To diagnose your condition, your doctor will review your symptoms and your medical and family medical history and do a physical examination.
Your doctor will also order tests to measure your heart rate, establish a link between a slow heart rate and your symptoms, and identify conditions that might be causing bradycardia.
Electrocardiogram (ECG or EKG)
An electrocardiogram, also called an ECG or EKG, is a primary tool for evaluating bradycardia. Using small sensors (electrodes) attached to your chest and arms, it records electrical signals as they travel through your heart.
Because an ECG can't record bradycardia unless it happens during the test, your doctor might have you use a portable ECG device at home. These devices include:
Holter monitor. Carried in your pocket or worn on a belt or shoulder strap, this device records your heart's activity for 24 to 48 hours.
Your doctor will likely ask you to keep a diary during the same 24 hours. You'll describe any symptoms you experience and record the time they occur.
- Event recorder. This device monitors your heart activity over a few weeks. You push a button to activate it when you feel symptoms so that it records your heart's activity during that time.
Your doctor might use an ECG monitor while performing other tests to understand the impact of bradycardia. These tests include:
- Tilt table test. This test helps your doctor better understand how your bradycardia contributes to fainting spells. You lie flat on a special table, and then the table is tilted as if you were standing up to see if the change in position causes you to faint.
- Exercise test. Your doctor might monitor your heart rate while you walk on a treadmill or ride a stationary bike to see whether your heart rate increases appropriately in response to physical activity.
Laboratory and other tests
Your doctor will order blood tests to screen for conditions that might be contributing to bradycardia, such as an infection, hypothyroidism or an electrolyte imbalance.
If sleep apnea is suspected of contributing to bradycardia, you might undergo tests to monitor your sleep.
Treatment for bradycardia depends on the type of electrical conduction problem, the severity of symptoms and the cause of your slow heart rate. If you have no symptoms, treatment might not be necessary.
Treating underlying disorders
If a disorder such as hypothyroidism or obstructive sleep apnea is causing bradycardia, treatment of the disorder might correct bradycardia.
Change in medications
A number of medications, including some to treat other heart conditions, can cause bradycardia.
Your doctor will check what medications you're taking and possibly recommend alternatives. Changing drugs or lowering dosages might correct problems with a slow heart rate.
When other treatments aren't possible and symptoms require treatment, a pacemaker is necessary.
This battery-operated device about the size of a cellphone is implanted under your collarbone. Wires from the device are threaded through veins and into your heart. Electrodes at the end of the wires are attached to heart tissues. The pacemaker monitors your heart rate and generates electrical impulses as necessary to maintain an appropriate rate.
A wireless pacemaker has been approved by the FDA. The leadless system holds promise for people who need pacing in only one ventricle, but more study is needed.
Preparing for your appointment
Whether you start by seeing your primary care provider or get emergency care, you'll likely be referred to a doctor trained in heart conditions (cardiologist) for a diagnostic assessment.
What you can do
Make a list of:
- Your symptoms, including those that seem unrelated to your heart, and when they began
- Key personal information, including major stresses or recent life changes and your and your family medical history
- Medications, including vitamins and other supplements you take, including doses
- Questions to ask your doctor
If possible, take along a family member or friend to help you keep track of the information you receive.
For bradycardia, basic questions to ask your doctor include:
- What is likely causing my slow heart rate?
- What tests do I need?
- What's the most appropriate treatment?
- What risks does my heart condition create?
- How will we monitor my heart?
- How often will I need follow-up appointments?
- How will other conditions I have or medications I take affect my heart problem?
- Do I need to restrict my activities?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, such as:
- Have you had fainting spells?
- Does anything, such as exercise, worsen your symptoms?
- Do you smoke?
- Are you being treated for heart disease, high blood pressure, high cholesterol or other conditions that can affect your heart?