AF Association
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Why?

The one thing that is constantly mentioned by the medical profession, is that a normal pulse/heart beat, ranges in the 60 to 100 mark! The question I would ask is; Why are many of us, (including myself) (and the medical profession for that matter), accepting that it is right to have a pulse rate in the low 50s/high 40s, bearing in mind that it is not the "Norm"?

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I don't think they do unless one is an athlete- they call it bradycardia of course ( I have it!) but don't take any action until it gets low enough to cause more problems than a pacemaker would .

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rosyG.There are many on here who are not athletes. A lot of the feedback informatively mentions that blah medication gives them/me certain symptoms, including in many cases a lower than normal pulse - I am wondering as to why "We" are not striving to get back to "normal" range.

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That’s a different case really if it’s meds causing the low pulse rate and the dose age would need adjusting perhaps ?

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I guess what I am saying is; Why aren't the medical profession aiming for normal? Why are they accepting that outside the normal range is acceptable?

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Maybe they think a little low with meds is preferable to very high in AF without meds?

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I am thinking that not enough fine tuning is being done with meds/tablets to get people back into normal range. Bearing in mind that most of us have zoomed up to 200+, then normal ie 60+ would be going down the right road. Don't get me wrong, the low 50s that I have is comfortable - unfortunately..... not normal tho. Having said that, a low pulse rate (when you are not an athlete) imo does not help to keep my blood pressure down (due to my heart not working hard enough) (purely my own thoughts). The reason I am mentioning various points, are because some seem rather contradictory in terms of treatment.

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john6

You raise an interesting semantic point. My random observations are

1. The reverse of normal is abnormal which sends out a potentially worrying message

2 . Two standard deviations from the mean under a bell curve encompasses one definition of normal. Outside that range increases the probability of pathological abnormality.

3. Targeted investigation outside an arbitrary "normal " range is generally more productive.

4. Substituting usual for normal may be helpful.

5 But yes informed advice is to consult your doctor if your heart rate is outside range 60-100. In an ideal world perhaps?

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My take is that outside the " normal" range is a sign one should consult a medic who then, following investigation will use his/ her clinical judgement to ascertain whether a particular rate is normal for you. What is normal for me is not normal for another. We are all different. I have odd episodes which others would fly to the doctor with but after 10 years of them I am still here so now they are "normal" for me.

A bit off topic but years ago I was dancing in a somewhat inebriated state with a psychiatrist. Says I "don't know why I'm dancing with you, I don't need a psychiatrist" immediate reply " whoever told you that?"

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Without seeking out the historical origins of how this "normal" figures were accepted, you make a point which trumps such norms. If someone is otherwise healthy then something unusual can be accepted. I have lab tests etc dating back over 20 years. My potassium level is always a little too high. So when it recently became "normal'' I flagged it as suspicious. What matters is change, not the absolute value.

I like this book: . Rose T & Ogas O. The end of average: how to succeed in a world that values sameness. Penguin: Allen Lane, UK 2016

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Good point John, I think the medical profession are fully conditioned into responding to emergencies only, in their specialty field only, and loose sight of 'the whole person' health.

I always had a low pulse and BP at 60 and 115/65 respectively now aged 64. The Flecainide I was put on 4 years ago, although supposedly just a rhythm drug, reduced my pulse around 5 points, so now 55. I don't think this is fast enough for good overall health, so I pack in as much walking, up and down stairs during the day as I can to get the rate up.

No point mentioning it to the medics, who would no doubt consider that's not 'an emergency'.

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My normal had been 48-52 after being on propafenone it eventually dropped to 33 and I thought my bp machine at home was wrong, ended up in ER in afib. So it went from 33 NSR to 150 in afib. When they converted me, yes it was 33 in ER. I ended up with a pacemaker due to meds.

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This was recently discussed at the patient support day in Exeter. Although the ‘norm’ is accepted as 60-90 latest thinking is that unless the HR exceeds 120 for some time, then it wouldn’t cause concern.

Ditto for a low HR, the determining factor is - how symptomatic are you?

It was admitted that often a blunt hammer is used to crack an egg - basically there are no one effective Pharmaceutical for everyone - we are all so individual and react so differently it is a suck it and see approach.

Hopefully - if this AF epidemic is as huge as it is looking - we may get more effective treatments in the future. Research follows the money - Which follows the potential earnings.

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Interesting. I'm not an athlete but my pulse is around 45. When prescribed flecinade and bisopropol it went to a temporary drop to 38 it is now back to 45. I have always thought that 45 is too low but my ep assures me it better than too high! More research needed.

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I can see his reasoning that lower is better - than an extreme higher. Having said that, I feel that the medics are taking that as a (done) job - when it is not. That type of medical patching up, will imo, eventually cause high blood pressure problems, due to the heart not working our blood through the arteries hard enough, (especially those who are older and less active). Younger people would probably get away with it due to a more active lifestyle.

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Totally agree. It's more like putting a plaster on it. Because the medication( all 12 tablets ) are keeping the incidents under control they seem happy to not see me anymore!

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Isn’t the timescale and frequency of relevance as well? How many of us record the same HR throughout the day? I sometimes have a HR below 60 but not every day and not for more than a few minutes.

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In fairness some valid points. However, it still comes back to a lower than what is considered the norm resting pulse. To my way of thinking, we/they should be aiming to get back to what is considered normal. Imo blind acceptance will possibly bring further problems down the line.

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Surely pulse rate is a symptom, not a cause in itself to be concerned about.

If I have a larger than average stroke volume (or heart) for the size of my blood system, my heart will need to beat more slowly than average to maintain the same pressure and blood flow than someone whose heart has a smaller stroke volume relative to the size of their blood system.

The net effect of those ratios may put either of us at the extreme of the bell curve - someone has to be at the extreme of every bell curve.

But surely it's not the pulse rate per se that should be the cause for concern, but rather whether that pulse is causing insufficient or excess flow/pressure. Too little flow could starve the body of oxygen unless compensated (e.g. by an idle lifestyle or a higher volume of oxygen bearing cells - in which case the causes of those should perhaps be considered first). Conversely, too much flow could cause excess pressure and risk of aneurysm, etc.

I think I would rather a doctor consider the pulse rate "symptom" in the context of the flow and pressure, and assess the balance of risks to the patient of taking action on it versus the risks of not doing so, than see him act on it as if it were an absolute to be corrected.

Steve

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Surely we are talking about being outside of the already set extremes! I understand a doctor (to a degree) going lower in order to alleviate the threat of a stroke, unfortunately I think that they may be missing a trick by not recognising that too low could result in a high BP.

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Excellent points.

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I agree that a medically induced low pulse rate is generally accepted as being OK. However, when you are so tired you fall asleep every time you stop moving, when walking you stop dead in your tracks when you hit the tiniest of inclines, when you have chest pain when your pulse dips into the 40's... it's time to complain. I know because I do all these on a tiny dose of Bisoprolol - and no, I am not nor ever have been an athlete. If you can't tolerate a low pulse, you need to do something about it.

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I would like to think that the post is not so much about intolerance of any of the drugs/tablets that we take. The point that I was trying to bring forward is; Are the drugs (Whatever they be) in the long term going to cause other issues by imo being incorrectly applied? As mentioned, many of us (including myself), have accepted a (lower than normal pulse)! My pulse is in the low 50s and feeling comfortable, having said that, I recognise that the effort that I have put in, is not reducing my BP as much as I would like. This set me thinking that a lower than normal pulse rate for an older person, is likely to cause higher blood pressure, in turn possibly causing the very "Stroke" that we are all trying to avoid.

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At the risk of extending this story with horrific low pulse rates - surely the best way is the 24 hour ECG? Last summer after returning from a transatlantic flight my ankles had swelled up, so after prompting from my doctor son I went off to the GP - she sent me off to the A&E (do NOT drive she said) - I had a pulse rate of 32 and was in AF. I had a 24 hour ECG which showed that my pulse during sleep dropped as low as 20 and that there were 5 second gaps between beats at times!

I have always had a lowish pulse rate - late 40s/early50s and used to be able to "think" my pulse down to around 36. I had no other symptoms at all - no tiredness, dizziness, passing out etc which come with bradycardia.

Since diagnosis I have had a cardioversion - didn't alter the heart rate and AF came back after 5 days, so at the end of August had a pacemaker fitted and underwent two ablations - the first didn't even get into the heart properly and the second earlier this month seems to have done the trip and got rid of the AF - I am particularly glad to have stopped the Amiodarone which didn't agree with me.

Overall my point is that its possible to have a very low pulse rate with no discernible symptoms and function normally without being an athlete. I have always exercised and still go to the gym and cycle but there is no way that I would consider myself an athlete

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Glad you stopped Amiodarone should only be used as last resort caused liver failure in my husband should not be used if you have thyroid problems, terrible drug. Wishing you all the best.

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Tbh I find a low pulse rate quite pleasant. In your case you appear to be an exception, insomuch you have always had it, no doubt that your body/system has adjusted accordingly. It would appear that most fall into the 60/100 range, who are in many cases now into the high 40s/low 50th (not the norm for them). My question is; Are the drugs/meds that are keeping us at an abnormal low heart/pulse rate - going to cause another problem ie a stroke, because our heart is not pumping blood hard enough through our arteries......thus narrowing/keeping them narrow.

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