Arrhythmias cause heart rate to drop in the 20's...cause for concern?

Hi, I'm a 38 yo female in decent shape, pretty healthy. Caffeine intake is limited to 1-2 cups of coffee a day. I haven't had soft drink in 4 years. Noticed my heart rate at rest is mid 50's to mid 60's. When I have arrhythmias, sometimes HR jumps to over 150 and sometimes it drops to 30-40, a few times it went to mid 20's. I've had a cardiac workup and just normal arrhythmias but my concern is there a drop that's too low or a spike that's too high? Normally, I don't feel anything but sometimes when the dip is significant, like from 115 to 40, I will feel nauseated or light headed. I'm concerned if I'm sleeping and my heart rate is in the 50's and I have an arrhythmia that drops it below 20. Cause for concern or not? Thanks for any input.

9 Replies

  • Hi Sheeren,

    are you estimating the rate by palpation of your pulse ?


  • I use my Apple Watch that monitors it all day/night and also compare it with a blood pressure cuff. I verify my readings with the doctors and it always matches up. I was concerned at first maybe the reading was false but it is not, it was caught on the halter monitor.

  • The problem is that both the Apple Wach and blood pressure cuff measures the pulse rate and not the heart rate. In normal sinus rhythm the pulse rate and the heart rate is equal. BUT in arrhytmias the pulse rate might be lower then the heart rate. This phenomenon is the "pulse deficit". With eventual low pulse rate youd should consult your doc that maybe you have pulse deficit.

    There is a not very accurate and accepted method, to experince wether you have missing pulse waves. Usually smartphones can monitor your pulse wave on your finger tip. I sinus rhythm you can see regular uniform waves. In arrhythmia there might be some missing beats. It neccesary to download an appropriate API. It needs little practice learn how to use it. I tested four different free APIs until I found wich one is good for me.

  • Thanks, I'll look into that.

  • Everyone is different in what may trigger their AF, however the lovely consultant who did my ablation at Birmingham said to me 'cut out the coffee or you'll be back to see me very soon' . He also told me not to get drunk and stay off malt whisky which isn't too bad for me.

    I've not had any coffee since Oct 2015 (previously one or two a day and many at weekend).

    Your system may be fine with caffeine- we are all different and I'm not qualified to advise- but it would be the first thing I'd stop for a couple of months to see if it makes a difference to heart rate.

    Good luck

  • my doctor told me that caffeine would increase my HR but not really make it decrease. It would be a great thing to rule out though. I might switch to decaf for awhile so that can be noted as a factor or not. Thanks.

  • Hi Sheeren. If it drops that low I would see / speak to the GP or consultant. Personally I think it too low a rate without some investigation, unless the consultant says so.


  • I have an appointment in two weeks. Just curious if others may have experienced this. What if I did this and my heart rate went to zero? Just scary.

  • I'm not qualified either, but I'm sure that your heart rate should never get as low as 20. I have an ICD Device and its set to pace me should my heart rate go below 44. There are many different types of Arythmia and I would get checked out with your GP. Stimulants such as caffeine will sometimes trigger tachycardia and it's good to cut this out completely. I drink decaf green tea now and don't miss coffee at all. Go get checked and insist on a Holter monitor. Good luck.

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