You can’t go by heart rate alone. When the baseline heart rate slows over time, the body adjusts. In trained athletes, fewer heartbeats are needed to maintain the cardiac output (blood flow). In fact, many trained athletes feel great at a heartbeat of 45 bpm.
Watch for symptoms. As the heart’s conduction system ages, and the heart rate slows to 50 bpm or less, many people have fatigue, malaise, lightheadedness and even confusion. But before getting a heart pacemaker, you want to make sure your doctor rules out other causes of these symptoms such as the use of beta blockers or a heart block.
Anyone with heartbeat pauses of 3 seconds or more should be evaluated for a heart pacemaker. This can be measured, as it was for my colleague’s father, with a 24-hour Holter monitor test.
Like my colleague’s father, I've had many a patient who "felt great" and resisted having a heart pacemaker put in. I can't tell you how many come in for their follow up check-up to report that they have more energy, no longer need an afternoon nap and that their head is clearer.
But the real happy ending here is that my colleague’s dad didn’t have a cardiac event from those long heart pauses. If your heart rate is low, and if you have low energy or mental fogginess that you’ve chalked up to “aging,” you want to get a cardiac evaluation—sooner than later.