Do older adults tend to have slower pulse rate?

Fribblet · Jul 14, 2010

Those patients are often on a lot of meds, and some of them, such as beta-blockers or digoxin, slow the heart rate.

Blackheartednurse · Jul 14, 2010

Those patients are often on a lot of meds, and some of them, such as beta-blockers or digoxin, slow the heart rate.

Well my patient takes EXPIRED Reglan (yup!) and some fiber supplements from over the counter.All his other meds are totally expired and I told him to stop taking them automatically (Colace) His main problem is constipation and GERD as well as arthritis.

Fribblet · Jul 14, 2010

Might just be his normal. Although we are taught that a "normal" heart rate is between 60-100, some people's "normal" falls outside the bounds.

As long as he's not symptomatic, I don't think it's cause for concern.

Blackheartednurse · Jul 14, 2010

Might just be his normal. Although we are taught that a "normal" heart rate is between 60-100, some people's "normal" falls outside the bounds.
As long as he's not symptomatic, I don't think it's cause for concern.

According to the agency I work for RN suppose to notify the MD if the pulse is

allnurses Guide · Jul 14, 2010

Bradyarrhythmias and Conduction Disturbances

Intrinsic conduction system disease and acute disorders affecting the conduction system (eg, MI, digitalis toxicity) are more common among the elderly than among younger persons. Therefore, most bradyarrhythmias and conduction disturbances (see Table 91-3) are common among the elderly. However, sinus bradycardia with 1.6 seconds, and high-degree AV block are rare among healthy persons > 60 and are often associated with ischemic, hypertensive, or amyloid heart disease.

Pathogenesis

Widespread age-related histologic changes in the conduction system may contribute to the striking age-related increase in the incidence of bradyarrhythmias and conduction disturbances. The number of pacemaker cells in the sinoatrial node begins to decline progressively by age 60; only about 10% of the cells are still present at age 75. The sinoatrial node becomes enveloped by fat, which may partially or completely separate the node from the atrial musculature.

Age-related changes in the His bundle include loss of cells, an increase in fibrous and adipose tissue, and amyloid infiltration. Some degree of idiopathic fibrosis may affect the left side of the cardiac skeleton (central fibrous body, mitral and aortic annuli, and proximal interventricular septum). The fibrosis may also affect the AV node, His bundle, and proximal left and right bundle branches because of their proximity. If extensive, the fibrosis may cause AV block. This fibrosis is the most common cause of chronic AV block in the elderly.

Some age-related histologic changes in the conduction system are apparent on the standard 12-lead ECG. Although resting heart rate does not change with age, respiratory variation in resting sinus rate (known as sinus arrhythmia) decreases. Heart rate variability is reduced, and PR and QT intervals are somewhat prolonged; however, QRS duration is unchanged. The increase in PR interval is due to a delay that is proximal to the His bundle; conduction time from the His bundle to the ventricle appears to be unrelated to age.

The QRS frontal plane axis shifts left with age, probably reflecting the combined effects of fibrosis in the anterior fascicle of the left bundle branch and a mild age-related increase in left ventricular wall thickness. This left axis deviation is the most common ECG abnormality among the elderly, occurring in about half. For elderly patients without organic heart disease, neither first-degree AV block nor a left axis deviation of 130° is associated with increased cardiac morbidity or mortality rates.

THE MERCK MANUAL OF GERIATRICS, Ch. 91, Arrhythmias and Conduction Disturbances

Fribblet · Jul 14, 2010

According to the agency I work for RN suppose to notify the MD if the pulse is
Well good! As long as his HR is in the 50's, as you said in the OP, you don't need to worry or call the MD. :)

Well-Seasoned · Jul 14, 2010

After triaging pts for many many years and asking the same questions as this I can tell you that for an elderly, inactive pt to have a low pulse in usually one of two things:

A. and the most common is drug related (beta blocker, dig ect) The majority of elderly pts are on them and they will produce a HR of 40.

B. As people age they develop conduction problems like sick sinus syndrome.

The question you need to ask is ,"is he symptomatic". If he is not, check his previously recorded pulses to see if they were in the same range and do orthstatics on him. He may have been on the meds so long that this is his baseline.

If there is a question that he is symptomatic you could hook him up to a monitor or do an ecg to make sure it is sinus brady and nothing more serious. These steps are within an RN's scope of practice. Then you can have that info available for when the doc sees him.