There is typically no change in the resting heart rate associated with aging. There is, however, a definite decrease in maximum heart rate in response to exercise, which can be estimated in adults by the formula 220 minus age.

Bradycardia is defined as a rate of less than 60 beats per minute. Sinus bradycardia can be normal in some adults including the elderly, during sleep when rates can go down to 30 or 40 beats per minute. Initially, an ECG +/- holter monitoring may be needed to identify various bradyarrhythmias, heart block, etc. Drugs that cause bradycardia include beta blockers, certain calcium channel blockers and digoxin. Other causes include hypothyroidism (check the TSH), hypothermia and occasionally sepsis.

Treatment isn’t required for asymptomatic patients with sinus bradycardia. If the bradycardia is due to an offending drug, e.g. beta blocker or calcium channel blocker, it will require dosing adjustment. Referral to a cardiologist for pacing is needed for disorders such as sick sinus syndrome.

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