Q. My pulse rate suddenly reduces to 40 bpm with dizziness. Is this a sign of heart block?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Oct 08, 2020

Hi doctor,

I am an 80-year-old woman with a little history of hypertension but without any other significant health issues. I am not on any medication at all. My blood pressure historically has been in a band of 120/80 up to 140/100 or so. My pulse is generally 80-95 bpm. I usually measure my blood pressure and pulse once or twice a day to monitor it. In the last week, I noticed my pulse fell significantly to around 40-50 bpm while doing this. It stayed that well for some hours or overnight. However, lately, I had back up to 80-90 and has remained stable at that level in recent days. I had an ECG done, which showed nothing, and a Holter monitor test (results attached).

My questions are, is what I am describing showing heart block? If yes, then what sort of heart block is it? Can a heart block be intermittent i.e., pulse fell to 40 but then recovered to 80? 90 bpm and has stabilized at that level. If it has stabilized, can I leave it alone? Is the treatment required for this? I prefer to avoid pacemaker or other surgeries.

#

Hello,

Welcome to icliniq.com.

Yes, it is a heart block, and it is a 2:1 AV (arteriovenous) block. Block can be intermittent, present at sometimes, and recover at other times. This certainly requires treatment as it can be life-threatening or may lead to syncope if the heart rate drops further down. I guess you are not on any medications like beta-blockers, which may cause this. Also, we have to rule out the possibility of hypothyroidism and electrolyte imbalance. So you should undergo a thyroid profile, renal function test with electrolytes. Also, echo should be done as a part of an evaluation to rule out coronary artery disease.

Overall this appears to be an age-related heart block, and a pacemaker is a treatment of choice for this if we do not find any reversible cause. Medications are not reliable for this issue. So most probably, a pacemaker will be necessary. And it is a not major surgery and done under local anesthesia only.

I hope this helps.

Thank you doctor,

Is there a reason that I would do an angiogram over an echocardiogram?

#

Hello,

Welcome back to icliniq.com.

Echo will always be done to see heart function or to find any evidence of coronary artery disease. If echo shows any evidence of blockages or even otherwise, an angiogram may be performed before the pacemaker to rule out the possibility of blockages. Because if there are blockages in the arteries, then treating them might cure heart block, avoiding a pacemaker's need. So angiogram may be performed before the pacemaker.

Thank you doctor,

If the echocardiogram is normal, then is there need for an angiogram? Is there still a need for a pacemaker?

#

Hello,

Welcome back to icliniq.com.

If echo is normal, then still angiogram might be performed as a screening procedure, to be sure. This case depends on the doctor's assessment or hospital protocol, and some doctor may just perform stress echo or CT coronary angiography as a screening. So here, angiogram may or may not be done. But then a pacemaker is a must.

However, if an echo is abnormal, then an angiogram is a must, and if it shows blockages, then those blockages will be open with angioplasties or bypass depending upon the extent of blockages. Because opening of blockages will cure heart block and avoid pacemaker surgery.

So, in a nutshell, you will either need a pacemaker or some coronary procedure.

Thank you doctor,

Is angiogram risky procedure? Can it cause a heart attack? After the angiogram, will I need to take Aspirin or blood thinners temporarily or permanently? Does this depend on whether the angiogram involves angioplasty or stenting as well? Or does a basic angiogram require Aspirin afterward forever?

#

Hello,

Welcome back to icliniq.com.

No, angiogram are relatively safe and does not carry significant risks. It is extremely rare to get a heart attack during an angiogram. Since it is a diagnostic test, you do not need to take any blood thinners or Aspirin lifelong unless there is a disease within vessels or you undergo stenting. So basic angiogram does not need anything afterward.


Was this answer helpful?

 | 

Related Questions:
ECG report shows down spikes with heart palpitations. Please explain my report.

Do you have anxiety or stress ...   Read full

Is it true that athletes have a low heart rate?

The medicines which reduce the heart rate have many side effects and can lower your blood pressure as well as stamina ...   Read full

ECG shows RBBB and marked left ventricular hypertrophy. What does it mean?

.. (electrocardiogram) is showing incomplete RBBB (right bundle branch block) or early RBBB and features of left ventricular hypertrophy, and also heart rate is on lower side nearing 60 beats per minute. But as you mentioned, he is a basketball playe...   Read full

 

This is a sponsored Ad. icliniq or icliniq doctors do not endorse the content in the Ad.

Also Read Answers From:

Comprehensive Medical Second Opinion.Submit your Case

Related Questions & Answers


Is there any relation between excessive sleepiness and cardiac insufficiency?

Query: Hi doctor, I am wondering about the connection seen between my excessive fatigue or sleeping issue with cardiac insufficiency. I have excessive sleepiness due to mild sleep apnea. But I have a strange disconnect regarding exertion. Even, a slight anaerobic activity reduces my breath and it takes ti...  Read Full »

What number of APCs are normal for a 24 year old female?

Query: Hello doctor, I had a 24-hour heart monitor on for tracing palpitations. Results showed nothing but 700 pacs. No runs. I am a 24 year old female and this number worries me. What is the amount of pacs a person my age would usually have? And how many pacs is too many? I fear of it leading to afib.  Read Full »

I felt lightheaded and like my heart stopped. What should I do?

Query: Hello doctor, I am a 74 year old male in excellent health, and I am not on any medications. Recently, I had a strange chest sensation. It felt like my heart stopped or skipped, and I felt lightheaded like I might pass out. I had an EKG, echocardiogram, and a Holter test done. The EKG results were n...  Read Full »

Also Read


Sinusitis - Causes, Symptoms and Treatment
Sinusitis is the infection of the air cavities within the nasal passages. Normally, the healthy sinuses are filled with ...  Read more»
Asthma and Its Rising Incidence
This article explains about asthma and its causes. It also focuses on the benefits of starting early treatment to lead a...  Read more»
Parkinson's Disease: Historical Aspects and Current Treatment Approaches
This article discusses the historical aspects of Parkinsonism and, the evidence based approaches currently available for...  Read more»

Ask your health query to a doctor online?

Ask a Cardiologist Now

* guaranteed answer within 4 hours.

Disclaimer: All health Q&As published on this website are not intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek the advice from your physician or other qualified health-care providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website.