Low heart rate: I am 21 yrs old. So... - British Heart Fou...

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Low heart rate


I am 21 yrs old. So recently my cardiophobia has gotten worse and I'd like some reassurance if anyone can provide any.

So my sleeping heart rate averages low 50s, when I sit it ranges from 50-80 and when I'm walking around it is 80-110 depending.

My concern is that it gets too low when I sleep.

I live a sedentary lifestyle and so I am not active or fit at all. I've had ecgs, holter monitor, echo and stress test done last year and the results came back fine. My BP is also normal. I also have no history of heart problems, besides palpitations.

However last year, my rhr was higher than it was this year. I'm scared that it will go even lower when I sleep, I have had an instance where my apple watch notified me that my hr dipped to 34 once when I was sleeping earlier this year.

When I lie down after standing up, my hr slows down really fast as well.

I also used to have constant palpitations where I can also feel my heart beating in my chest, but now I have to really focus to feel it beating.

I'm just wondering why my hr is so slow, since normal resting hr is between 60-100, when I'm not active at all. Should I be worried? And is having an echocardiogram good for detecting any possible heart problems? Since I got it done last year and doctor said everything is okay, should I get another one this year?

37 Replies

my resting HR during the day is normally mid 50’s.. lowest recorded while sleeping is 39.. last few nights has been 42.. have been advised by GP and Cardiologist to get help if i feel particularly unwell when it drops.. this happened once when i felt really uwell.. had to call 111 who sent out an emergency ambulance.. spent 2 nights in hospital..

would advise you to call 111 or 999 if you start to feel unwell

borahae in reply to Manhattan1

hello, sorry to hear you are experiencing this. What do you mean by unwell?

Manhattan1 in reply to borahae

dizzy.. nauseous.. chest discomfort.. feeling as if you may pass out

Your heart rate ranges sound normal, but it wouldn't be appropriate for us to give you false assurances here. If you have concerns see your GP, or ring 111.

If one has complete heartblock then the heart rate is in the low 30's. Have it checked out and do tell your GP about heartblock.

borahae in reply to Palpman

would a heart block appear on an echocardiogram? Because I had that done last year and everything was normal. I also had an ecg done last month and it was fine too

Hiyaall in reply to borahae

Yes it would how accurate are Apple watches? Ask for a 24 hour ecg it would be more accurate

The ECG would state the type of block you have. Could be 1'st 2'nd or 3'rd degree heartblock with class 1, 2 and 3 between. Or it could be Bundle Branch Block left or right.

It is important to read the machine's diagnoses as the ECG does show all the heartblocks but it is complicated to interpret.

borahae in reply to Palpman

it just says sinus rhythm does that mean its normal?

borahae in reply to Palpman

it just says sinus rhythm does that mean its normal?

Palpman in reply to borahae

Not necessarily. It may be in NSR but also have anomalies. It would state the duration of P, QRS, QTc that the doc would have to interpret. It would not tell you if the durations are irregular.

What is written on the top of your ECG. I may be of help.

borahae in reply to Palpman

Im just wondering that if there were some abnormalities why wouldnt the doctor point it out?

and what do you mean on top of my ecg? sorry for the questions

Palpman in reply to borahae

It would be printed on the top of your ECG trace print out.

borahae in reply to Palpman

on top of my ecg it says normal ecg unconfirmed? it doesnt list anything else

Charlie_G in reply to borahae

Across the top of the pink print out it usually lists anything detected. For example, I have an arrhythmia that is normal sinus rhythm but stuck at mega speed, which for me usually results in some anomalies with other parts of the trace (for example Q, P, ST elevations), and these are listed in an ecg printout. To properly interpret these, however, you generally need to be able to read the ecg and have the cardiac understanding to determine what’s significant and what’s not. Anything of clinical note would have been explained to you, particularly things like heart block: even though first degree heart block rarely has symptoms, you still would have been told about it. Second degree usually causes significant symptoms, and third can be a medical emergency: what I’m trying to say is that whilst Palpman is trying to help, a condition like heart block wouldn’t have been ignored. Had they found anything relevant on the ecg or any of the other tests, all things being equal, they would have flagged it with you and provided treatment and guidance as appropriate.

It’s ‘normal’ for sleeping hr to drop below 60. For some people, it’s normal for daytime hr to drop below 60. In reality, an average heart rate of anything between 40 and 100 bpm is considered acceptable in the absence of any cardiac issues or symptoms that suggest otherwise. Palpitations in and of themselves are also common and not necessarily a concern, and an absence of palpitations would have me jumping for joy to be honest. No palpitations is a good thing, not a reason to worry there’s something wrong. Also, as long as it hasn’t jumped up to something like 120+ without good reason, a heart rate that drops back to resting rate quickly is also a very positive sign. I would be much more concerned if it was taking you 5 minutes or more to get back down to your rhr, or if rather than going to resting it suddenly plummeted past that to below 50.

It sounds like you’ve had the full gamut of tests to establish whether or not there’s anything wrong with your heart, and everything is coming back normal: go out, live your life, and if you start getting symptoms of something being wrong, worry about it then. Palpitations in the absence of any other symptoms or concerns is very often not that time. It might also be worth considering whether your Apple Watch is reassuring you about your heart, or actually adding to your anxieties, particularly overnight? Just a thought.

borahae in reply to Charlie_G

hello thank you so much for your input. I've developed cardiophobia due to an anxiety attack early last year. I'm always convinced that there is something wrong with my heart since I do have some symptoms which makes me thinks so but it overlaps with other possible health issues.

I keep thinking that perhaps the doctors have missed something. Or that I may have developed a heart problem within the last month and need to get everything checked again.

I have to admit that I've developed obsessive habits over my heart rate and my apple watch doesnt make it easier.. It's to the point where I am not sleeping at all because I'm scared something might happen to me when I'm asleep

Charlie_G in reply to borahae

Anxiety is awful. I’ve never had health anxiety, (which is fairly ironic considering all the things I’ve had wrong whilst still only being in my mid 30s), but I have previously suffered with generalised anxiety and had panic attacks, so I can completely empathise with how you must be feeling. The physical symptoms that anxiety can cause really do have to be experienced to be believed, and it’s no surprise that people experiencing intense anxiety can become fixated on something physical having to be wrong. It also makes complete sense that many people with health anxiety worry so much about their hearts when you look at the common physical symptoms that come with anxiety, and the fact that the heart is 50% of what keeps us alive.

I think the key thing has to be about balance: I’m not going to patronise anyone and say doctors don’t make mistakes, because the unfortunate reality is that doctors can and do make mistakes, and it’s happened to me more than once. They’re only human, the same as us. But checks and balances do exist to try and catch those mistakes, and the incidence of really serious mistakes in the UK is thankfully very low. I would also never, ever say to anyone that the symptoms they’re experiencing were definitely anxiety, because I’m not a doctor and that’s not a statement I’m qualified to make. Unfortunately, I think there’s huge stigma attached to mental health issues (from experience), and some medics are far too quick to dismiss things as stress or anxiety when there is a genuine physical cause, so I would *always* encourage people to seek medical advice or tests if they were concerned, even if the medics weren’t taking it seriously.

The thing is, though, if your condition/symptoms aren’t deteriorating in any way, and you’ve had all the appropriate tests to determine a cardiac issue to explain the palpitations (beyond the fact that some people just have a much greater awareness of their own heartbeat than others), then at some point we all have to accept that there’s either nothing wrong or that there’s nothing that can currently be found. To give you an example, I have a diagnosed cardiac condition, an arrhythmia. Prior to that arrhythmia in my mid 20s, I had never, ever had palpitations in my life. Not once. Since my arrhythmia was diagnosed, even though it’s well managed with medication and I haven’t had an episode in 5 years now, I have loads of palpitations. Really intense, bounding ones in my chest and throat. Some that can even wake me up from my sleep. They’re horrible, even having experienced them for so long, but I’ve learnt to live with them. Why? Because bar a loop recorder, I’ve had every appropriate test to try and determine if there’s anything pathological behind them, something of concern, and it’s all negative. I had symptoms whilst on a holter, and there was nothing of note. They’re not getting worse, or better, they just are and have been for several years now, and my choices are to fixate on them and let the fear of them rule my life, or put my faith in 2 different cardiology teams not both being wrong, and accept that they can’t find a reason for them that I currently need to worry about. If at any point my symptoms change at all, or worsen in any way, then I will seek fresh advice and push for a referral or tests if I feel I’m not being listened to, but...we only have one life. Unless you have a faith or belief system that believes in reincarnation, we get one shot at this. Just one. If we spend our days unnecessarily worrying about how or when we’re going to die, we’re missing out entirely on living. That’s time that could be spent making the most of what we have so that when the day does come, whenever that is. at least we can say we did everything we could in the days or months or years we were allotted.

It’s far easier said than done, but all anxiety can be managed with time, and the right treatment, and effort. Because unless you’ve been there, people don’t realise that it takes a huge amount of effort to go against the cycle of thoughts anxiety triggers. To do the opposite of what your brain is telling you. To fight your instincts. But you already are by even posting about these things and challenging those thoughts that you have. Half the battle is recognising the problem, the other half is deciding what you’re going to do about it.

Charlie_G in reply to Charlie_G

Just an additional thing I should have mentioned, but have you made any lifestyle changes like cutting out caffeine, alcohol, cigarettes? For those of us with arrhythmias, that can make a huge difference to the frequency they’re experienced for some people. My benign palpitations were always far worse after caffeine or alcohol. Another thing that is well known to exacerbate palpitations generally is insufficient sleep...

borahae in reply to Charlie_G

Hello, thank you so much for your words. I feel like this severe anxiety has eaten away the past two years of my life, and its sad since I'm only 21. I do believe I manage my anxiety and depression better than I did last year but sometimes it just gets really hard.

I just keep thinking about the mortality of human beings and how easy it is to just die, I have had thanatophobia ever since I was a kid as well.

I guess I just really need to start making changes in my life..

As for the palpitations, I only ever drink water and my sleep has always been bad. But I think my overall stress has lessen

Excellent answer and hopefully it will reassure borahae so he can relax and enjoy his life.

I am so sorry you are going through that at your young age. However it is my understanding that when asleep a heart rate of 40–50 BPM is common, and is considered normal. Speak to one of the nurses if you are worried. Which you are. Anxiety is terrible and can do all sorts of things. The imagination runs riot. Truly I am so sorry at you tender age that you have to have such worries and anxieties and I do hope you can get something sorted to allay your fears.

Hi there

If your cardiologist is happy that every thing is ok try not to think too much about it but personally I would go for a second opinion and if all clear then try to see someone for your anxiety if it is not getting any better

It is scary when your heart goes very low or very high

my sister’s heart rate was 28 during her pregnancy but her dr was happy that every thing was fine!

Exercise ,mindfulness should help

Good luck

Well it is quite easy to think oneself into worries, which may turn out to be groundless. Certainly I would put little faith in an apple watch monitor. From what I have been advised, the heart would normally not allow the rate to drop below 40, my gp told me that there is an automatic self-protection system. Take proper medical advice, get fit and try to stop worrying.

Is there a reason why you follow an inactive lifestyle?

borahae in reply to Ianc2

I have depression and gp said I might have chronic fatigue syndrome. It is extremely hard for me to find motivation to get out of bed when I wake up. Throughout this quarantine I've just been glued to my bed. The last time I've been active was back in 2015 when I was still in high school

Hi, no worries my heart rate is really low 37/38 during the night when I'm sitting on the sofa and 80/85 when I'm working , during the activity goes up to 150/160 if I do an intense exercise but my average is 43 .

So don't worry a low heart rate is an healthy heart. Salvatore

NO. No you should not be worried unless you have a condition you have not alluded to. In fact HR 50 to 80 Is a better health check for resting heart. Mine is between 45 to 50 bpm during the night. It is not uncommon for these values to be experienced. As I say, unless there is a problem you have not indicated, you are lucky to have such numbers. Take care Ian

If there was an issue I’m certain your cardiologist would have went over it with you.

Normal heart rate is between 60 and 100 BPM but it does not mean that anything that falls out of that range is abnormal.

If it makes you feel any better when I was your age I also had a low resting heart rate. One time I was in the emergency room and fell asleep. A bunch of nurses and the dr ran into my room shaking me awake. They asked me how I felt and I was feeling fine, they said they woke me because my heart rate dropped down to 28 but for some reason during sleep this was normal for me. I had many holter monitors that caught my heart rate in the 20s and 30s during sleep. My cardiologist was not concerned.


Like others responding my heart rate is below "normal" and has been for some time. Usually around 40-45, it drops below 40 (lowest has been 33) whilst asleep. Have had various tests and in the absence of any symptoms of lack of oxygen to the organs of the body and in the proven absence of any heart block neither my GPs or the cardiologist seem worried. Whilst on the treadmill, I can elevate it to over 125 and then at rest it settles down again to the 40s or 50s. Have been hypertensive for many years but this is well controlled on amlodipine 2.5mg od. Don't think you have anything to worry about if your cardiologist seems happy and you don't have any symptoms of cerebral hypoxia (light headedness, fainting, increased tiredeness).


Art W

As well as following all the good advice given in these posts you should consider asking for professional help for your anxiety and you should become active. Couch to 5k comes highly recommended.

Hi, I can only reiterate that it sounds like you are perfectly healthy. Even if Doctors do miss things, this is rare, 99.9% of the time they will spot any abnormalities. At just 21 your body and internal organs are all likely to be in great shape. So please don't worry, especially if you are showing no symptoms.

Of more concern is your anxiety and it is really this you need help with. I too suffered with health anxiety through my 30's, especially the heart. I was convinced I was going to die at any given moment or chest pain or palpitation. It really held me back and stopped me enjoying life. It turns out all these worries and phobias are related to incidents in our lives. Some thing will have happened to make you worry like this, more than likely in your childhood, it could be a family bereavement or some other traumatic incident. In my case it was losing my father in law when I was 25 (he was 55) to a heart attack, he was ill for sometime and didn't look after his health and had hereditary problems. So it was on the cards, but even so it hurt my wife unbelievably and in turn me.

It took me until a few years ago when I did some NLP (Neuro Lingusitic Programming) work I discovered the root cause of this phobia and anxiety. It also resolved it, very easily! So much so I am now a trained practitioner in NLP. The mind is the most powerful organ in your body and has the ability to make the irrational and illogical seem rational and normal. It's only when you unpick these illogical though patterns and behaviours that you can get to the bottom of them and solve your worries once and for all. I have done it and seen many other too with some terrible phobias.

Good luck and please try and get some help for this.

borahae in reply to Thecyclist

Thank you for reassuring me. I'm sorry to hear that you have suffered from health anxiety too. My fear of death occurred when I was a child and I don't remember why, all I remember is staying up countless nights just thinking about death which also lead me to my chronic insomnia. I've also always been quite the hypochondriac, but it wasn't as debilitating as it is now. I started seeing a therapist last year but I stopped because nothing changed. I should perhaps find another one soon.

Hi have you thought about asking your GP to take your blood pressure while standing? Not just while sitting down like they do. My blood pressure was always done while sitting, and was always ok. Until one GP decided to do it while I was stood, and my blood pressure drops while I stand? I hope you get help with your anxiety? I am 59 years old and only found out after passing out at work, in 2018, that I was born with a congenital heart condition. That was missed. Like you my heart rate drops and goes up.

Regards Denise.

You needn’t worry at all. Mine is extremely low as well. Has been pretty much my whole life. My daughter is the same and she’s 18. If all your tests are pretty much normal and you feel fine example no dizziness etc then live your life and don’t worry😁

I agree with Still Concerned below, we shouldn't be stopping you from checking with your GP.

But for reassurance my RHR is often 45-48bpm. My GP said gosh but said it was alright and my head cardiologist said so long as I was functioning normally I was not to worry. That was 2 years ago and I have learnt to not worry unduly about it.

You need to call for emergence assistance when your condition becomes that low. Take care.

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