Bradycardia or not!

[Confused01]

Hello,

I wonder if anyone can shed light on something or experienced similar?

A couple of years ago I was diagnosed by A&E with bradycardia (by ecg only), followed up by confirmation by a cardiologist . after he did all the gold standard main heart tests. No treatment. This was added to my nhs records.

I then had to see a different cardiologist regarding syncope. He went over all my heart test results, including many ecg’ss, heart monitor for two weeks etc. He diagnosed my syncope but also said I don’t have bradycardia, though bmp on the low side (54-58), low blood pressure.

I am now at a loss. My health watch frequently shows under 60cm but sometimes it bounces from 54 straight up to 115 and straight back down.

Obviously a diagnosis of bradycardia has to be declared for many things, including insurances and dr’s often blame bradycardia for other symptoms (nothing major).

Where do I go with this? Am I misdiagnosed? Should I discuss with my gp and ask for bradycardia to be removed, if they can? Which cardio is even correct?

Confused.com 😊

[BobD Volunteer]

Normal heart rate is betyween 60 and100 but there is generally an "soft" allowance of ten either way so technically a rate of 54 to 58 is borderline. That said syncope is caused by something, usually HR dropping suddenly . I did for a while suffer pre-syncope where I stareted to feel as if I was passing out but never did and subsequent tests resulted in my pacemaker being fitted about three years ago. No problems with DVLA or insurance.

[Confused01 in reply to BobD]

Hi,

Dr’s now believe I have recurring vasogal syncope. I always get the pre warning, for 30 seconds about. Last two events were worse than before, one with loss of consciousness and form of fit. Takes days to get over.

I agree the vasogal syncope diagnosis but I’m kind of lumbar with bradycardia as a separate condition. Seems it’s part of the syncope but wouldn’t be all the time. Then there is the sharp 58-115 and back down immediately bpm.

Interestingly insurance questions ask re AF , which bradycardia comes within, as part of vasogal syncope.

I just don’t want bradycardia diagnosis sitting on my records if it’s not the case. It’s clearly not very low and it runs in the family along with low blood pressure (both involved with vasogal syncope reacting).

Did you have a pacemaker purely due to the near fainting events? Are you nhs?

I’m thinking if my passing out continues I maybe should request something is done about it. It doesn’t happen very often but does block me from some insurance and driving.

[BobD Volunteer in reply to Confused01]

My EP saw things on my ECG which he did not like and spent two years convincing me a PM ws the right thing to do ( it meant I had to stop electric welding amongst other things) but one particularly close call made me agree.

[Confused01 in reply to BobD]

I must say gobsmacked how life changing it can be. I guess for me I will have to see how the severity of events go as the last two were considerably worse. If continues I will go down the route of a solution.

Thank you for your replies.

[JOY2THEWORLD49]

Hi

Seemed to me you need a Heart Monitor. Before H/Specialist gets you in for a conversation he asks for EGC, Weight, then after ordered a Heart Monitor.

I had 3 in 2021 before when on Metoprolol breathless on exertion.Found 186 avg bpm Day and pauses at night. Changed to Bisoprolol no breathlessness and no pauses.

Another Heart Monitor Day 156! Still uncontrolled. Aim 100 or under.

2 years 3 months now.

Left so my Locum who has had AF sent me to a private Heart Specialist.

Introduction CCB Diltiazem. 120 CD mg early AM.

Still remained on 2.5mg Bisoprolol for BP. Take PM.

H/R now 60s.

In the latter part of 2024 my BP went low so I weaned off it.

Settling H/R 60s till afternoon creeps up to 90. Still under 100 and controlled.

My night Rate normal stays at 47avg bpm. Great.

Diagnosed with Stroe, Rapid and Persistent AF and 4 days in Thyroid Papillary Cancer so it caused the AF which caused the left frontal lobe - a clot/ stroke.

Be patient and ask your questions. Choose your best specialist.

cheri JOY. 76. (NZ)

[Confused01 in reply to JOY2THEWORLD49]

Thanks for replying. Sorry to hear you’ve been through so much.

I have had all the gold star scans, two heart monitors a year apart (both 14 days each). Showed bradycardia, sometimes as low as 29 bpm but not that low all the time. Rarely with a high jump.

Not on meds to cause. I do have spine issue which I read can make a difference but they won’t take into account.

Diagnosed first by A&E after simple ecg (as good as that moment only), then after heart scans alongside several ecg’s by cardiologist and again after severe syncope events by a different cardiologist. Latter cardiologist says no bradycardia by looking at my previous holt results and other cardiologist report. Basically he disagrees sighting vasogal syncope caused by a series of metabolic body and environmental events simultaneously.

So it’s a dilemma that I cannot get to the bottom of. I don’t want my current bradycardia diagnosis sat on my records if incorrect.

[ForensicFairy]

Your post is confusing. Bradycardia is a symptom, not a diagnoses. It usually signifies an underlying condition and is often caused by or exacerbated by many cardiac meds.

You can have bradycardia today, but not tomorrow. Your heart rate constantly changes and is meant to constantly change. Wide variations are not usually normal unless you’re active or parasympathetic nervous system response has kicked in high mode.

Athletes can have bradycardia because of their cardio fitness. Others can have it because of things like heart block.

[Confused01 in reply to ForensicFairy]

Hi,

Exactly…but I have confirmed cardio letter stating bradycardia diagnosis. My gp records now state bradycardia, my insurance takes and requires bradycardia to be declared (as AF too). Incidentally mine is 100% NOT to being young, very fit etc.

My Cardio Dr most recently seen, told me what you have said, which I had also read previously. He doesn’t think I even suffer with bradycardia yet it falls within the syncope diagnosis he has given. Insurance companies confirm this for screening.

I really just want to know if bradycardia should be on my gp records or is it unnecessary?

Note ; I have had the full gold star heart scans which were all normal.

My bmp are not constantly very low and I believe to be bradycardia they would be, rather than up and down.

Variation of consultants opinions is the issue here tbh.

[bantam12 in reply to Confused01]

I had bradycardia but it wasn’t all the time, took them 2 years of monitoring to catch it. I only had pre syncope which was largely ignored until the monitor showed 2nd degree heart block so I then had a pacemaker fitted.

Your complete blackouts sound alarming and very much the same as my late husband suffered with, again repeat monitoring never picked much up but then he had a serious collapse and was blue lighted in, they found complete heart block where he needed an emergency pacemaker op.

Rather than soldier on with your collapses maybe something more should be done in case it turns out to be a serious heart block.

[Confused01 in reply to bantam12]

Hi and thanks for replying.

I’m litterally stuck in the middle of two cardiologists contradicting which I am signed off from both and my gp is as useful as a chocolate teapot as they are not specialists. So frustrating.

I’m thinking the only think I can do is see if my vasogal syncope severe events happen again. Last one with loss of consciousness 😬 . Symptoms around the event aren’t akin to fainting though, I’m sure. Maybe environmental though. If happens again so severely I will have to push for cardio again to consider treatment. My poor husband is terrified when happen.

x

[bantam12 in reply to Confused01]

I can totally understand your husbands worries !

My husband just used to drop when he collapsed, on the deciding event even the paramedics were in panic mode as his heart was so slow and near to stopping.

Before I had my pacemaker I had 2 consultants with different opinions but I had already made up my mind I wanted a pacemaker and be done with it so that’s what happened.

I hope you sort things out soon as it’s not a nice situation to be in for you or your poor worried hubby !

[ForensicFairy in reply to Confused01]

Yeah, ok. I understand now. I’m in another country and we don’t have these issues with our health system. It looks like others have given advice so I hope you can get sorted. By the way syncope can also be a symptom of some types of tachycardia including AF, SVT and VT. Even a bundle branch block with tachycardia can cause syncope.

[Confused01 in reply to ForensicFairy]

Thank you. I wonder if there are heart issues, or around the heart, that aren’t picked up on heart scans 🤔. U.K..NHS…my area is atrocious tbh. Postcode lottery..doesn’t lend to much faith. Most private Consultants work for nhs but do private as well, so they sometimes still work on nhs basis..not all I am sure.

My last syncope was really bad and worrying, some of it not typical of fainting. I’ll see how I go.

x

[Tapanac]

both my husband and I were given pacemakers. Hope your appointment goes are sorted out ok

Pat

[Confused01 in reply to Tapanac]

Hi,

I’m signed off of Cardiology, no treatment.

If my vasogal syncope events continue or are as bad I think I will have to revisit. Doesn’t seem to be any consistency in my medical opinions to date.

[Tapanac in reply to Confused01]

Oh that’s so frustrating isn’t it. Horrible to be left confused snd twixt between.

Thinking of you and I would keep on pestering if your faints keep happening as could damage yourself if fall hard

[Redactrice]

I get bradycardia (shown by Kardia device) if I increase my dose of metoprolol to counter an episode of fast AF. It had not occurred to me to declare it along with AF when buying travel insurance. Thank you for the heads-up.

[Twosumsmum]

I have tachy/brady arrhythmias, so I have a pacemaker and high dose calcium channel blockers. My pacing is set at a higher rate so I feel more stable

[Confused01 in reply to Twosumsmum]

Can I ask what bmp you were averaging, any symptoms and are you U.K. ? How did you get to point of pacemaker with a dr?

[Twosumsmum in reply to Confused01]

My heart rate was swinging from 30-150 repeatedly throughout the day . So I had a dual pacemaker set eventually at rate of 70 . My cardiologist organised the pacemaker within a fortnight of starting apixaban . It did help but I went onto having a biventricular pacemaker a couple of years later followed by an av node ablation .

[Confused01 in reply to Twosumsmum]

I have a feeling my bmp isn’t varying enough for them to be overly concerned. My watch shows min 43 to max 116 ( not sure how accurate it is). The worrying thing is it is low then straight up high and straight back down then levels at around 54.

[Ppiman]

I would say that the term isn’t meaningful in and of itself since asymptomatic bradycardia is, so far as I’m aware, of no medical concern. It’s when syncope is caused by the lower heart rate that it matters and becomes meaningful, i.e. there is a possibility of fainting rather than just a slow rate. Then a pacemaker might be needed to speed up the rate and maintain heart output and blood pressure.

My own heart rate often falls daily to mid forties and I do sometimes feel slightly lightheaded. Whether a pacemaker lies somewhere in my future, I don’t know but it has been mentioned.

Steve

[Confused01 in reply to Ppiman]

Thanks for your reply. My syncope event loss of consciousness and severe..days to get over. Dr’s aware but just verbal diagnosis of vasogal syncope and on my way. Just really worrying that the syncope wasn’t the first but each one getting more severe. Bradycardia diagnosis before but Consultants differ in opinion (they don’t know each other).

[Ppiman]

Poor you, eh? You do have it badly. It must be very worrying. VVS isn't said to last for days, so is there an explanation of why that is what occurs in your case? To last for days means something must be measurable that is causing the symptoms. Reading about it, it seems like there are factors or triggers that you might be able to look out for or avoid.

Steve

[Confused01 in reply to Ppiman]

The after effects are a lot of weakness and wobbly walking. Does return to normal. I always get warning before it happening, all be it maybe 30 seconds.

Tested for epilepsy..ruled out.

Cardiologist has given me prevention tips, an exercise etc.

[Ppiman]

An elderly friend has had it a few times, but he always blames low blood sugar. I'm not sure that's the real cause as he also has persistent AF.

Steve

[Confused01 in reply to Ppiman]

My cardiologist explained to me as ‘happens with a variation if metabolic body things going wrong at the same time, can many or few..examples: low blood pressure, lack of salt with or without dehydration, bmp, extreme humidity/hot weather and more’.

It’s a can of worms by sounds 🙄

[Ppiman]

That sounds a good explanation!

Steve