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Bradycardia, constant weakness, tiredness.

Good day!

Height 173 cm, weight 70 kg, age 30 years.

complaints:
There is a constant feeling of weakness, tiredness.
Noticed that the low pulse affects other organs. It is worth to me at the time of the next pain in the stomach to do physical exercises (pull-ups, push-ups) for 15 minutes, as all the symptoms of the disorder disappear (often tormented discomfort, gastrointestinal disorders).
I feel myself well, and head works fast only when the pulse of 80-85 beats / min. (pressure 115/70).

research:
The results of the ECG:
30.06.1999 (15 years) - 55 beats / min; Diagnosis: Sinus bradycardia. Signs vagotomy.
30.05.2007 - 51 beats / min; Diagnosis: Sinus bradycardia. Signs vagotonia.
08/05/2013 - 49 beats / min; Diagnosis: Sinus rhythm. Bradycardia. Violation of intraventricular conduction in all decree. holes V1 V2 RS with serrated. Early repolarization syndrome
09/30/2014 - 44 beats / min; Diagnosis: Sinus bradycardia

Holter test results:
During the daily monitoring of ECG Holter registered 84,654 complex. The basic sinus rhythm with episodes of sinus arrhythmia with an average heart rate of 69 beats / min. Max. Heart rate of 141 beats / min. at 19:38 (when walking), Min heart rate of 36 beats / min. at 6:19 (sleep).
Against this background, recorded: 1 ventricular parasystole 1 supraventricular arrhythmias. Paroxysmal ectopic rhythms, long pauses and accurate ST segment depression was not revealed. Patient complaints from the heart does not show.

As you see i have been having the diagnosis bradycardia since childhood. In recent years, the pulse rate on the ECG became lower.
Please, what research needs to be done?
Which reasons of bradycardia should be sought?

Yours faithfully,
Alexander
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replied October 28th, 2014
I'm trying to accentuate what worries me below:

1. Almost every day I feel tired and weak.
2. Sluggish thinking.
3. Periodically, it hard to concentrate.
4. I'm cold, where other people do not complain of the cold.
5. There are problems of the gastrointestinal tract.
If I am under stress, all the above problems are disappear.
As stress bring body to produce adrenaline, the heart begins to NMS need quickly. That is why I tried to connect all of this symptoms with bradycardia.
Also I made the measurement of pulse and pressure and found that both at 85 beats / m and 115/70 I have no complaints.
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replied November 1st, 2014
I found key of this problem - it's increasing average heart rate.

I understand the complexity of the processes of the body, so i try to consider all sides.

Am I right in thinking that bradycardia may be as induced vagal tone and as other reasons?
Do I understand correctly that bradycardia by itself (without delving into the cause) may cause the other symptoms I described?

Are there any comprehensive studies on the identification of vagal tone or tone of the parasympathetic nervous system?

I've read an article about autonomic nervous system.

As I understood the mediator for the parasympathetic nervous system is acetylcholine. For sympathetic - adrenaline.

If the activity of the parasympathetic system is large, it can be used an anticholinergics, isn't it?

"When the amount of acetylcholine is increased, the excitatory receptors of the adrenal medulla, and therefore, a large amount of adrenaline"
Therefore it's protective mechanism against high activity of the parasympathetic nervous system. How to check that it works well?


Two more my ECG are below :

03/05/2014 - 49 beats / min; Diagnosis: Sinus rhythm. Bradycardia. Violation of intraventricular conduction on the right bundle branch block in all decree. V1 V2 RS with serrated. Early repolarization syndrome
07/25/2014 - 44 beats / min; Diagnosis: Sinus bradycardia. Violation of intraventricular conduction on the right bundle branch block
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replied November 12th, 2014
Hello!

I've read article, that bradycardia can be caused by:

1. Changes in the heart that are the result of aging.
2. Diseases that damage the heart's electrical system. These include coronary artery disease, heart attack, and infections such as endocarditis and myocarditis.
3. Conditions that can slow electrical impulses through the heart. Examples include having a low thyroid level (hypothyroidism) or an electrolyte imbalance, such as too much potassium in the blood.
4. Some medicines for treating heart problems or high blood pressure, such as beta-blockers, antiarrhythmics, and digoxin.


I've checked an electrolyte imbalance already by blood tests (as i understand it):
Ca++, Free Calcium, Calcium ionized - 1.14 mmol/l refer:(1.03 - 1.23)
Ca, Calcium total - 2.31 mmol/l refer:(2.10 - 2.55)
+, Potassium - 4.3 mmol/l refer:(3.5 - 5.1)
Na+, Sodium - 140 mmol/l refer:(136 - 145)
l-, Chloride - 103 mmol/l refer:(98 - 107)
g, Magnesium - 0.86 mmol/l refer:(0.66 - 1.07)

It's looks good.
What also i can check according the described symptoms?
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replied November 27th, 2014
The results of the latest Holter monitor:


Duration of monitoring 23:26. Recorded leads: V2, V5, aVF
Sleep from 23:10 to 6:20.
During the study analyzed 84,930 complexes QRST.
Of these to artifacts attributed 1.6%
RHYTHM
Basic rhythm - sinus
HEARTH RATE
min avg max
sleep 34 46 80 3:53:41 3:00:19
awake 40 67129 in 6:20:51 22:33:10
day 34 in 3:53:41 to 22:33:10 60129

Duration of bradycardia 6:51:40 :
* 30 to 40 beats / min 00:21:25
* 40 to 50 beats / min 6:30:15
Duration of tachycardia 00:20:10 :
* 90 to 100 beats / min 00:17:20
* 100 to 120 beats / min 00:02:25
* 120 to 150 beats / min 00:00:25
Circadian index is equal to 1.46 (normal 1.24-1.44)
BREACH ATRIOVENTRICULAR CONDUCTION
Episodes conduction abnormalities not registered
ECTOPIC SUPRAVENTRICULAR ACTIVITY
Total for the day found 3 supraventricular extrasystoles 2 during wakefulness and 1 at bedtime. Interval of coupling from 0.51 sek. (at 17:06:49) to 0.73 sek. (in 3:56:11). 3 of them are single.
VENTRICULAR ECTOPIC ACTIVITY
Ventricular extrasystoles are not identified
PAUSE (FALL-OUT QRS)
Blockade were not identified.
Total found 124 (73 during sleep) an apparent sinus arrhythmia. Duration RR: 1.8-2.0 sec - 3 (during sleep); <1.8 sec - 121 (70 during sleep); Maximum arrhythmias RR 1.90 sec. in 2:37:54
Maximum RR 1.90 seconds . in 2:37:54
DYNAMICS PQ INTERVAL
Episodes of increasing and shortening of PQ interval are not registered.
DYNAMICS OF ST-T
ST-segment deviations are not registered
DYNAMICS OF QT INTERVAL
Periods of increasing and shortening of the QT interval are not revealed. The average daily duration of intervals: QT = 0.40 sec., QTc = 0.40 sec.
RATE VARIABILITY
HRV analysis for all time monitoring:
time analysis HRV:
Description Value Norm
Mean | Average value of all RR intervals | 995 | 795 (583-1090)
SDNN | Standard deviation of the study | 229 | 143 32
SDNNi | Average SDNN in 5-minute sections | 78 | 64 15
SDANNi | Standard deviation of averaged over a 5-minute values of RR intervals | 231 | 130 33
rMSSD | RMS difference of adjacent RR 44 35 11
PNN50 | % of adjacent intervals differing more than 50 ms 16 13 9

Additional rate variability analysis was performed on short sections, consisting of 33 intervals RR
All worked up plots in 2304 (88% of the time study).
Heart rate variability: increased
SIGNS OF FEELING SICK
signs of feeling sick are not available.
CONCLUSION OF DOCTOR
Throughout the study, recorded sinus rhythm with a predominance of sinus bradycardia in the passive period with min. averaging. heart rate of 34 bpm. min. at 03:53 (sleep) and max. averaging. heart rate 129 bpm. min. at 22:33 (walking). Episodes of bradycardia less than 34 bpm. min. have been identified.
The daily average heart rate of 60 beats per min. The daylight hours average heart rate of 67 beats per minute. The night average heart rate 46 beats per min.
Throughout the study, with a predominance during sleep episodes were recorded marked sinus arrhythmia, max RR 1,9 sec.
During the study, 3 registered supraventricular arrhythmias.
Diagnostically significant ST-segment changes haven't been identified. Submaximal heart rate of age is not reached.
Increased heart rate variability and increased circadian indexes are detected.
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