Pulse in 30s? How low is too low?

[starsinthesky5]

Hey, bit of a strange one but I read online that slow pulse isn’t a problem as long as there’s no symptoms. Does anyone know how slow this applies to? Does there realistically become a point where too slow is bad even if asymptomatic?

only reason I ask is I’ve strangely had a really low heart rate today- I have a history of SVT (avnrt, atrial, junctional) as well as various intermittent blocks (2:1, wenckebach, Lbbb). Basically a walking talking ecg textbook at this point unfortunately.

i naturally have a low resting heart rate anyway (late 40s- low 60s) which I think is more due to how much intense exercise I do - I take medication (CCB) for my other arythmia but it doesn’t actually lower my heart rate, it just stops the problematic rhythm. My resting heart rate stays the same with/without the medication and I’ve not had any issues with the meds

today I felt a bit sick and tired and I checked my heart just out of interest and it was sitting about 31-39. I think the sickness was more just hunger tbh because I felt better after eating and I didnt have any other symptoms. The low pulse definitely wasnt to do with the medication because I hadn’t taken it today anyway.

im not sure why it was so low today but im assuming its from exercise

does anyone know, how low is too low? Or is it basically just the case if there’s no symptoms it’s always fine? I feel fine whereas when I previously had svt/blocks I felt unwell, but just wasn’t sure if I should be worried about this or not? I’ve attached my Apple Watch below- NOT so people can interpret it but just as proof of the low pulse

Do you have a cardiologist? I would call their after hours line just to make sure.

I'll preface this by saying I'm no expert, but have had experience of cardiac issues (my own and husband).

Whilst you're fit and base pulse is low I suspect 30s is too low. My husband has an ICD (internal defibrillator) which doubles up as a pacemaker which steps in if he goes into the 40s.

I'd seek medical advice in your position. Better to be safe than sorry.

This is too low, and can absolutely cause you to feel sick and tired. You are severely bradycardic with symptoms and have a large history of arrythmia. Please call an ambulance and get checked over in hospital, you may need an IV infusion to keep your heart rate up.

I am a cardiology nurse, this pulse needs checking in hospital even without symptoms.

I don't think it's easy for any of us to help given you're on medication and have a history of heart issues. Most of the cases where a low RHR isn't a concern are "natural" situations with no other factors affecting the heart, and are not one-offs.

But to answer your question re. how low is too low, I think the lowest on record is 27, some athlete or other.

The women in my family have a RHR of approx. 39. We're all checked regularly because any new health professionals we see for any other reason usually panic when they take our pulse, and don't take our word for it that it's our norm.

*edited for typo

A heart rate below 40 meets the criteria for absolute bradycardia. A medical emergency which requires urgent assessment.

It astounds me people will sit waiting for replies on Mumsnet rather than seeking actual medical advice.

Hopefully no response as you're already in hospital, if not here's another voice to say this is a medical emergency, you need to be seen in A&E and NOT to drive yourself there.

It shouldn’t be too astounding that people would ask on a public forum if anyone has any knowledge or experience with things

of course I’m not relying on replies for exact medical advice, and of course in some situations it’s obvious someone needs medical attention, but in some situations it isn’t and there’s absolutely nothing wrong with asking if anyone else has experienced something

I actually fell asleep after messaging on here last night. I feel absolutely fine now but will definitely follow up with my cardiologist

Just to update, it was ok this morning/afternoon but then seemed to suddenly drop again about 4oclock. I’m going to get an ecg done because it’s sitting between 31-37 at rest although I don’t have any symptoms so I think it probably is just from exercising

Did you see this @starsinthesky5 ?

Or call 111?

Yes but I had fallen asleep after posting last night and when I woke up it was ok today, I’m going to get an ecg done at a&e👍🏼

How are you now OP? I hope you have been seen now and there is a plan for you.

Honestly not really a plan. When I got to a&e it was a bit faster again so it was generally all ok. It was ok yesterday but now today it’s back down to 32-40 and apparently in my sleep was 29 (I know in your sleep your heart rate goes lower but it’s never been that low) So frustrating

I’ve had episodes of really low heart rates before but this is probably the longest it’s lasted on/off. It’s definitely not the medication because I haven’t taken it from when it started (I’ve never had any issues with the medication and it’s been great at controlling the other problems)

Just thought I’d post an update in case anyone else is about. It’s still sitting low 30s so I’m just going to go back again. I don’t feel unwell other than tired so feel like a bit of a fraud going to a&e but equally it’s just a bit too low for comfort, maybe I’m just stressing about nothing though but I don’t like the idea of it going from 30s to 20s when I’m sleeping

Sorry just posting again to see if anyone knows, I totally understand your heart rate can go low during your sleep and it doesn’t cause any issues but is 29 too low? Or does it not matter since I’m asleep so not exactly going to get any symptoms? Getting help for this from hospital has been challenging and I feel like im going round in circles

I don't want to worry you, but one of DH's symptoms was a very low resting heart rate. It turned out that he needed a valve replacement. Please seek medical advice.

My RHR is around 35, no other symptoms though - if you have symptoms then get checked out!

My cardiologist says he's not concerned unless it drops below 40 for a length of time so 30 definitely isnt ok. Id go to a&e

As others have said even without symptoms that's A&E worthy if it's persistently below 40. Unless may you're an ultra marathon runner world class fitness level then potentially might be ok.

Id be surprised if A&E assessment didn't result in a cardiology review, unless maybe there's an obvious simple cause/fix like medication change that they might have the expertise in department to sort i.e. Stop a beta blocker of you're on one.

If very weirdly A&E discharge you without sorting goto your GP for a follow up/referral back to cardiology.

Yeah it’s so weird, I normally take medication for my heart (CCB) but I haven’t taken it in days so it’s definitely not that, and I’ve had this happen before where it goes really fast then really slow and it was without my medication so we know it’s not that but equally nobody seems to know what it is. It’s so frustrating! I’ve never had it go quite this low for this long. It’s about 32-35 now

Mine drops into the 30s at night which as you say the cardiologist seemed relaxed over. I have LBBB and LVSD. But if it was consistently that low in the day combined with your known heart conditions, I do wonder if you may need a pacemaker/ICD. The fact you exercise a lot is a complicating factor! What did A&E say?

It matters a lot because you have not had an assessment while it happens and a cardiologist has said that it's ok. If you were my patient and your HR dropped for a prolonged time to 29bpm, even a few minutes I would want to start a medication to support you through that. My concern is that your electrical conducting system will become discoordinated and each stage of the electrical impulse takes longer to go through. I'm worried that your heart rate will stay too low while you are sleeping.

hi there @starsinthesky5
I was in a similar position to you lots of exercise, family history of low heart rate - my heart rate at rest 39 or 40 for several years. Although unusual everyone, including me, thought it was just because of the genetics and the exercise.

This year I started to develop palpitations and feel dizzy with them. Carried on totally ignoring i. It started getting worse . Went to A&E a month ago and my heart rate had dropped to 27.

At some point actually what has been happening was that I’ve been getting progressively worse heart block and then a couple of weeks ago it deteriorated to the point at which it actually became life-threatening.

I was admitted and was then getting between four and eight seconds pauses between heartbeats and had to go on an IV drip until a pacemaker could be fitted. The whole experience has been terrifying.

I really really would stress it’s very important to go to hospital and get this checked. I put it off and left it until I had a really bad episode to present to A&E at which point it become life-threatening.

For goodness sake go to A&E OP.