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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest ways to rule out bradycardia

Answered by
Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 2850 Questions

Posted on Mon, 11 Jun 2018 in Medicines and Side Effects
Question: I had ear ringing and the doctor prescribed clarithromycin in case it is middle ear infection, I think he is right as I started to get mild fever. However on the leaflet it says consult GP/pharmacist if clinically significant bradycardia. I do not know if I have that, I've never been assessed though I have noticed from time to time that I have a heartbeat below 60 bpms and not an athlete. On the other hand I have had multiple ECGs, an EKG and a holter test and a stress test (not for bradycardia but for chest pain) however no tests showed any issues with heart at all and there is no family history of heart problems.I'm wondering if I should just take the clarithromycin, its not practical to wait for a test specifically investigating bradycardia?
Answered by Dr. Bonnie Berger-Durnbaugh 17 minutes later
Brief Answer:

Detailed Answer:

The study that led to this warning (in 2013) was actually about a different antibiotic, azithromycin (Z-pack), which is in the same class as clarithromycin. The bradycardia that happens was associated with a "long Q-T interval" which it sounds like you do not have. Long Q-T means the interval between when the electrical stimulation that causes contraction of the ventricles and the time before there is depolarization allowing the heart to relax.

The problem happened mostly in people who already have a lengthened Q-T interval and in the elderly.

Clarithromycin is prescribed routinely with no need for a cardiac evaluation unless there has been remarkable slow heart rate or identified long Q-T.

Many people have heart rates that are less than 60 bpm. Did the doctor(s) who did the holder and stress tests discuss see that there was bradycardia and have concerns about it, or was it not happening during that time?
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Bonnie Berger-Durnbaugh 39 hours later

The Holter, the stress test were done separately, first as a precaution around subjectively experienced arhythmia that was not found to be a concern after holter testing and the stress test due to shoulder pain that likely had a muskulo skeletal origin also not concerning. I've never told any doctors that I think I have bradycardia but none of the tests Holter, Stress test, ECG, EKG ever found anything of concern and the cardiologist who reviewed the holter and the ECGS at that time two years ago or so did not detect anything concerning in heart rhythm. In fact, no heart test I have ever taken has shown anything of note or concern.

I did not check my pulse or measure it at those times so I had nothing to report to the medical staff. However I have had my pulse taken perhaps 30 or 40 times by doctors and never anything to worry about, none of them mentioned bradycardia.

Answered by Dr. Bonnie Berger-Durnbaugh 2 hours later
Brief Answer:
Thoughts o this.

Detailed Answer:

Given what you told me, unless your pulse has recently been notably slow, then it would not be a concern to take the clarithromycin.

I hope you are feeling better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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