As a cardiac electrophysiologist, my specialty is treating heart rhythm concerns. This could be a heart rate that is too slow, too fast or irregular. Let’s learn more about what your heart rate means and when to be concerned.
What Does Your Heart Rate Measure and Why is it Important?
Your heart rate is the number of times per minute that your heart is sending an electrical signal through the heart muscle to pump blood out to the body. For most people, a normal heart rate range is somewhere between 60 to 100 beats per minute. That can vary throughout the day, for each person, based on multiple factors, such as:
- Your level of activity
- Whether you’re feeling well or under the weather
- If you’re well rested
- The medications or supplements you take
- What you’ve eaten or drank recently
Are Variations in Your Heart Rate a Good Thing?
Heart rate variations are normal and something that you want to happen. This change in rate is a marker of a healthy cardiac electrical system. It’s also a sign that your body is functioning properly.
For example, when you’re at rest or sound asleep in the middle of the night, your heart rates are going to be lower. This is because you’re not active, so your body doesn’t need or demand high levels of oxygen to perform various functions. Your body also doesn’t have a bunch of waste products from the cellular function that it needs to clean out.
When you get up in the morning, your heart rate starts to climb a little bit. And again, it varies throughout the day based on your activity. As mentioned before 60 to 100 beats per minute is the “normal range” but that is all in context. It is certainly not abnormal for your heart rate to be above 100 if you’re working in the yard, walking the dog or carrying in groceries from the car. We want your heart rate to go up to meet the demands of whatever you’re asking your body to do. But there are also situations when elevated heart rates can be abnormal. If you’re relaxing in the evening, watching TV and you start to feel a palpitation or pounding/fluttering in the chest and you check your heart rate and it’s 125 beats a minute that’s probably inappropriately high for the level of activity that you’re performing and could be a sign of irregular rhythm or something not so good.
The heart rate is just a single metric in the bigger picture of what we look at, but it can be a valuable one to help us figure out what’s really going on.
How do You Find Your Heart Rate?
The most straightforward way to check your heart rate is to grab a watch or use a clock on the wall with a second hand and then find your pulse. You can find your pulse at your:
- Wrist: At the base of the thumb is where the radial artery sits.
- Neck: The carotid artery in the neck just below the jawbone.
Once you feel your pulse, wait until the second hand hits one of the big numbers to start counting. Count every heartbeat for 30 seconds and then double it so you have a total for a minute which will tell the beats per minute that your heart is beating. Or you can track your beats for an entire minute as heart rate is defined by beats per minute. Keep in mind, that when you are checking your pulse, it should be a regular, steady rhythm.
- Wearable Technology: Another option is to use some different forms of wearable technology that perhaps are more efficient. Examples would be blood pressure cuffs, pulse oximeters or smartwatches.
How do Smartwatches and Wearable Technology Work?
Wearable technology can certainly give you the opportunity to have more understanding of your health day to day. But with that comes a lot of information and sometimes the ability to interpret that information can be challenging, which can lead to more anxiety or create more problems than it’s really helping. However, if you have a good understanding of what you’re looking for or what you’re using that tool for, these tools can be very helpful.
For the most part, smartwatches or smart devices that are measuring your heart rate do it through a function called photoplethysmography (using a light-based sensor). If you’ve had a smartwatch, you may have noticed when it rocks off your wrist a little bit, you see a red, green or blue light that is flashing on the underside. What’s happening is the device is shining these specific lights through the skin, and those beams of light are bouncing off red blood cells as they flow through the very small blood vessels (capillaries) in your skin. With each heartbeat, the flow and amount of blood increases in those vessels. Then in between each heartbeat, it slows down. The device measures the frequency of those changes in blood flow which is converted over to a number for beats per minute.
When Should You Be Concerned About Your Heart Rate?
First off, you know your body better than anyone. If you’re concerned for whatever reason, don’t ignore it. Call your primary care provider or cardiologist to discuss what is happening. If you’re having dramatic symptoms:
- Crushing chest pain
- Can’t breathe or inability to catch your breath at rest
- Lightheaded
- Dizzy
- Passing out
These are all things that should be seen in the emergency department right away.
On the other hand, if you’re otherwise feeling well and sitting down watching TV when your smartwatch gives you a “heart rate low” alert and states your heart rate is 52 beats per minute. Your initial thought may be, “Oh my gosh, my watch is telling me something bad is going on”. But if it’s evening time, you’ve had dinner, are finally able to relax from the day and you otherwise feel fine, then it probably isn’t something that’s an absolute emergency.
I tell my patients that their heart rate number is just that: a number. Certainly, there are numbers that are more concerning to us as physicians than others.
Low Heart Rates
Heart rates in the teens, 20s and 30s usually are outside the normal range. But for many, overnight or at times of significant rest, it’s not uncommon to see their heart rates dip down into the 50s or sometimes even the high 40s. If you feel fine, you’re not feeling lightheaded, short of breath, really fatigued, extremely drowsy, then that probably is just a marker that your body is in a deeper state of calm and isn’t needing to have those higher heart rates to meet the metabolic demands.
If you are having symptoms in addition to low heart rates, it could be a marker of some problems going on with the electrical system of your heart that need to be checked out and potentially addressed with either medical therapy, or even sometimes device-based therapy. The most common symptoms that come with slow or low heart rates are:
- Shortness of breath with activity
- Lightheadedness or dizziness with activity or position changes
- Overall sense of fatigue
High Heart Rates
On the high end of heart rates, it’s a little bit of a different story. When you’re exercising or doing vigorous work, it’s expected that your heart rate increases. It could get up over 100 depending on the level of activity. But at rest or sitting down watching TV at the end of the day, you wouldn’t necessarily expect your heart rate to be elevated – above the 100 range. That would be a little bit abnormal based on the level of activity at that moment. There are a variety of reasons as to why your heart rate is elevated. Some of them are heart-related and some of them are not heart-related but still lead to increased levels of adrenaline which results in higher heart rates. Either way, these situations usually need attention. At a minimum, you want to have some reassurance to say, “That’s okay”. And certainly, if there’s something more going on, we want to figure it out and get on top of it.
Diagnoses and Treatment Options for Low and High Heart Rates
The first step in all of this is to get the whole story. The context oftentimes matters a lot in these situations. I want to figure out:
- What are you feeling?
- When are you feeling it?
- What kind of things bring it on?
- What kind of things seem to help it go away?
We need to make sure we’ve got the full comprehensive history.
Step two is the diagnostic portion. If you have a smartwatch that records things, we go through and look at the heart rate graphs and distribution. For example, we see at 7 a.m. your heart rate was 65. Then at 8 a.m., it jumps up to 120. And then by 9 a.m., it’s back down to 65. What were you doing at 8 a.m.? Does the jump make sense or is it abnormal? To gain additional insight into what is going on during times like these, you may be asked to wear an external monitor. These monitors watch every single heartbeat and are programmed to record tracings of heart rhythms when they fall out of the parameters we set. Whether that be too fast, too slow or just irregular.
Once we’ve been able to make a diagnosis: atrial fibrillation, atrial flutter, supraventricular tachycardia (SVT), sinus bradycardia, heart block, etc. We then we talk about:
- What do you have?
- What are the implications of that diagnosis?
- What are the treatment options available (medical therapy, device-based therapy, interventions with ablation procedures)?
Half of my job is making the diagnosis, but the other half is the treatment process. At Bryan Heart and Bryan Medical Center we have multiple tools to provide interventions that can help people get back to their best selves, living their life to the fullest with the highest degree of ability and quality.
Slow Heart Rates/Rhythms
Slow heart rates are typically best managed with the implementation of a pacemaker device. These situations may be caused by:
- Bradycardia – Your natural pacemaker is wearing out a little bit and can’t keep up with the demands.
- Heart block – The wiring that carries signals from the top chambers to the bottom chambers are starting to break down, causing you to miss beats.
Fast Heart Rates/Rhythms
For fast heart rhythms, pacemakers don’t truly help in these situations. Fast rates/rhythms are typically treated with medications that slow down signals in the heart, or with ablation therapy.
The diagnosis, the patient, their values and their goals, determines what we do or when we do it.
If you are experiencing abnormal heart rates or rhythms, please contact your primary care provider or local cardiologist.
Grant Wallace, MD is a cardiac electrophysiologist with Bryan Heart. Cardiac electrophysiologists focus on the diagnosis and management of heart rhythm disorders. This could be slow, fast or irregular heart rates or rhythms. They care for patients 18 and older.
Grant Wallace, MD
Cardiac Electrophysiologist, Bryan Heart
