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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Is pulse rate of 40 bpm a cause for concern?

Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7011 Questions

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Posted on Mon, 29 Aug 2016 in Hypertension and Heart Disease
Question: I have afib that acts up maybe 6 times a year. I am in afib now. I am 75 years old, female. Usually the afib doesn't have symptoms, but today I am having light-headed feelings that are occurring in waves. Sometimes I feel hot when this happens. If I breathe deeply when I feel one about to happen, it does not happen. About an hour ago I took about 1/5 teaspoon of salt, some tomato paste to get potassium, 1/2 t. of baking soda, 500 mg of taurine, and 1/2 cup of milk. I take magnesium everyday and believe I have a good store of that. I didn't eat much today and worked outside in hot weather for a 2-3 hours so I've drunk a some water in case i was dehydrated. I am feeling much better and my afib is still going but not as strong. However, the light head-headed waves are still occurring. This has been going on for a couple of hours. Can you comment on the light-headness? Should I go to a hospital emergency room?

Forgot to say my blood pressure has been around 140/60 and my pulse has been around 40 during this problem. That's about usual for my BP; my pulse is usually around 50.

Right now BP is 153/74. Pulse =51.

Light-Head waves greatly reduced. Just one during last 10 mins.

Just happens that I have my 6-month appointment with my cardiologist tomorrow,
doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your actual medical conditions and would like to explain that your light-headed feelings seem to be related to extreme bradyarrhythmia (around 40 bpm).

You are usually bradycardic at around 50 bpm, but 40 bpm is quite low and may produce several complaints like light-headed feeling, vertigo, body weakness, etc.

Also, atrial fibrillation by itself leads to irregular heartbeats and hence non-uniform cardiac output. This may exacerbate similar neurological symptomatology.

Coming to this point, tha fact you have a persistent bradycardia and recurrent episodes of atrial fibrillation raises the necessity of a thorough heart rhythm and rate investigation for ruling in/out a possible sich sinus syndrome (SSS), which may be responsible for similar clinical complaints and dangerous life-threatening complications (prolonged sinus pauses, ectreme bradycardia, syncope, cardiac arrest).

In such case, it would be necessary to perform an ambulatory 24 to 48 hours ECG monitoring (Holter).

If sufficient evidence about SSS it gathered from Holter monitoring, probably pacemaker implantation would be the next rationale step.

As your complaint of light-headed feeling is diminishing, probably you need to discuss with your cardiologist tomorrow as scheduled on the above mentioned issues.

Otherwise, if the complaints returns again, you should promptly ask medical assistance to the nearest ER service to prevent any serious complicantions derived by extreme bradyarrhythmic state (as I described above).

Meanwhile, try to avoid certain stimulant substances (taurine, etc.) which may exert adverse effects on heart rhythm.

Hope you will find this answer helpful!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

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