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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
Satisfied Customers: 10341
Experience:  14 years experience in the field of Family Practice
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You answered my question regarding a need for a pace maker

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Hi Doctor You answered my question regarding a need for a pace maker last night. I hope you remember me.I neglected to mention that when I saw my doctor he did an EKG which showed a pulse reading of 47. He called this Brakycardia?However, my pr usually runs bet.50-58 resting.Would this be the reason for additional testing,since I also complained that I have felt my heart skipping?Are there other options for a slow heart beat besides a pace maker?Lastly, can anxiety cause irregular heart beats. I just retired from teaching 39yrs and I have been having trouble ajusting.My other concern is(anxiety) is this lower pr a sign of heart disease eventhough I jog 20 miles a week.Please advise.Thanks George
Anthony Bray, MD : Hello!
Anthony Bray, MD : No -- you are conditioned with your regular running! This is good for your heart ! The low rate in your circumstance is actually a GOOD sign!
Anthony Bray, MD : You almost certainly have good conditioning of your cardiovascular system and this allows for a very low resting pulse with rest....
Anthony Bray, MD : As long as the resting pulse of 47 was associated with good oxygen levels...good tissue perfusion....
Anthony Bray, MD : if the holter showed PATHOLOGY of concern such as an AV block or idioventricular bradycardia then those would be findings of concerns --- you history does not suggest these type of pathology ...
Anthony Bray, MD : So UNLESS you had some e
Anthony Bray, MD : some unexpected findings then you would not expect to need a pacemaker!!!
Anthony Bray, MD : runners tend to have very good healthy forms of low resting heart rate--- sinus bradycardia --- this means normal electrical conduction but just slow rate ... Rate less than 60....
Anthony Bray, MD : the running 20 miles / week fits best with this healthy type of SINUS BRADYCARDIA...
Anthony Bray, MD : I would bet palpitations that you feel are probably irregular beats known as PVC's ( premature ventricular contractions) these are like electrical hiccups of the heart -- we all have a few ...
Anthony Bray, MD : Many of us do not feel PVC's --- if very frequent or certain findings should be found( couplets of PVC' or greater groups) then this could be of concern ...
Anthony Bray, MD : So I think that you have reason to have the holter monitor to evaluate the Geary's conduction but the expectation is that this testing will most likely be benign or harmless in nature!!
Anthony Bray, MD : So by all means do get thorough testing with the holter monitor I would say but my expectation is that you will be found to have no serious abnormality. I certainly hope this to be the case for you.
Anthony Bray, MD : If you had frequent PVC's then you may well benefit from a simple over the counter magnesium supplement .
Anthony Bray, MD : magnesium oxide 250 mg tablets are over the counter and magnesium tends to stabilize the heart's electrical rhythm...
Anthony Bray, MD : in fact checking electrolytes and thyroid function is helpful part of checking into the issue of palpitations! Checking sodium, potassium , magnesium, phosphorus, calcium, TSH AND T4 levels would be good idea for your doctor to check...
Anthony Bray, MD : I hope this information is helpful for you! Let me know if you have further questions! Let me know as you get results in and I will be happy to review these with you as you progress in your testing!
Anthony Bray, MD : Let me know if you have further questions / concerns/ discussion --- I will be happy to get back with you if you do! Best regards!!
Anthony Bray, MD : Anthony Bray MD

Doctor You have been very helpful. One last question if i may-Why do you suppose my cardiologist mentioned "pace Maker" After he saw the EKG results,and recommended the holter monitor, he said,you may have need of a pace maker. This is what got me very concerned.Never expected to hear this.


Doctor Please Don't misunderstand me I don't want you to second guess the doctor.Just interested in your take on his comments

Hello again,
Well I can't read the thoughts of your cardiologist of course. Hopefully this was simply to convince you that you should have the further study with the holter monitor . I would agree with the Holter monitor being most useful test. I tend to doubt that you have condition in need of pacemaker. Simple bradycardia ( sinus Bradycardia ) is not reason to get a pacemaker. Your history of running seems to me to be consistent for a healthy type of sinus bradycardia.
There are of course reasons that the heart may need interventions--- pacemaker-- implantable defibrillator --- medications--- surgical intervention such as radio frequency ablation --- there are different indications for such interventions....
So far from your history I would NOT think that you have need for such interventions. Do proceed with the next recommended tests though. You need reasonable testing! This simply gathers information with regard to your heart rhythm . This I think is reasonable. Try not to worry to excess but I understand that when it comes to our heart it is normal to get nervous !! I think the indications do far are supportive of you being unlikely to have real problem and need intervention.
I hope this helps! Let me know if you have further questions or concerns ! Give me updates as you get more test results and I will be happy to get back with you!!
Take care and best regards!
Anthony Bray MD
Customer: replied 3 years ago.

Thank you Doctor One final related question-I did mention last night that I do have a long standing history of Hypertension which has been controlled 130/85 on average with medication and exercise. Does this in any way change your evaluation?

Hello again!
No your blood pressure is well controlled . If you take a beta blocker then that could well be reason for the low rate bradycardia. Still BP meds or not this per your report is well controlled at 130/ 85.
You just need further evaluation to check on the heart at this point . I think the tests will come out fine for you! I certainly hope this is the case for you!
Let me know if you have further concerns!
Best Regards!!
Anthony Bray MD
Customer: replied 3 years ago.

Just curios,how are oxygen levels measured with a blood test? There was one taken. I expect results tomorrow.

Hello again!
The pulse oximetry is measured by the detector on the finger... This uses the different color absorption if oxygenated hemoglobin vs non - oxygenated hemoglobin . ( blood is brighter red when well oxygenated) this test checks how saturated the hemoglobin in the blood is... It should stay above 90% and in most young healthy patients will usually be well above 90% .... Usually 94% to 99%...
I hope this helps !!
Best regards!!
Anthony Bray MD
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