DEAR DR. ROACH: I am a 65-year-old male who has enjoyed running on a regular basis for most of my life. Iβm not an exercise fanatic by any means, usually running 4 miles three to four times per week. My resting heart rate normally has been in the 50s, which has never created any problems for me. But this past year, my heart rate has been consistently in the mid-40s. I suspect that my bradycardia is the cause of a particularly bothersome symptom that Iβve been experiencing for the past several months: Almost every time I stand up after having been sitting for any length of time, I experience noticeable lightheadedness and weakness in my legs. Twice I have lost consciousness for a few seconds and fallen to the ground.
My family doctor suggested that dehydration might be the cause, but increasing my fluid intake has not had any effect.
Is there a medication that would help with my problem, or am I in need of an implanted pacemaker? β T.M.
ANSWER: βBradycardiaβ comes from the Greek roots for βslowβ and βheart,β and it is defined by a heart rate below 60. Many athletes have heart rates below 60, and as long as they arenβt having any symptoms, they donβt require any treatment. However, I agree that your recent symptoms of lightheadedness and even fainting upon standing are likely to be related to your slow heart rate.
In emergencies, we use medication for short-term increase of heart rate. For long-term use, a permanent pacemaker is the definitive treatment. A cardiologist (some of whom specialize in rhythm disturbances) may elect to do further testing, or may recommend a pacemaker, based on your clinical evaluation.
DEAR DR. ROACH: I am a 62-year-old female in good health, except for having high cholesterol and being overweight. About six months ago, I noticed that my right clavicle is larger than my left. Recently I was visiting my primary physician and showed it to him. He checked it and could see that there was a difference in the two sides, but due to the fact that I didnβt have any other symptoms, he wasnβt concerned. He did order an ultrasound, and nothing was found.
It concerns me that there is such a difference in the two sides. β B.B.
ANSWER: I see this fairly frequently. We all are slightly asymmetrical, and this may seem to get worse over time. Changes in muscle (including muscle spasm), posture and in the spine can accentuate the appearance of asymmetry. I have checked X-rays a few times in people where I, too, noticed a difference in the appearance of the clavicle and have yet to find anything seriously wrong, so my experience suggests that this is unlikely to be a problem.
