A slow heartbeat may not always raise immediate concern, but in many people, it signals an underlying heart rhythm disorder known as bradycardia. Defined as a resting heart rate of fewer than 60 beats per minute, bradycardia often remains undiagnosed because its symptoms are subtle, intermittent, or mistaken for routine fatigue or ageing. This “silent slowdown” highlights the importance of learning to decode your rhythm before the condition begins to impact everyday life.
The heart rhythm is controlled by its natural pacemaker, the sinoatrial (SA) node, which sends electrical signals to maintain a steady heartbeat. According to Dr. Anjan Siotia, Director, Cardiology Department, BM Birla Hospital, a chronic slow heart rate is not good and needs medical attention. “When these signals become weak, delayed, or irregular, the heart slows down. While a low heart rate can be normal in well-trained athletes or during sleep, persistent bradycardia, especially when accompanied by symptoms, requires medical attention,” he said.
In bradycardia, the heart may not pump enough oxygen-rich blood to meet the body’s needs. This reduced circulation can affect vital organs, particularly the brain, leading to symptoms that are often dismissed as non-cardiac issues.
According to Dr. Siotia, a few reasons why bradycardia mostly goes undetected are due to the fact that most of its symptoms mimic common and less serious conditions. Persistent fatigue and weakness are among the most frequent complaints. “Many patients attribute this to stress, poor sleep, or work pressure, unaware that their heart rate may be the underlying cause,” he said.
Dizziness, light-headedness, or confusion occurs when blood flow to the brain is insufficient. In more pronounced cases, patients may experience fainting or near-fainting episodes, which are often the first signs that prompt medical evaluation. Breathlessness, especially during mild physical activity, and chest discomfort may also occur, indicating that the heart is struggling to keep up with the body’s demands.
“Importantly, not all individuals with bradycardia experience symptoms. This makes regular health check-ups and heart rhythm monitoring particularly important for older adults and those with chronic conditions,” said Dr. Siotia.
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Bradycardia affects people of all ages, but it is more commonly seen in older adults, particularly those above 65. Age-related wear and tear of the heart's electrical system is a major contributor. Other risk factors include:
Bradycardia can affect anyone over the age of 65 years
Advancements in cardiac pacing have transformed patient care. Beyond traditional pacemakers, leadless pacemakers now offer a minimally invasive option. “Implanted directly into the heart without wires or surgical pockets, these devices reduce the risk of infection, improve comfort, and allow faster recovery, particularly beneficial for patients with limited venous access or higher infection risk,” said Dr. Siotia.
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