Heart related issues - need advice

[Pantofolaio]

This is long, apologies in advance.

I’m 55, F. My basic smart watch picked up a very low heart rate a few months ago over a few days. It was dropping to 40 frequently, and I could feel when it was happening and would then check. Family history of cardiac disease so mentioned to my GP.

Saw cardiologist, got 24 hr Holter monitor (he said only 1% PVCs). Echocardiogram and ECGs were ok. he said to get a Kardia device to do ECG if I felt symptoms. he took my BP, noted it was high (144/?) and said keep an eye on that and see you in 6-8 months).

So I got the Kardia and a blood pressure monitor last week. My Bp is measuring as elevated most of the day but in the late evening, it is climbing up to 140-160 systolic, but almost never as high as 90 diastolic mostly in 70s (no history of high BP). Then the last two days, both the Kardia and the BP monitor are showing my HR dropping regularly to as low as 36 bpm. I don’t feel faint, I am not athletic or on medication.

Looking at the ECG on the Kardia, I saw my ECG looks different to earlier ones. I sent two to their technicians for a report, Both reports came back noting PVCs (skipped beats), every second beat. Quite a number of the ECGs say Bradycardia.

So my question is - tomorrow, do I phone my GP and get an appointment (probably be Fri) and see what she advises or do I go straight to calling the cardiogist (no idea when he’d see me? I’m not used to dealing with consultants, so not sure how it works?).

Phone the consultant, you will usually explain yourself to his secretary and request a call back to discuss the issue. It can take a few days. I think GP is a waste of time as they can't do anything other than contact the consultant for you when you can do that directly yourself. GP can't refer you anywhere either since you've not been discharged.

The bradycardia is the big issue. You are at risk of heart block and are likely to be a candidate for a pacemaker. You need to see a cardiologist urgently and ask about your low heart rate.

Do you know what your heart rate is dropping to while you are asleep?

sounds like it'd be worth flashing the kardia strip in front of someone who can give a proper report because the one you've described doesn't sounds a bit amateurish. GP or the cardiologist should be able to do this.

Oh thanks for all for answering so quickly. @SeaToSki i only have stats for last two nights BPM - between 40-80 first night and 71-91 second night. The first time this happened a few months, it was low during the night.

i will contact the cardiologist first thing.

Great, you really need to focus on the low heart rate. Write a list of how often it goes below 45 and how low it goes.

If it drops below 45 then go to A and E. In particular if you are dizzy, have chest pain or short of breath. As you seem to be compensating for your low heart rate, then feeling brain fog or just sluggish should also send you in.

Has anyone ever suggested you have a thyroid problem, anaemia or low vit B12 ?

I had a resting heart rate of 42 and PVCs - turned out to be hypothyroidism and corrected once I was correctly medicated.

@SeaToSki I have the anti-tpo antibodies so getting bloods done every 6 months but the TSH was 2.1 when checked in Nov. No obvious symptoms. I take Galfer, Vit B12 & Vit D.
When I’m moving around, my hr is normal. It’s usually when sitting for a while that it drops. Would I really need to go to A&E? 😳

@DarkMode2025 did you go to a cardiologist or endocrinologist or just the GP for the diagnosis?

GP sent me to a cardiologist and the PVC showed up on an ECG, he said he was sure once my thyroid was treated that it would settle down and it did. My resting heart rate is now 66bpm.

It would be rare for. TSH of 2.1 to cause bradycardia , but not unheard of. If its been sliding slowly, you might have reached a tipping point since your last test in Nov

The risk with bradycardia is that your heart rate just slows and slows and then slows enough that you cant carry enough oxygen around your body, and you basically fall asleep and die.

I am NOT saying that this is going to happen to you..its the worst case with this disease. What you really want to get is a proper cardiac evaluation so if your heart rate drops down you should go to A and E, firstly so that you are safe if it drops even lower, and secondly you will then have a cardiac evaluation where they see that it is low. My DF went to A and E at my prompting with a heart rate of 45, they admitted him that night for monitoring. While on the monitors it dropped to 38 and he had a pacemaker installed the next day.

Dont ignore this, and dont let doctors ignore this. Since it sounds like yours bounces up and down a bit, having records..written and Kardia tracings of your low rate is very very helpful (the Kardia is excellent btw)

This is a good link that explains some of the medical details. The bit that it doesnt really mention is that you can progress from stage 1 to 2 and to 3 in some cases

https://my.clevelandclinic.org/health/diseases/17056-heart-block

I went to the GP with my heart rate dropping below 40 at night, and she said that a cardiologist had recently given a talk saying that with smart watches, they were seeing loads of people like this, and it was basically fine, unless it happened a lot during the day.

I'm less convinced, but I can't do much more about it now until/unless it happens more often. It has only happened a couple of times during the day for me, mostly in low 40s.

So you are lucky that you have a cardiologist willing to take it seriously and keep monitoring it!

So I decided to subscribe to the Kardia care - the free version only looks for 3 things and the subscription looks at more (including what the technician had determined - PVCs). I wanted to be able to download a summary report.
Since then every time I do the ECG, I get a normal heart rate, (it identifies that I have PVCs). I noticed that the heart rate is always exactly twice what my heart rate is showing on my watch and the BP monitor. A bit more digging around, and it seems that the PVC is not picked up by the BP monitor/watch so they only report the normal beat. So when the HR is being reported by them, it is eg. 41. But the reading of the Kardia (subscription version) is more detailed and as it’s looking at the electrics of the heart, it picks up the PVC beat too, so eg 82. My PVC is every second beat.
I’ll still get in touch with the consultant as the PVCs are very frequent but I think the bradycardia is pseudo-bradycardia. I feel ok, not faint, weak etc.

Thanks so much to @SeaToSki for all your advice and taking the time to get back to me, either way these things need to be taken seriously.
@SnowdropsBlooming as well as the previous episode of low readings over a few days (similar to this current episode) I have had occasional low readings from my watch during the night/day. It may be that you are getting a PVC or similar and the watch can’t read it, so reports the low HR. If it’s under 1% of your beats per day it is considered insignificant. Asleep it seems to be seen as within normal range. But I’m no doctor.