heart rate of 46

Was she a athlete? Athletes can have low resting heart rates. Some just run brady with no symptoms. Brady is only treated when person becomes symptomatic.

Also what meds was this person on?

A lot of people have asymptomatic bradycardia. I had a patient with a HR in the 30s the other day. No symptoms.

Depends on things such as age and conditioning. Often elderly will have a low heart rate and not realize until they fall or have a syncopal episode. Once they get a pacemaker they cannot believe how well they feel.

But at the same time it can be normal in a young person or an athlete.

this patient is an elderly patient in the 80's with dementia. doctors felt she is not a good candidate for a pacemaker. she is not taking any beta blocker. she is taking antibiotics and corticosteroid for upper respiratory infection, and other than that she is taking vitamins and anti-ulcer medications. do you think this patient needs digoxin? this there a good chance that this patient can code all of a sudden?

Digoxin SLOWS and strengthens the heart. Typically it is not to be given if a heart rate is less than 60.

If she is asymptomatic I would simply document and report it.

Um...no Digoxin! You don't give dig if they're under 60 bpm. What are the patient's trends? Has she dropped from 80 to 48 in the last few hours?

There are several reason why the patient might have asymptomatic bradycardia. One would be if he/she is an athlete whose heart has become ultra efficient due to training. Another would be hypo-thyroid. Also, medications such as beta blockers, digoxin effect heartrate.

What I would do would be to check the admitting vital signs, the H&P, the vital sign graphics, M.D. progress notes etc., to see if this has been addressed. But before I even did that, I would ask the patient when I was taking his/her VS if he/she tends to have a slow HR.

Then, if this is a new finding, I would call the doctor. If it's in the middle of the night, it might be influenced by sleep and I would most likely continue to monitor asymptomatic bradycardia through the night more closely and have the issue addressed in the AM. This would be done by check HR, BP and LOC more frequently than usual.

this patient is an elderly patient in the 80's with dementia. doctors felt she is not a good candidate for a pacemaker. she is not taking any beta blocker. she is taking antibiotics and corticosteroid for upper respiratory infection, and other than that she is taking vitamins and anti-ulcer medications. do you think this patient needs digoxin? this there a good chance that this patient can code all of a sudden?

hypoxia also can cause the patient to brady down before arresting. make sure the pt is not hypoxic. yes, a hypoxic patient can brady before coding, you want to oxygenate first.

individuals who abuse cocaine also have asymptomatic brady, particularly after coming off the drug after a binge

Let's not forget thyroid disorders can lead to bradycardia.

This woman could have a thyroid disorder, a med complication, or heart disease--maybe even complete heart block, running a ventricular rate.

She may very well not be a candidate for a pacer. It's okay to look at the big picture and not treat when the cure could be worse than the issue--but it's a shame to have an issue that might be simply treated by a little synthroid go for a long time without ordering at least a little blood work.

I discharged a patient this weekend with hr of 38-43 asymptomatic. she also was in and out of afib. she was elderly and just had a carotid via the groin. it was her norm