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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19456
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am a 70yr old male and I have some slight concerns about

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I am a 70yr old male and I have some slight concerns about my heart rate. My ‘at rest’ HR is regularly in the low 50’s and can sometimes be around 48. Even after exercise it can return to the high 50’s within a minute. I have one long term health concern of Peripheral Neuropathy for which I take 600mg Pregabalin daily and an 8 weekly Infusion of 300mg Lidocaine administered in Day Surgery. I have had this infusion for around the last 4 years.
I think for my age I am probably quite fit. Weekly I have 5hrs of strenuous exercise (badminton, walking football and keep fit class) 4+ hours of moderate exercise (cycling and table tennis) 2+ hours of light exercise (skittles and 10 pin bowling) plus gentle exercising of walking etc.
I do not generally feel any symptoms of a low HR but since the last infusion 4 weeks ago I have felt a little light headed at times. I had a new stats machine at the last infusion and the fact that it kept throwing up the message ‘HR too low’ brought the matter to my attention.
Is there anything I should be worried about and seek further advice on?
Hello from JustAnswer.
It will help if you could provide some further information.
Do you have the ability to check your blood pressure at home?
If so, have you checked your blood pressure and pulse during the periods of lightheadedness?
Customer: replied 3 years ago.

We have monitored our blood pressure for a number of years. It has been raised since my last infusion. Prior it was about 145/80. It has fluctuated a lot since the last infusion with a high of 178/97 and low of 134/69. During the period of light headedness I have only taken the blood pressure once and it was at the high mentioned above. The pulse rate does not seem to vary at all. All measurements have been taken at rest.

Very good.

Although a heart rate in the 50s (and occasionally down to 48) is low, the primary determinant of whether anything needs to be done for it would be if it is causing a drop in blood pressure that is causing lightheadedness. As long as the heart rate remains at this level, the only reason to consider treatment would be if there are symptoms that are attributable to the slow heart rate. In that situation, proper treatment would be placement of a pacemaker. Another reason to consider a pacemaker would be if the heart rate is unable to support your level of exercise, but it sounds like you are able to perform all the activity levels that you list without difficulty.

At this stage, it would be appropriate to consider stopping the use of any drugs that will slow the heart rate if you were taking any such medicines, but the pregabalin and intermittent dosing of lidocaine typically would not be the cause of this slow heart rate.

If the slow heart rate become profound (~40 or less), then it is appropriate to consider pacemaker placement, even if no symptoms are present. But until that point, it would be the presence of symptoms that would indicate that treatment is necessary.

So, at this point, it does not appear to need any treatment, but it would be appropriate to be monitoring symptoms and blood pressure to see if there are any episodes of a decrease in blood pressure related to the slow heart rate causing lightheadedness.

If I can provide any further information, please let me know.
Customer: replied 3 years ago.

Thankyou for your reply. Do you feel the level of blood pressure as it is, gives any reason for investigation. Also does a low HR have any relationship to a higher blood pressure. (In laymans terms if the heart is working at a slower rate does it have to pump harder) ?

The level of blood pressure would only be an issue if the blood pressure remains at the higher level of 178/97 more consistently. Having occasional peaks of blood pressure to this level is not as worrisome and typically does not require any investigation or intervention.

No, a slow heart rate does not cause a high blood pressure. High blood pressure is a function of arterial tone, not how hard the heart is pumping.
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