A slow heart rate which is medically known as bradycardia is not an uncommon occurrence in the elderly. In most cases it is a temporary fluctuation in the heart rate and rapidly restores within minutes. However, sometimes it becomes a recurrent problem or persists and can be dangerous. Normally the heart beats between 60 to 100 times a minute. Very fit people, like professional athletes, may have a lower heart rate and sometimes sitting below 60 beats per minute. This is considered normal for these individuals. However, for the vast majority of people a heart rate below 60 beats per minute most likely indicates a problem and therefore needs medical attention. It should not be mistaken for a sign of fitness in the elderly.

What is the heart rate?

The heart rate is the number of times the heart beats per minute. The heart being a muscular pump that beats throughout life needs to maintain a certain rate to maintain adequate circulation. Every time the heart beats, oxygen rich blood is pushed out throughout the body. As it relaxes, the heart fills again with blood. If the heart beats less than 60 beats per minute, less oxygen rich blood is supplied throughout the body. This means that cells throughout the body are slightly starved of a sufficient supply of fresh blood. Most cells can survive for a fair amount of time without adequate oxygen, but the cells in the brain are very sensitive and reacts almost immediately if its blood supply is hampered in any way.

Causes of bradycardia

Bradycardia can occur for any number of reasons. The activity of the heart is controlled by an internal electrical system known as the sinoatrial node (SA node) which i the natural pacemaker. This carefully coordinated mechanism can become interrupted at some point which eventually leads to a slower heart rate.

The most common causes of bradycardia in the elderly is related to :

• Medication, particularly those drugs used to control an irregular heartbeat, high blood pressure, and certain psychiatric disorders.
• High blood pressure.
• Age-related changes in the heart and its pacemaker.
• Dehydration.
• Heart failure.

There are several other causes of bradycardia, but those mentioned above are among the more common causes in seniors.

Signs and symptoms of bradycardia

In many instances bradycardia is asymptomatic meaning that the are no symptoms. It is only once the condition reaches the point where the oxygen supply to the body’s tissues is insufficient for it to function properly that the symptoms become evident. This is particularly the case with the brain tissue which is very sensitive.

These symptoms of bradycardia include :

• Dizziness
• Weakness
• Tiredness
• Shortness of breath
• Decreased endurance and stamina

In more severe cases, the person may also experience episodes of fainting, confusion, blurred vision, poor memory, and chest pains. The symptoms closely resemble a heart attack or stroke.

Treatment of bradycardia in the elderly

Bradycardia can arise with many conditions and it is therefore important to first tend to these disorders. Successful treatment and management of the underlying cause will ultimately restore a normal heart rate.

Another important factor when treating bradycardia is to reassess the use of chronic medication. Sometimes bradycardia can occur when

• the incorrect dosage is used,
• medication is mixed up and may be used simultaneously with other drugs that can cause drug interactions,
• or the body’s tolerance to a certain dosage has changed all the time.

Older patients should therefore consult with a geriatric physician to have the drug regimen changed if necessary. Never stop or change the dosage of any medication even if it seems to decrease the symptoms without first consulting with a medical doctor.

Once the natural pacemaker of the heart is compromised, either due to heart disease or age-related dysfunction, then an artificial pacemaker needs to be inserted. These pacemakers are lifesaving devices that can improve one’s quality of life and ultimately extend a person’s lifespan.