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Low Pulse (Bradycardia): Causes & Treatment

A low pulse (bradycardia) refers to a heart rate below 60 beats per minute. It can be harmless or may require medical treatment.

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Things worth knowing about "Low Pulse"

A low pulse (bradycardia) refers to a heart rate below 60 beats per minute. It can be harmless or may require medical treatment.

What Is a Low Pulse?

A low pulse, medically known as bradycardia, occurs when the heart beats fewer than 60 times per minute. In healthy, well-trained athletes, a low resting pulse is completely normal and can even be a sign of excellent cardiovascular fitness. In other cases, however, bradycardia may indicate a heart condition or another underlying health problem and should be evaluated by a doctor.

Causes

The causes of a low pulse range from harmless to serious conditions:

Athlete heart: Endurance athletes often have a resting pulse of 40–50 beats per minute because their heart pumps more efficiently due to training.
Sick sinus syndrome: Dysfunction of the natural pacemaker of the heart can slow the heart rate.
AV block: A blockage of the electrical conduction between the atria and ventricles leads to a slowed heart rate.
Hypothyroidism: A deficiency of thyroid hormones slows many bodily functions, including the heartbeat.
Medications: Certain drugs such as beta-blockers, calcium channel blockers, or cardiac glycosides can lower the pulse.
Vagal reactions: Severe stress, pain, or vomiting can temporarily lower the pulse significantly via the vagus nerve.
Electrolyte imbalances: Changes in potassium or calcium levels in the blood can affect heart rhythm.
Heart attack or heart disease: Damage to heart tissue can impair the electrical conduction system.

Symptoms

A mildly low pulse may cause no symptoms at all. However, a very low pulse can lead to the following complaints:

Dizziness and lightheadedness
Fatigue and general weakness
Shortness of breath, especially during physical activity
Fainting or near-fainting episodes (pre-syncope)
Chest pain or a feeling of tightness in the chest
Difficulty concentrating and memory problems

Diagnosis

Diagnosing a low pulse involves several examination methods:

Pulse measurement: The simplest method – manually at the wrist or neck, or via a pulse oximeter.
Electrocardiogram (ECG): Records the electrical activity of the heart and detects rhythm disturbances.
Holter monitor (24-hour ECG): Monitors heart rhythm over 24 to 48 hours to capture occasional episodes of bradycardia.
Blood tests: Assessment of thyroid function, electrolytes, and other relevant parameters.
Stress test (ergometry): Measures heart rate under physical exertion.
Echocardiography: Ultrasound examination of the heart to assess its structure and function.

Treatment

Treatment depends on the underlying cause and the severity of the bradycardia:

Watchful waiting: In asymptomatic bradycardia without a clear cause, especially in athletes, no treatment is usually necessary.
Medication adjustment: If a drug is the cause, dose adjustment or switching to a different medication may be required.
Treatment of the underlying condition: For example, treating hypothyroidism with thyroid hormone replacement therapy.
Pacemaker implantation: In severe or symptomatic bradycardia that cannot be managed otherwise, a pacemaker is implanted. This small device sends electrical impulses to regulate the heartbeat.
Emergency treatment: In acute, life-threatening bradycardia, medications such as atropine or adrenaline may be administered intravenously.

When to See a Doctor?

A low pulse should be evaluated by a doctor if it is accompanied by dizziness, fainting, chest pain, or shortness of breath. A resting pulse below 40 beats per minute without an athletic background also warrants prompt medical attention. In an emergency – such as loss of consciousness or severe chest pain – emergency services should be called immediately.

References

Brignole M. et al. – 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. European Heart Journal, 2021;42(35):3427–3520.
Kasper D. L. et al. – Harrison's Principles of Internal Medicine. 20th Edition, McGraw-Hill Education, 2018.
World Health Organization (WHO) – Cardiovascular diseases (CVDs). Fact Sheet, 2023. www.who.int

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