low heart rate

[Ms.RN]

hi everybody

i got a question for you guys. what can cause a low heart rate of 32 but normal blood pressure and respiration rate? i had a patient with heart rate of 32 and c/o feeling dizzy but her other vitals are fine.

[Pudnluv, ASN, RN]

I have seen HR in the 30's many times where the patient is asymptomatic. Many times meds can cause this resulting in profound sinus bradycardia. If the patient is asymptomatic, the MD usually will watch them and if they don't improve, they will buy themselves a pacemaker. Just because the patient is asymptomatic though, doesn't mean that they won't become symptomatic. I would notify the MD if it was new, keep atropine on hand and monitor their vs frequently. I work nights and we watch the monitors ourselves, (no monitor techs) and I frequently see people dip down in the 30's while they are sleeping (especially if they have sleep apnea). If the rhythm was an idioventricular rhythm, I would either send the patient to the ICU or try to convince the MD to D/c tele (if the patient was a DNR). This is usually a sign that the patient has somewhere else to be. Of course, if I had a patient with a heart rate that low, and they were not on tele, I would certainly call the MD and have them sent to the tele unit, asymptomatic or not.

[Straydandelion]

My brother has had a HR 38-42 for at least the past 5 years asymptomatic as far as we can tell being Down's.