Low Heart Rate?

[Friedbrain]

I had my most obvious symptoms of dysautonomia years ago when I was under a lot of stress, with spikes in heart rate, postural hypotension, shaking spells, etc., under various conditions and at various times. And I *crash* after strenuous activity (but maybe more related to adrenal insufficiency or a combination?), literally fall asleep and can't move for hours. I used to take xanax during particularly shaky times to help me calm down, until one night after one of my periodic and spontaneous shaking spells. After taking the xanax, I tried falling back to sleep but felt like I was barely breathing. It scared the beejebers out of me and I woke my husband, asking him to make sure I kept breathing. That was the last time I took xanax, and was a long time ago. However, after getting an apple watch earlier this year, I have learned that my heart rate is very low and, at times, very low!  It's scary. I'm an athletic 50yo (using 2x electrolytes when I work out to avoid post-workout shakes, as mentioned in a previous post) so the doctor said that my baseline heartrate in the 50s is not abnormal. But my watch shows me that it drops into the 40s for over ten minutes at a time (I set it to give me alerts when this happens) during the night after daily stressors, and it even drops into the 30s! This doesn't happen often but it has after traumatic experiences like my car battery dying on my way to work (most people could handle this but I started violently shaking from the stressor), and my heartrate dropped into the 30s that night and I had numerous low values every night for about a week.  At work that week, I was feeling breathless and could see from my watch that my heartrate had dropped. I went for a vigorous walk to get my heart pumping, which helped a lot. I'm fortunate that I've learned ways to balance my body but I'm afraid I will die one night from my heart just....petering away. My endo said that was bad and I should see a cardio; the cardio thinks it's an endo problem but will put me on a 48hour heart monitor to rule out any specific cardiac problems just to be sure.  For MANY years, I've seen a correlation between stressors and those symptoms followed by the counter-response symptoms.  Am I the only one who has problems with counter-low heart rate?  I also found that the daytime crashes are associated with extra-low heart rates in the 40s. As you can imagine under these conditions, I am too out of it to seek help even if I did think I needed to go to the ER. So far, I've survived all of the daytime and night time low heart rates but.....?

[Pistol]

Dear @Friedbrain - the only way to determine what is going on is by following your physicians advice. A monitor is a reasonable diagnostic tool for what you describe. If you or your doctor think that your low HR could be linked to dysautonomia you might want to consider an autonomic specialist.  At this point you should follow your doctors advice and see what the 48 hour monitor shows I had MANY of those when I first became ill with POTS and I WISHED it would have been a slow HR - that could have meant a pacemaker. So - please do not get too worried - your docs seem to be on top of it!!! Hang in there. 

[p8d]

@Friedbrain have you ever checked your BP during these episodes?  I know my HR drops into the 40s and occasionally 30s when my BP is near crisis territory (180/100).  They sound scary and I agree with Pistol that the testing should hopefully get some answers.

[Sushi]

@Friedbrain I can empathize as my HR used to be concerningly low with resting HR of about 47 and a sleeping rate of about 43. I also occasionally dipped into the 30s. If you feel that your cardiologist doesn’t give the help you need, seeking an electrophysiologist (they specialize in heart rhythms) might also be something to consider. I also stayed up for a whole night when my HR was in the 30s. I would move around every few minutes to raise my HR. My electrophysiologist did give me a pacemaker and I love the thing as it has eliminated some troublesome symptoms for me and setting the base rate at 70 has made my OI better. Best wishes and let us know what the monitor shows.

[toomanyproblems]

I have the same problem as others have stated -- my normal HR at night is in the 50s with dips into the 40s and rarely into the 30s. I find when my Fitbit derived resting HR average is lower, I generally feel worse. IDK if that's because there's more of a jump up to 120 or so multiple times a day upon standing or whether the low resting HR itself causes me to feel bad. And by bad I mostly mean more dizzy.

[Friedbrain]

Thank you SO much for the feedback! It's good to know I'm not alone. I do need to follow up with the cardiologist to wear the heart monitor and rule out any other things but I don't always (in fact, I actively avoid them lol) have the symptoms so I don't know how useful. It's too cold to go hiking up a forest, which can make me crash afterwards, so...  @toomanyproblems I agree, I feel worse when my heart rate drops. I figured this out once I started wearing the smartwatch and could see it RT. I was completely stressed last weekend before a good friend's funeral (I was going to give a eulogy) and my blood pressure beforehand was something like 125/90, which was really high for me, with heartrate up to 100 for nine hours (the following day, peak was 89 max). I took my first 1/2 xanax pill in years because I didn't want to suffer the health fallout from so much stress-the half pill barely took the edge off of my shaking but I'm sure I would've been worse had I not had anything! Note to self for next time-I can handle a full pill (they're tiny!).  I don't think I've ever seen my bp over 145, and at that point, I felt awful! Can't imagine it higher than that, yikes.  @Sushi I've read about the pacemaker being a solution for low heart rate rather than dying from it, but I'm afraid of that solution because I like to exercise. If you don't mind, I'm curious what it is like having a pacemaker. Can you still exercise and get a higher heartrate? I really don't know much about it.

 

Thank you!

[Sushi]

2 hours ago, Friedbrain said:

I've read about the pacemaker being a solution for low heart rate rather than dying from it, but I'm afraid of that solution because I like to exercise. If you don't mind, I'm curious what it is like having a pacemaker. Can you still exercise and get a higher heartrate? I really don't know much about it.

Recent pacemakers can be set to support your lifestyle, so yes, you can exercise and get a normal rise in HR commensurate with your activity. Also, there are different models with different features—for instance the one I have is MRI safe and has an algorithm that will try to outpace PACs. I have found that this feature works well, terminating them quickly. There are so many settings on new pacemakers that a good device check person can adjust it to behave just as you would like. You would need to see a good EP though if you want to consider a pacemaker—you would want an EP with a lot of experience in implanting pacemakers. Mine is buried in the pectoral muscle so it is invisible on the outside.