A normal resting heart rate for healthy adults is generally between 60 and 100 beats per minute (bpm). When the heart beats slower than this, it is known as bradycardia. This happens because of the sinoatrial (SA) node, the heart’s natural pacemaker, which sends electrical signals telling the heart when to contract. If these signals slow down or get delayed, so does the heartbeat.
A slow heart rate is not always a cause for concern. It is common during sleep and in athletes, whose hearts pump blood more efficiently. The problem arises when the heart can’t pump enough oxygen-rich blood to meet the body’s needs, reducing blood flow to the brain and other organs. This can cause dizziness, fatigue, shortness of breath or fainting.
Who is at higher risk: adults over 65, people with coronary artery disease, previous heart attacks, high blood pressure, thyroid disorders, congenital heart conditions or those on certain heart or blood pressure medications.
The cause and pattern of a slow heartbeat can vary, depending on where in the heart’s electrical system the problem begins.
The sinoatrial (SA) node produces signals more slowly than usual. It is common in athletes, but also linked to ageing or medical conditions.
2. Sick sinus syndrome
The SA node malfunctions, causing pauses or alternating fast and slow rhythms.
3. Heart block (atrioventricular block)
Electrical signals are delayed or blocked between the heart’s upper and lower chambers, ranging from mild to severe.
Many people with bradycardia don’t feel any noticeable symptoms. But when the heart slows down too much, the body starts showing the following common signs:
Signs of worsening bradycardia
A slow heartbeat can be caused by a number of factors, some within the heart itself and others linked to the rest of the body. Some common causes of this condition are:
Risk increases with older age, high blood pressure, diabetes, obesity, smoking, chronic kidney disease, sleep apnoea and a family history of heart disease.
The cardiologist looks for the reason behind the slow heart rate and whether it is affecting heart function. This evaluation may include:
These tests help determine whether observation, medication changes or a pacemaker is the most suitable treatment.
Treatment of bradycardia is based on the cause, severity of symptoms and your complete heart health. The treatment options involve:
People with mild sinus bradycardia and no symptoms may not require immediate treatment. Regular followup is usually enough to monitor the condition.
Some medicines used for heart disease or high blood pressure can slow the heart rate. Your doctor may adjust the dosage or recommend an alternative medication if appropriate.
Managing the underlying cause can improve the heart rate. This may involve:
Medication is usually reserved for specific situations rather than long-term treatment. In emergency settings, medicines may be given to temporarily increase the heart rate until further treatment is planned. Depending on the cause, other medicines may also be considered under specialist supervision.
When symptoms are significant or the heart’s electrical system is permanently damaged, a pacemaker may be recommended. A pacemaker is a small device implanted beneath the skin near the collarbone to deliver electrical impulses whenever the heart slows excessively. Pacemaker implantation is a minimally invasive procedure that usually takes one to two hours.
Recovery depends on the type of treatment received. Patients who undergo pacemaker implantation are usually discharged within one or two days and can gradually return to their normal routine over the next few weeks. Your doctor will advise you on when it is safe to resume work, exercise and other daily activities.
The follow-up care may involve:
Adopting a positive lifestyle, such as eating a balanced diet, staying active, managing existing medical conditions and avoiding smoking, can help maintain your heart health and reduce the risk of future complications.
Managing bradycardia requires input from multiple specialists, particularly when the condition is associated with other heart disorders. At the CK Birla Hospital, patients have access to:
If you are experiencing persistent low pulse rate symptoms or have been diagnosed with bradycardia, consulting a cardiologist or an electrophysiologist can help determine whether treatment is needed. The heart specialists at the CK Birla Hospital, Delhi, provide detailed evaluation and personalised treatment plans.
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Yes. If bradycardia is caused by medications, thyroid disorders, electrolyte imbalance or other reversible conditions, treating the underlying cause may restore a normal heart rate. A pacemaker is generally recommended only when symptoms are chronic or the heart’s electrical system has permanent damage.
No. Many people, particularly athletes and physically active individuals, naturally have a slow heart rate without symptoms. Treatment is usually considered only when bradycardia causes symptoms or affects blood flow.
Bradycardia is evaluated and treated by experienced cardiologists at the CK Birla Hospital. Patients with complex heart rhythm disorders or those requiring pacemaker implantation may also be managed by an electrophysiologist, a cardiologist with specialised training in diagnosing and treating abnormal heart rhythms.
