Should I worry about my slow heartbeat?
I AM 73 and taking mild medication for high blood pressure and high cholesterol. At present, my heart rate averages between 50 and 54 beats per minute but I gather this is slower than the normal rate (between 65 and 75). And when I was younger, in my 50s, my rate was about 45 to 48 beats per minute.
As someone with a mechanical engineering background, it seems to me that a machine or engine, such as the heart, which can cope with the demands asked of it by working at a slow, easy rate is likely to have a fairly long and troublefree life. However, I have read that a low heart rate is not a good thing and may be the cause of other conditions.
Is it feasible that a low heart rate could be beneficial?
J. Graham, Warrington.
From what you tell me I’d suggest you are a man in good health, and certainly not one with heart problems. Quite the opposite, in fact. But first I should comment on the fact you are on medication for raised blood pressure.
There is a class of drugs for this called beta-blockers — such as atenolol and bisoprolol — and one of the things they do is lower the pulse rate. They do this by homing in on receptors in the heart muscle and effectively blocking the actions of adrenaline, a hormone which speeds up the heart.
But I assume that you are not being treated by one of these drugs as your low pulse rate seems to have been a lifelong characteristic.
So how can a low pulse rate be healthy — but in some cases, as you’ve read, also unhealthy? Let me explain.
The heart pumps around five litres per minute when at rest. With each beat, an amount of blood is ejected from the main pumping chamber, the left ventricle, through the aortic valve, into the aorta, the main blood vessel leading away from the heart.
If your heart beats at around 50 beats per minute, as yours does, each beat will push out about 100ml of blood — the quantity is known as ‘stroke volume’.
But if your resting pulse rate was higher, say 70 beats a minute, the stroke volume would be just over 70ml per beat.
When you are exerting yourself, the body needs greater blood flow to carry oxygen and other nutrients to the muscles, and it is fair to say that a lower pulse rate is a sign of efficiency of the heart, good fitness and health. Your heartbeat is at the lower end of the spectrum, but it’s healthy rather than abnormal (and note that with increasing age, our resting rate may increase slightly, as yours has).
I had a patient in his 60s who was a runner, a keep-fit enthusiast. His heart rate was always in the 40s whenever he came to see me. After some years I noted it had dropped to 38 beats per minute — I arranged for him to see a cardiologist, who declared he had an athlete’s heart.
THISmeans that, with years of training, his heart had adapted, increasing the stroke volume of each beat and becoming super-efficient. A few years later, his heart rate was 30, and after this he had a pacemaker fitted.
No one wanted to wait and see what might happen if his rate dropped even lower — bouts of fainting, maybe, if the stroke volume could not meet his needs during exertion one day and his system was unable to maintain a good blood pressure.
This was an exceptional story, and never for a moment had my patient felt unwell. I do not describe this anecdote to worry you, but rather to illustrate that your heart rate is within the bands of a wide normal range and you need have no concern. I HAVE recently been diagnosed with the very painful ‘policeman’s foot’. My doctor is unable to give any more information except that it is chronic.
Joan Tolson, Biggleswade, Bedfordshire. THere are several different conditions that are sometimes described as ‘policeman’s foot’, or ‘policeman’s heel’. one of these is plantar fasciitis, the most common cause of heel pain, which accounts for at least 10 per cent of all foot symptoms requiring professional treatment.
The plantar fascia is a tough membrane that stretches from the heel to the middle bones of the feet and supports the arch of the foot, acting as a shock absorber. Plantar fasciitis is an inflammation of this membrane, at the point where it attaches to the calcaneus, or heel bone.
This is due to a combination of factors, mainly repeated minor trauma, such as when running on hard surfaces, or wearing shoes with poor cushioning or arch support. Typically, it causes pain under the front part of the heel pad, which is often worse when getting out of bed; the site is also very tender if pressed.
Policeman’s heel is also used to denote a different condition, calcaneal bursitis. This is inflammation and swelling of the bursa, a fluid-filled sac that sits between the Achilles tendon and the heel bone. The condition is linked to Achilles tendinosis, where the tendon is damaged through overuse, causing pain at the back of the heel, particularly when walking or running. It’s worse when rising up on to tiptoes.
There are a number of treatments for plantar fasciitis but little evidence to show us what is best. rest helps, as does refraining from running.
CuSHIoNedshoes with a 1cm pad under your heel can help, while gentle stretching of the Achilles tendon and plantar fascia with regular exercises taught by a physiotherapist may ease the symptoms. eighty per cent of cases resolve within a year.
For the calcaneal bursitis — and you will need your GP or a physio to help identify your exact diagnosis — it is also important to avoid activities that cause the pain as much as possible.
An ice pack, applied for 20 minutes two or three times daily, anti-inflammatory medication such as regular ibuprofen, and the use of a cushioning pad inside the shoe can prove invaluable.
It is a good idea to see a physio for treatment, as ultrasound can help (it’s not clear how, but it seems to ease pain and boost healing). The condition usually resolves within several weeks.