DR MILES DALBY

A slow heart beat can be normal and commonly occurs at night, in athletes, in many normal people and in patients on cardiac, medication. Sometimes however the heart beat can become inappropriately slow such that the pumping function of the heart is impaired resulting in symptoms such as dizziness, fainting or breathlessness.

An inappropriately slow heart beat or ‘pauses’ during which the heart stops for a short period are usually a result of problems with the electrical conduction of the heart. These abnormalities affect the conduction at different levels, but the commonest important bradycardia is caused by ‘heart block’ due to problems with conduction between the atria and the ventricles of the heart. Sometimes drugs can cause or exacerbate problems with a slow heart rate and stopping or changing them can improve the situation.

Limited degrees of heart block can be well tolerated and may simply need careful follow up with periodic ECGs or holter monitors. However more significant levels of heart block such as ‘complete heart block’ particularly when they result in very slow heart rates or long pauses, dizziness or fainting may need to be treated with a pacemaker.

When investigating rhythm disturbances in the clinic your cardiologist will need to take a history and perform a physical examination. In addition they will want to perform some tests which will often include blood tests, a chest x-ray, ECG and echocardiogram as well as a holter monitor. The length of monitoring will usually depend on how frequently the abnormal rhythm is occurring. Sometimes a patient activated monitor or implantable monitor may be necessary.

Dr Dalby will discuss these tests, their implications and any subsequent tests, treatment or follow up with you so that you may reach a mutually agreeable management plan.