Low heart rate: how much to worry and what to do?
May 16, 2012 4:15 PM   Subscribe

I went to see the doctor this morning about some stomach pain I thought might be an ulcer. When the nurse checked my heart rate, it was 48 bpm. Neither the nurse nor my doctor (who knows my med history) said anything about this. I wasn't concerned until I googled it when I got home, and now I'm having a lot of anxiety about it. Called my doctor and he said that a one time reading of 48 with no other symptoms is not troubling. Nurse said I should check my pulse tomorrow and if it's still in the 40s, call them. How much should I be freaking out right now?

I have a lot of anxiety issues and am prone to cyberchondria, and the Google tells me that my heart rate is abnormally low and I'm kind of freaking out. Google tells me normal is 60-100, below 50 can be Not Good.

I am a 27 year old male, 6'1", ~175 pounds. I eat a very healthy diet, practice relatively rigorous yoga 4-6 times per week along with some meditation, but I do not consider myself an 'athlete' by any means. I used to be a pretty heavy drinker and occasional smoker, but I quit all of that and now I drink very rarely. No coffee because of my anxiety, though I drink green tea some mornings. Last month I had complete metabolic profile done, complete physical, and everything checked out fine. I have always had low blood pressure. I don't really track my heart rate in any consistent way, so I don't have a lot of comparative data.

I've been taking Klonopin for a little bit to get through an extremely anxious time - no more than .5mg 2x a day (1 mg total). I had not taken my klonopin this morning before my pulse was checked, but I did take it last night. I also recently started Lexapro at 10mg a day, with the goal of quitting the klonopin and treating my anxiety with an SSRI.

I was also on 12 hour fast because of a blood test I needed to have done. I don't know how much of a difference any of this makes.

No other symptoms, other than feeling perhaps a little more tired and run-down than usual, which I've attributed to the fact that I moved last week, it's the end of a really anxious couple of months (work stuff), my adrenaline has been going crazy, and I'm just crashing a little. The klonopin also makes me sleepy.

A month ago when I went in for my annual physical, my heart rate was 68. I'm concerned about the drop. Doc says not to worry, but, you know, I have anxiety problems. I just checked my pulse rate and it's at about 52, which is still pretty low. How worrisome is a heart rate of 48? What does it mean if I still have that heart rate tomorrow? Is it really okay to wait until tomorrow and see if it's still low (i.e. should I trust my doctor, or does this seem a more emergency type situation)?
posted by The Pantless Wonder to Health & Fitness (17 answers total)
IANYD. But yes, it is really OK to wait until tomorrow. If you need reassurance, you know you can check your heart rate anytime you want with just your fingers, right? Just the act of getting anxious about it will probably get you up plenty higher than 48.

Remember that reading was just a moment in time, people can have readings above or below the normal range transiently and it doesn't mean their heart rate is always low or high.
posted by treehorn+bunny at 4:17 PM on May 16, 2012 [1 favorite]

I just noticed you are rechecking your heart rate yourself and I would not worry about 52. See it all the time in people whose hearts are working just fine.
posted by treehorn+bunny at 4:18 PM on May 16, 2012 [2 favorites]

My heart rate has been measured as low as the mid 30s by a heart rate monitor. I'm still alive. It's lower in the morning or if I'm napping and gets up to a whopping 58 or 60 if I drink a lot of coffee or I'm anxious. My mother and siblings run equally slow. My dads normal.

Some of us are just part zombie I guess.
posted by fshgrl at 4:19 PM on May 16, 2012

I would be not at all worried.. For healthy people 50s can be really normal. 48 with no symptoms (not light headed, woozy etc.) is also not a problem (or so my cardiologist told me).
posted by lucasks at 4:19 PM on May 16, 2012

Having a low resting HR is not a bad thing. Endurance athletes brag about how low their resting HR is all the time.
posted by computech_apolloniajames at 4:20 PM on May 16, 2012 [1 favorite]

The fact that you don't drink caffeine can make a big difference. For a while I was off it completely, and my heart rate was 20 bpm lower than it has been all my life. I thought this was because I'd started running, but my doctor said it was more likely due to being caffeine-free, and sure enough, now that I've started coffee again it's back up.
posted by something something at 4:20 PM on May 16, 2012

Ok, thank you everyone so far. This is making me feel a bit more at ease.
posted by The Pantless Wonder at 4:27 PM on May 16, 2012

IANAD, but if you don't have any heart issues or any associated symptoms then you don't have much to worry about. Also, as mentioned above, a lot of endurance athletes do have very low RHRs (and indeed do like to brag about them); for example, Miguel Indurain (the cyclist) used to have a RHR of between 25 and 30 -- don't sweat yours!
posted by un petit cadeau at 4:43 PM on May 16, 2012

This is the equivalent to fretting about a high credit rating, great gas mileage, or a low cholesterol score.

You're a young, healthy person who is also on anti-anxiety medications. I'd be concerned if your resting heart rate WASN'T low!
posted by ErikaB at 4:53 PM on May 16, 2012 [3 favorites]

The Mayo Clinic says well-trained athletes often have a resting heartbeat in the 40s. I think regular yoga + meditation + no caffeine together are a very logical explanation for a lower heartbeat.
posted by looli at 4:56 PM on May 16, 2012 [3 favorites]

Hey! This just happened to me a couple weeks ago! I also had a resting heart rate of 48bpm, iirc. My doctor prescribed me an echocardiogram, which is basically an ultrasound for your heart. It was pretty cool getting to see my heart on the screen, but they didn't find anything unusual. I am absolutely not an athlete. I thought that it might just have been faulty equipment at the time, but now I wonder if it's just something weird that some people have.

Anyway, I wouldn't (and didn't) worry about it! Your heartbeat was measured at 48bpm this morning, but in all likelihood it's been this way for a while. If you've felt fine so far, I see no reason for anything to change.
posted by segfault at 5:24 PM on May 16, 2012

My pulse often measures in the low 50s. One time when I was getting the little exam before giving a pint of blood the nurse saw my heart rate and said, "you must be a runner". I think that you're just in good shape.
posted by octothorpe at 6:04 PM on May 16, 2012

My fasting heart rate ranges from 38-45 on any given day and after seeing two cardiologists and have had several EKGs, stress tests, echos, TEE, etc all is well. My doctor said as long as that range is my norm and that I don't experience other symptoms I am good to go. He did say that in 30-40 years I am likely to need a pacemaker, but I don't worry about that now.

Just an FYI though, if this is your new norm, be prepared to have to explain when you have unrelated doctors visits. I had an endoscopy once to check for a potential ulcer and they hooked me up to a heart rate monitor and boy oh boy! Every few minutes the thing would beep like mad when my heart rate went below 40. Ended up having to reach out to my cardiologist to get the ok to leave.

Having said all that though, if you are trending down over a period of time, I wouldn't freak out, but I'd keep an eye on it and maybe just check with your doctor if after a few weeks you see a fairly consistent drop and you notice increased fatigue.
posted by SoulOnIce at 6:21 PM on May 16, 2012

I'm in not-particularly-good-for-me shape at the moment and my heart rate is under 60. When I'm riding more than 100mi/wk, my heart rate first thing in the morning is in the low to mid 40s. (I'm an engineer, so I like to measure things.)

What with the no caffeine, anti-anxiety meds, and the yoga, I think you're just in shape.
posted by notsnot at 6:59 PM on May 16, 2012

We should all be so lucky.

It isn't just RHR that can be low. For a while there, my mom and her dad both had blood pressure readings so low that they didn't have a perceptible pulse in their wrists. Seriously, they were sitting around with borderline hypotension, which you usually only see with things like massive blood loss and persistent anemia. But they were just fine.

So you've got a RHR that's on the low side of normal. Good for you.
posted by valkyryn at 7:28 PM on May 16, 2012

Low heart rate is usually a good sign; in the absence of any other issues you shouldn't worry.
posted by spaltavian at 8:37 PM on May 16, 2012

Thanks again everyone; I feel much better. I do keep checking it, and it hasn't dropped below 48 all day, though it has tended to hover between 50 and 60 at rest. I'm going to keep an eye on it, but I don't feel nearly as worried. Thanks again.
posted by The Pantless Wonder at 8:51 PM on May 16, 2012

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