The term bradycardia refers to a slowing of the heart rate, which is a decrease in the number of beats per minute (bpm) of the heart, in its function of pumping blood through vessels to the body’s tissues.
Generally, in an adult and healthy subject, the physiological interval of heart contractions is between 60 and 100 beats per minute, therefore while the term tachycardia indicates the pictures in which the number of contractions exceeds 100 beats, the term bradycardia indicates the opposite situation, in which the number of contractions is less than 60 beats per minute.
However, there are particular conditions in which some subjects, especially highly trained professional athletes , have a heart rate below 60, but obviously falls into a completely physiological condition linked to training.
There is also another exception: the heart rate during fetal life and in newborns is significantly higher than that of adults, therefore in these cases a picture of bradycardia is defined when the rate falls below 100 beats per minute ( bpm).
Sinus bradycardiait is not a pathological event in itself, it is in fact a symptom that in most of the times arises without a cardiovascular disorder at the base. It is a phenomenon that strongly depends on the lifestyle, therefore on smoking, sedentariness, alcohol abuse and in subjects who follow a diet rich in fat.
Therefore, it should be noted that by making significant improvements to one’s lifestyle and avoiding the risk behaviors described above, bradycardia can improve significantly. In other cases it may actually be a symptom of a cardiovascular disease, but it is a minority of cases and which can still be treated with drug therapies or surgery.
What are the symptoms of bradycardia
Sinus bradycardia is a condition characterized by fewer heart beats per minute, a condition that results in a lower flow of blood and therefore of oxygen and nutrients to the tissues.
This determines strong repercussions on the physical performance of the subject who exhibits the following symptoms:
- Tiredness;
- Dizziness;
- Dizziness
- Chest pain
- Breathing difficulties, in particular apneas and “air hunger”.
The organs that need a greater blood supply are the brain and kidneys, therefore a reduced blood perfusion that lasts for a long time determines repercussions to damage these two important organs, also causing syncope, mental confusion, and nocturnal repercussions on the sleep quality.
In which cases it is completely normal to have bradycardia
There is only one case in which suffering from bradycardia is completely normal and we are talking about very trained athletes who often have a number of beats per minute that are below 60.
Let’s now analyze how the different types of bradycardia are classified in the medical literature.
What are the
types of bradycardia?Bradycardia can be divided according to severity into mild, moderate and severe depending on the threshold below which the heart rate falls.
There is a picture of mild bradycardia when the heart rate is between 50 and 60 beats per minute. In this case, the symptoms are very subtle and are usually limited to a state of physical fatigue. Moderate bradycardia occurs when
the number of beats falls within the range of 40 to 50 beats per minute, and in this case the symptomsthey become more important and limit the subject’s normal daily activities. In fact, there is a more pronounced perception of muscle fatigue, reduction of physical strength, severe limitations in practicing sports , dizziness and syncope.
Finally, there is a picture of severe bradycardia when the number of beats falls below 40 beats. Subjects in this condition experience severe limitations in making not only the most intense or prolonged physical efforts, but also the simplest activities such as standing alone. Blood pressure is reduced and above all there is a reduced perfusion of oxygen and nutrients to the brain and kidneys causing damage to these organs. In addition, the subject experiences difficulty in breathing.
Another classification of sinus bradycardia provides for the distinction based on the causes that caused it:
- Neurogenic bradycardia : this type of bradycardia arises as a result of compromising the brain region from which the vagus nerve starts. This nerve is the one that plays a role of primary importance in the regulation of functions regulated by the central nervous system, including the decrease in cardiac contraction;
- Myogenic bradycardia : the causes depend on the muscle tissue of the heart, that is the myocardium;
- Drug or chemical bradycardia : this is a particular form of bradycardia that is consequent to the intake of particular drugs (for example beta blockers) but also the use of drugs and excess potassium in the blood (hyperkalaemia) can cause ‘establishment of this condition.
What are the causes of bradycardia Bradycardia
, as previously mentioned, does not necessarily represent the symptom of a pathological picture, but rather, very often it is a phenomenon that is connected to an incorrect lifestyle.
In other cases, on the other hand, it relates to a true pathological picture of arrhythmia or a situation in which there is an alteration of the normal heart rhythm which can be consequent to damage to the normal system of conduction of the cardiac electrical impulse. The most common causes are listed below : Lifestyle
Bradycardia
and a condition frequently linked to bad habits such as smoking, alcohol and high-calorie diets that lead to an increase in blood cholesterol (a condition that facilitates the formation of atherosclerotic plaques).
Atherosclerotic plaque
A condition facilitated by high blood cholesterol values , which are associated with diets rich in saturated fat. Over time, these plaques can occlude or limit blood perfusion through the coronary arteries, triggering ischemic cardiomyopathy or myocardial infarction.
Sinus bradycardia It
affects the sinoatrial node, that is the area of ​​the heart where the electrical impulse transmission originates, which allows the heart to contract and therefore to pump blood.
High blood
pressure We talked about what normal blood pressure should be like in an in-depth article that you can read here .
Hypothyroidism
Situation in which there is a decrease in the production of hormones by the thyroid and which is accompanied by a slowdown in the basal metabolism. This condition involves a constant feeling of tiredness, bradycardia, drowsiness and poor ability to concentrate.
Excess of potassium
High levels of potassium in the blood (hyperkalaemia) can be responsible for the onset of bradycardia .
Medicines
Taking certain medications can cause a slow heart rate, such as beta-blockers, anti-arrhythmic and anti-hypertensive drugs.
Other causes are:
- tissue damage to the cardiac conduction system, often related to aging;
- congenital heart disease;
- hemochromatosis, a genetic pathology that causes the accumulation of iron in internal organs;
- obstructive sleep apnea, which is the continuous interruption of breathing during a night’s rest;
- complications of heart surgery;
- autoimmune diseases such as SLE (Systemic Lupus Erythematosus).
Let’s now go into the ways in which the doctor makes the diagnosis and what are the most effective therapies to treat this disorder.
When to go to the doctor
As we have seen, bradycardia can be the consequence of a wide range of conditions and to obtain the identification of the triggering causes, the right diagnosis and appropriate therapies it is necessary to consult a cardiologist and not attempt to self-diagnose.
In case of breathing difficulties, fainting and chest pain it is strongly recommended to call the emergency number 118 as soon as possible or go to the nearest hospital. These symptoms imply a medical emergency that must be treated as quickly as possible.
How the diagnosis is made
Diagnosis of heart disease should be done by a cardiology specialist .
During the visit, the doctor generally conducts a thorough investigation of the symptoms perceived by the patient, then asking questions such as: when the problem arose, what symptoms do you feel, if you feel more difficulty in carrying out daily activities, if you experience difficulty in breathing, confusion mental, dizziness and syncope.
The doctor will then proceed to visit the patient, listening to the chest for noises or heart murmurs. In addition, he will examine the blood vessels in the neck, checking their turgor and rigidity.
Based on the diagnostic suspicions, the cardiologist will be able to refer the patient to aelectrocardiogram (ECG) , a fundamental test to check the electrical activity of the heart and the regularity of the heart rate, which can be performed both at rest and during exercise.
In addition, the doctor may suggest a 24-hour ECG Holter , which allows you to record the electrical activity of the heart over the course of a whole day. An echocardiogram will then be useful to view the internal structures of the heart and to check the flow of blood through the atria and ventricles.
A blood sample can also be useful in assessing the blood levels of potassium (which can be performed with a dosage of electrolytes in the blood ), cholesterol and thyroid hormones.
In general, bradycardia does not represent a pathological symptom, therefore in most cases no therapies are administered other than indications that correct the subject’s lifestyle. Therefore, eliminate smoking and alcohol and start a diet low in saturated fat.
Conditions of actual clinical interest can be treated pharmacologically or by means of an electrical heart stimulation surgery, then applying a peacemaker.
If bradycardia is a consequence of an underlying disease, such as hypothyroidism or obstructive sleep apnea, treatment of these disorders is necessary to stem the disorder and correct the bradycardia.
If bradycardia is identified by your doctor as a side effect of a drug, you will most likely decide to discontinue therapy.
The installation of a pacemaker is one of the most adopted choices by cardiologists for the treatment of moderate and severe bradycardia. It is a battery-operated device that is implanted immediately under the collarbone and its threads are led to the treatment to be implanted at the level of the cardiac contractile tissues.
The pacemaker is able to control the heart rate and generate the electrical impulses necessary to allow adequate cardiac contraction. Some particular types of pacemakers are able to record information necessary for the cardiologist to monitor the functioning of the heart.
Before leaving, I recommend that you read the advice of the scientific community for the prevention of bradycardia.
Prevention
The most effective way to prevent the onset of bradycardia is to reduce the risk of developing heart disease. If you already have heart disease, it is undoubtedly necessary to undergo the proper checks to minimize the risk of complications.
The actions to be put into practice to carry out a correct prevention are the following and are recommended by:
- Eat healthy and exercise regularly: the foods to be preferred are fruits, vegetables, whole grains and good fats such as extra virgin olive oil. A quick walk for half an hour a day is enough to keep fit;
- Keep your weight stable: being overweight increases the risk of developing cardiovascular disease;
- Keep blood pressure and cholesterol levels under control;
- Avoid smoking;
- Consume alcohol in moderation;
- Do not use drugs;
- Control anxiety and stress
- Undergo periodic check-ups.
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