to. In your opinion, could this be possible?

Thanks again for your counsel.

XXXX
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
My opinion is as follows.

Detailed Answer:

Hello,

You are right! I don't think you need a pacemaker. There is no reason why a pacemaker should be implanted. You are quite asymptomatic and without any confirmation regarding possible cardiac electrical system disorders.

Just a simple asymptomatic bradycardia could not be taken into account as a reliable suspicion for sick sinus syndrome.

Regarding Amlodipine you are exact! There exist some scarce case reports linking Amlodipine use with possible bradycardia, QT prolongation and even ventricular arrhythmia.

Nevertheless, they are not methodically clear enough to consider definitely as other health issues and medications were present too.

Data from large population in USA and Europe have not confirmed such isolated finding.

As we have no methods to confirm such a causative relationship, the only way to clarify this issue would be to stop Amlodipine for a while (two to three weeks) and see the difference in heart rate.

That's my professional opinion.

Hope to have been helpful to you! Let me know if I can assist you further.

Regards,
Dr. Iliri Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (13 minutes later)
Thanks again.....could my many years of aerobic walking be contributory to the lower heart rate?
My last question I promise.
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
I would explain.

Detailed Answer:

Hello,

I mentioned this alternative at the beginning of our thread when I considered a favorable cardiovascular conditioning (muscle conditioning) to physical exertion.

In general, this conditioning is present in physically well trained individuals and a reflection of this ability is the appearance of relatively low heart rates while resting and on exertion.

An appropriate way to confirm such a conclusion would be to undergo a cardiopulmonary exercise stress test.

Just think about it and discuss with your cardiologist on the opportunity of performing the mentioned test.

Hope I have answered your query.

Regards,
Dr. Iliri Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 4714 Questions

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Is low resting heart rate a cause for concern?

Brief Answer: I would explain as follows. Detailed Answer: Hello, I carefully reviewed your medical history and would like to explain that being in a good physical condition; that is following a physically active daily profile is quite important for your cardiovascular well being and endurance. It is true that you are overweight with a BMI of around 29, but from the other side you demonstrate a satisfactory physical conditioning as shown by successfully performing all the various daily physical tasks. Being generally in a relatively low heart rate is a thing, but it could not be correctly adjudicated without considering the underlying clinical symptomatology. In fact, your heart rate increases progressively in an escalating manner, and this sounds quite correct and normal. This is demonstrated also by the fact that it surpasses 90 bpm while trying intensive exertion. On the other hand, you don't experience any obvious clinical symptomatology (like dizziness, excessive breathlessness, chest pain, or syncope, etc.) Bradycardia is the most common finding in sinus node dysfunction, but your relatively low heart rate could not be considered clear evidence of such a supposition. First, your heart rate exhibits a normally escalating increase and this is important. Second, you have no suggestive clinical symptomatology. And third, it is important to investigate any other clinical evidence that may be related to a slightly low heart rate fashion. A metabolic cause, such as endocrine (thyroid gland dysfunction, adrenal, etc.), an electrolyte imbalance, etc. should be sought and excluded. In additionto that, good physical conditioning could underlie your heart rate profile. Besides the above mentioned investigations, in order to correctly answer your concern, it is advisable to explore your heart rate and rhythm trend by means of an ambulatory 24 to 48 hours ECG monitoring (Holter) test. An exercise cardiopulmonary test would be valuable to investigate your cardiovascular endurance and physical conditioning. You need to discuss with your attending physician (cardiologist) on the above mentioned issues. Hope you will find this answer helpful! In case of any further questions, I would be glad to discuss with your again. Regards, Dr. Iliri Sharka Cardiologist