Why deep bradycardia (35 BPM) is a disease for some people and for other people is a sign of fitness and health? What makes the difference in the deep bradycardia (35 BPM) between disease and fitness?
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You raised a very good point. Cardiologist usually looks at the ECG and patient's symptoms. If the ECG does not show any features of conduction abnormalities and the patient is fit, healthy and has no symptoms, then it is reassuring especially if they are athletes. However, if the ECG shows a conduction abnormality or delays then it is of a concern and if the patient has symptoms of lightheadedness, fainting, collapses or exertional breathlessness, then it is of concern and needs more investigations and possible pacemakers if the condition persists after stopping all heart slowing medications.
You need to bear in mind that a single ECG could confirm a conduction abnormality if present, but does not 100 % exclude as the condition could be intermittent, This is why a period of continuous cardiac monitoring is recommended for the patients who have symptoms could be related to conduction abnormalities.
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