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Large BPM Heart Rate Variation

Commented on November 18, 2013
Created October 16, 2013 at 5:50 PM

I recently had a heart monitor (Holtor Monitor) for 48 hours issued by my GP after a recent dizzy spell that resulted in fainting. My test results came back as technically "normal", but my GP was a little alarmed that my heart rate varied from 40BMP to 80BMP during the 48 hours. Is this anything to be concerned about?

I should also note that I did not do any intense exercise or anything out of the ordinary during this time, nor did I have any symptoms of dizziness. I also recently had an EKG while I was in the hospital after I fainted that came back normal. All bloodwork/urine tests have also come back normal.

INFO:

26yo Female, 105lbs, 5'7", pretty active about 5 days a week (HIITx2, strength training x3, volleyball). Have not been able to workout/be active for long periods of time since this happened (aug 16) because I feel to weak/tired/short of breath and dizzy feeling (spinning sensation). I also get dizzy/lightheaded when I'm standing for long periods of time or trying to focus on one thing (like someone's face, or a computer screen) if I move/tilt my head at all.

EDIT ** I've called my doc and arranged to get a copy of the test results today. I'll post more info ASAP **

**UPDATE **

Sorry about the long delay on this one. I made an apt to go back into my GP to get the test, but it just so happens that he went on vacation at the same time so I wasn't able to get the tests until he came back.

Turns out my resting heart rate is around 54BMP, with the heart rate variating 40-60BPM within the time frame. Yep, turns out he misread the chart. Does this seem normal?

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on November 18, 2013
at 02:43 AM

This might seem like an odd question, but what were your B12 and D levels? Specifically, I'm wondering if your D was near 35? and B on lower end of normal.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on November 17, 2013
at 03:14 AM

don't hate :)

F291857fa12a0291688ea994343156dc

(720)

on November 17, 2013
at 02:43 AM

Thanks for the clariifaction... :)

F291857fa12a0291688ea994343156dc

(720)

on November 17, 2013
at 02:42 AM

See my answer to your "hack my yellow skin"...

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on November 17, 2013
at 02:28 AM

I'm still getting dizzy spells, but they're happening less now (not daily)... I'm going to get my thyroid tested and see if perhaps that's the issue...

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on November 17, 2013
at 02:27 AM

I'm still getting dizzy spells, but they happening less now (not daily)... I'm going to get my thyroid tested and see if perhaps that's the issue

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on November 17, 2013
at 02:26 AM

You're right in assuming 40 to 60 is a variation of my resting rate @BobK ... sorry that wasn't clear

F291857fa12a0291688ea994343156dc

(720)

on November 17, 2013
at 01:33 AM

But clearly the data indicates otherwise... ;) Your "estimate" was a guess based on what you thought the data she was supplying represented. Her explanation wasn't & still isn't 100% clear. But then again her doctor gave bad info too. Yes, but is 40 to 60 a variation of her resting rate. Is the 40 to 60 the range of her absolute lows (per the sample data I posted) or is it the absolute min and absolute max? I assuming it's the range of her resting but it's only an assumption.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on November 17, 2013
at 01:16 AM

@Linds There's nothing that seems off. Do you still get the dizzy/fainting spells?

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on November 17, 2013
at 01:15 AM

I'm not one to toot my own horn, but look at my original post at my estimate for her resting heart rate.... I'm just saying, that's pretty good.

F291857fa12a0291688ea994343156dc

(720)

on November 16, 2013
at 10:57 PM

Looks like we got bad data originally. Still didn't get an event report or activity log. Perhaps the numbers we;re now getting are ... 54 resting average. She mentions "the heart rate variating 40-60BPM within the time frame." Which heart rate has a range 40 to 60? Min or Resting. And we never got her max or average max. What about her dizziness? :(

543a65b3004bf5a51974fbdd60d666bb

(4493)

on November 16, 2013
at 09:39 PM

thx for the update. so if i am reading this correctly, it looks like over the 48hrs, your resting heart rate was 54 and your minimum heart rate ranged from 40 to 60. nothing seems abnormal there to me, given your age, fitness etc.

@CDone may be able to add...

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on November 16, 2013
at 08:39 PM

Blood sugar testing comes back normal and I passed the orthostatic/postural hypotension test from my doc. I do have lower blood pressure (95/65), but I've always been that way.

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on November 16, 2013
at 08:36 PM

Thanks @MM2204 ... I think you may be right. I'm going to ask for a TSH test when I see my new naturopath this week and see what happens after that. Anything else I should be asking for as a baseline to address these concerns?

F291857fa12a0291688ea994343156dc

(720)

on October 31, 2013
at 12:48 AM

@Linds @daz pinged you but did not include a message flag... per his ping, what's up?

Would to know the resolution and current situation as the original one was a real mystery.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 30, 2013
at 10:23 PM

did you get all the details in the end Linds...hope its all good now

F291857fa12a0291688ea994343156dc

(720)

on October 18, 2013
at 09:57 PM

Actually she said .....

"I did not do any intense exercise or anything out of the ordinary during this time", whatever that means. The asjective "intense" is more than a bit subjective.

Not, "said she had no exercise during her time period"

Perhaps the study you find will be more useful.

F291857fa12a0291688ea994343156dc

(720)

on October 18, 2013
at 09:52 PM

Hopefully her GP suggest an activity log..... BPM data without an activity log won't be very useful, That would be akin to blood sugar readings w/o a food log.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 18, 2013
at 12:33 PM

This study does not control for activity. Britt said she had no exercise during her time period.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 18, 2013
at 07:09 AM

yep, the mins okay, but that max of 80 bpm over 48hrs makes no sense, can't wait to find out more when Linds gets the info from her doc & posts up...

one explanation, looking at that pdf, is 40 bpm was her min while sleeping & 80 bmp was her min while awake.

603ffd5a9edb22b9efa742cff330c6b9

(0)

on October 18, 2013
at 03:33 AM

agree with daz here. the causes of these symptoms need to be established.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 18, 2013
at 01:09 AM

It is almost certain that some combination of fasted training leading to exercise-induced hypoglycemia and not breathing enough is at the root of this. I'd guess anxiety is part of the issue now.

Try eating something before you lift (like a banana) and go low rep (15 is a shit-ton). breath in on the way down, out on the way up, and then take an extra breath at top. Also I wouldn't do back squats until you figure this out. Grab some dumbbells and hold them at your side.

Also, stay hydrated.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 18, 2013
at 12:59 AM

She's young and athletic. The normal "resting" heart rate for a 21 year old athletic female would be closer to 50-55 bpm. Dropping, momentarily, 10-15 bpm is not abnormal. I would say her range appears to be in the average range for her demographic.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 18, 2013
at 12:55 AM

Bradycardia is only a problem if it is accompanied by low blood oxygen or low blood pressure. Strong, efficient hearts can push enough oxygen through the blood at fewer heart beats. My resting rate is below 50, and there is no concern.

If Britt's doctor is even a little bit competent and concerned, he/she would have given her a oximeter measurement and then ordered a arterial blood gas test. Since he/she didn't obviously he/she is not that concerned. The dizziness spells are, almost certainly, not a function of her heart-rate.

F291857fa12a0291688ea994343156dc

(720)

on October 18, 2013
at 12:51 AM

I'm thinking of a bell curve of the population's min to max. Linds seems like an "outlier" to the low end. Yeah, 85 for a resting is high but I must have missed where 80 was characterized as a resting number as opposed to an absolute max for a 48 hour period.

BTW a 500 char field ain't much.. vamos a ver

the comment character counter is still not working!!!!

F291857fa12a0291688ea994343156dc

(720)

on October 18, 2013
at 12:49 AM

40 to 80 seems to me to be on the low end of a normal total range when most people probably operate in the 65 to 120+. Thus her range appears shifted to the low end of normal. IMO, her operational range (if that's what the 40 to 80 actually is) seems a bit odd.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 17, 2013
at 09:21 PM

& two other possible causes of the light-headedness/dizziness could be low blood sugar (hypoglycemia) and low blood pressure when standing up (orthostatic/postural hypotension)

F291857fa12a0291688ea994343156dc

(720)

on October 17, 2013
at 06:34 PM

Don't worry...I'm not confused about resting vs min/max.

The heart rate 'info' in this situation is only part of the mystery / puzzle. My SWAG, there are other, yet to be revealed, issues at play

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on October 17, 2013
at 05:37 PM

No caffeine or anything like that before lifting. I try to be conscious of my breathing...I don't think that I'm holding my breath...although maybe I'm not breathing normally. I used to workout fasted before this started and had no issues. Now I can't seem to lift even light weights (15lb dumbbells) without getting that light headed feeling. I can only get through 1 set of 15 before I start feeling a bit off. I'm wondering if I'm psyching myself out and causing myself anxiety since I'm worrying about getting dizzy/fainting again...but I feel like it's more than that.

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on October 17, 2013
at 04:14 PM

I only saw my regular family doctor -- not a specialist.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 04:12 PM

What kind of doctor did you go see?

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on October 17, 2013
at 04:02 PM

I was having palpitations and chest pain (usually after exertion such as squatting heavy weights) along with dizzy spells but my doctor chalked it up anxiety and prescribed cipralex...which I refuse to take. I'm thinking I'm going to need to get another opinion...

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on October 17, 2013
at 03:58 PM

I'm getting a copy of the test today -- maybe that can help provide some insight.

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on October 17, 2013
at 03:44 PM

Hmmm, it seems I don't have enough information here. I've called my doc and arranged to get a copy of the test results today. I'll post more info then. Thanks for all the feedback!

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 01:24 PM

do not confuse resting with min/max.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 01:23 PM

it is not resting. it is minimum. a minimum of 40 is not a conern

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 01:22 PM

40 bpm is the minimum -- not the resting heart rate. There is no concern for a minimum heart rate of 40. Also Bradycardia requires an test of the blood oxygen. Low heart rate is only one of the pieces of the puzzle.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 01:20 PM

her resting heart rate is not 40. that was her minimum over the course of a day. that is not a concern

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 01:19 PM

low end? Anything over 85 is a concern. 40 is not her resting heart rate. it is her low.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 17, 2013
at 05:39 AM

yep @BobK we are all just guessing. The absolute max heart rate of 80bpm does not make any sense, esp given the Q heading, 'Large BPM Heart Rate Variation', a min/max range of 40bpm over 2 days is far from large.

On the contrary if that were the case, i could understand if the doc was concerned over a Small bpm heart rate variation, ie. that the heart rate never got higher than 80bpm over 2 days...

climbing up a few flights of stairs at a 'normal' pace should easily get you over 80

F291857fa12a0291688ea994343156dc

(720)

on October 17, 2013
at 04:52 AM

Good points all.... without a better view or explanation of the data, we're just guessing. I figured from the OP that the overall range (high to low) over the 48 hour period was 40 to 80. Absolute minimum (deep sleep) to absolute maximum (some sort of normal activity).

I wonder if GP asked her to keep an activity log? nah..too much science.

My MIL has low heart / low BP issues (85 years old) but hers is medcation driven.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 17, 2013
at 02:30 AM

maybe linds had a resting heart rate of 40bpm during sleep one night and a resting heart rate of 80bpm during sleep on the other night...now that would be a bit weird (a little alarming) & may warrant more monitoring/testing

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 17, 2013
at 02:24 AM

but if her doc is "little alarmed" by how much her (resting?) rate varied, i'm guessing he has info/facts that we do not/we are missing some info...

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 17, 2013
at 02:19 AM

I think @linds needs to clarify the details a bit more. i am making the assumption that the 40 & 80 numbers are both Resting heart rate (i could be wrong). it would seem from the info in the question that her doctor is Not alarmed by the 40bpm...but was a 'little alarmed' by how much the (resting) rate varied within 48hrs.

Now, her doc has access to the result detail & i don't of course, but if the 40bpm was during sleep & the 80bpm was while standing still, then these numbers are not abnormal.

F291857fa12a0291688ea994343156dc

(720)

on October 17, 2013
at 12:56 AM

Agree... BB is definitely a special case (as are most highly conditioned athletes) but OP might also be an "outlier"? I still think 40 to 80 is way low

F291857fa12a0291688ea994343156dc

(720)

on October 17, 2013
at 12:06 AM

Combine with the dizziness / fainting a range of 40 to 80 BPM is a bit on the low end and, to me, a reason for some concern.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 16, 2013
at 09:16 PM

are they your resting heart rate numbers?

rather than min & max rates, i would find it hard to believe that your heart rate never exceeded 80bmp over 2 days. you would have to have been very (very) sedentary for 48hrs. (but of course i do not know your details or your situation).

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9 Answers

0
Ba20b502cf02b5513ea8c4bb2740d8cb

on October 31, 2013
at 01:12 AM

get your blood sugar checked...

0
F291857fa12a0291688ea994343156dc

(720)

on October 18, 2013
at 03:09 AM

And perhaps this is why OP's GP is concerned...

results of a study of data from Holter recording of ~75 people

http://medind.nic.in/jac/t05/i2/jact05i2p136.pdf

Her reported min / max makes her somewhat of an outlier.

Maybe she's an outlier for safe, good, explainable reasons...maybe not.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 18, 2013
at 12:33 PM

This study does not control for activity. Britt said she had no exercise during her time period.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 18, 2013
at 07:09 AM

yep, the mins okay, but that max of 80 bpm over 48hrs makes no sense, can't wait to find out more when Linds gets the info from her doc & posts up...

one explanation, looking at that pdf, is 40 bpm was her min while sleeping & 80 bmp was her min while awake.

0
603ffd5a9edb22b9efa742cff330c6b9

on October 17, 2013
at 07:27 PM

Linds, first off dont worry too much about this. the more your explaining, the more the possibilities of other causes are coming to light. dizziness standing or from focusing on one thing too long can be signs that these issues may not be directly related to the heart. seen as your an active female athlete and seem to be training on the more elite side of things this could come down to a possible hormone imbalance. blood tests done in the hospital for "fainting" may not pick this up, neither will a single EKG. however thyroid problems can cause the symptoms you have described including the palpitations,dizziness and erratic heart rates. a simple TSH (thyroid simulating hormone) blood test may help. Its sounds to me that you've had a basic cardiac work up done and has come back relatively non-specific apart from the Holter reading. your GP needs to look for other causes now if this is affecting your day to day activities. this is a process of elimination, as each body system is checked the cause will soon come to light, sooner rather than later. dont despair : )

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on November 16, 2013
at 08:36 PM

Thanks @MM2204 ... I think you may be right. I'm going to ask for a TSH test when I see my new naturopath this week and see what happens after that. Anything else I should be asking for as a baseline to address these concerns?

0
3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 04:20 PM

I just read your comment about how your dizziness spell occurred "after exertion such as squatting heavy weights".

This is fairly common, especially amongst novice lifters (although it can happen to anyone). There are two things at play:

1. NOX/Caffeine/etc intake before lifting

2. Improper breathing technique

Do you drink caffeine or some other "booster" pre workout?

How many sets/reps do you preform?

Do you hold your breath on the push up?

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on October 17, 2013
at 05:37 PM

No caffeine or anything like that before lifting. I try to be conscious of my breathing...I don't think that I'm holding my breath...although maybe I'm not breathing normally. I used to workout fasted before this started and had no issues. Now I can't seem to lift even light weights (15lb dumbbells) without getting that light headed feeling. I can only get through 1 set of 15 before I start feeling a bit off. I'm wondering if I'm psyching myself out and causing myself anxiety since I'm worrying about getting dizzy/fainting again...but I feel like it's more than that.

0
603ffd5a9edb22b9efa742cff330c6b9

on October 17, 2013
at 03:50 PM

There needs to be a bit more clarity here. Post states "heart rate varied FROM 40 to 80 BPM" (i read that as a heart rate range of 40-80 BPM). If it varied BY 40-80BPM that is different alright i.e. heart rate was 60BPM and varied (meaning increased or decreased) BY 40-80BPM, there is still an issue. Linds, your GP needs to be clearer with you. He probably only got a report of the telemetry (48 hour heart monitor) but didn't see the data (rhythms and rates) from it, which are important. Again, you need to know what kind of cardiac rhythm caused the heart rate to increase/decrease BY 40-80BPM and the context the varied heart rate occurred in- time of day, active at the time and even emotional state- stressed, relaxed, under pressure at work, involved in high pressure situation etc.

CDone-Bradycardia is merely a medical term for a "slow heart rate" diagnosed by ECG/EKG(which is what Linds 48 hour heart monitor was). Bradycardia is not diagnosed on or by blood-oxygen levels,although it can affect Blood-oxygen levels, but that's a discussion for another day!! CDone-No necessarily, as per AHA (american heart association) guidelines in ACLS (advanced cardiac life support) an ​"unstable bradycardia" is described as a slow heart rate with symptoms of dizziness,chest pain, diaphoresis, pallor or alerted LOC. I agree that Bradycardia can affect SpO2 readings but SpO2 readings from pulse-oximetry or ABG are not how Bradycardia is diagnosed. Athletes of course have a lower resting heart but this is wihtin a context! check out links below for more info http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Bradycardia-Slow-Heart-Rate_UCM_302016_Article.jsp http://acls-algorithms.com/bradycardia

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 18, 2013
at 12:55 AM

Bradycardia is only a problem if it is accompanied by low blood oxygen or low blood pressure. Strong, efficient hearts can push enough oxygen through the blood at fewer heart beats. My resting rate is below 50, and there is no concern.

If Britt's doctor is even a little bit competent and concerned, he/she would have given her a oximeter measurement and then ordered a arterial blood gas test. Since he/she didn't obviously he/she is not that concerned. The dizziness spells are, almost certainly, not a function of her heart-rate.

0
603ffd5a9edb22b9efa742cff330c6b9

on October 17, 2013
at 06:17 AM

A heart rate of 40bpm is known as a Bradycardia. For a healthy, even very fit person, this is verging on dangerous especially if it associated with dizzy spells, fainting, palpitations or chest pain. The results of your 48 hour monitoring also need to be considered in context ie what time of the day did these "low" readings occur. Another factor apart from the heart rate is the heart rhythm. This is very important to establish to insure there is no underlying cardiac arrhythmia (abnormal heart rhythm) causing the slow heart rate and dizzy spells. You might consider going back to your GP and asking for more details or get a second opinion of the results, preferable from someone with a good Cardiology background.

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on October 17, 2013
at 04:02 PM

I was having palpitations and chest pain (usually after exertion such as squatting heavy weights) along with dizzy spells but my doctor chalked it up anxiety and prescribed cipralex...which I refuse to take. I'm thinking I'm going to need to get another opinion...

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 01:22 PM

40 bpm is the minimum -- not the resting heart rate. There is no concern for a minimum heart rate of 40. Also Bradycardia requires an test of the blood oxygen. Low heart rate is only one of the pieces of the puzzle.

0
00cd3b6f51530a6832fcda1712edbec3

(2411)

on October 17, 2013
at 12:48 AM

The tennis player Bjorn Borg, who was marvelously fit in his prime, had a resting heart rate of 54 BPM. A BPM of 40 for a non-athlete seems dangerously low.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 01:20 PM

her resting heart rate is not 40. that was her minimum over the course of a day. that is not a concern

543a65b3004bf5a51974fbdd60d666bb

(4493)

on October 17, 2013
at 02:19 AM

I think @linds needs to clarify the details a bit more. i am making the assumption that the 40 & 80 numbers are both Resting heart rate (i could be wrong). it would seem from the info in the question that her doctor is Not alarmed by the 40bpm...but was a 'little alarmed' by how much the (resting) rate varied within 48hrs.

Now, her doc has access to the result detail & i don't of course, but if the 40bpm was during sleep & the 80bpm was while standing still, then these numbers are not abnormal.

F291857fa12a0291688ea994343156dc

(720)

on October 17, 2013
at 12:56 AM

Agree... BB is definitely a special case (as are most highly conditioned athletes) but OP might also be an "outlier"? I still think 40 to 80 is way low

0
F291857fa12a0291688ea994343156dc

(720)

on October 17, 2013
at 12:05 AM

Linds-

Despite not knowing the specifics of your situation...height, weight, age, physical conditioning, I would still tend to lean towards agreement with your GP especially considering the symptoms of dizziness / fainting.

Did you or anyone double check the monitor against a simple "timed count"?

Again if 40 to 80 was your true max, min.... ime, that would be a bit troubling unless you're a total yoga master. :)

I'm used to much higher numbers... resting BPM ~60 to 75 with exertion driven spikes to ~120-ish. But I'm 6' / 190.

http://www.mayoclinic.com/health/heart-rate/AN01906

Perhaps the heart rate is not the issue but rather not enough food (hunger induced fainting)?

I had a episode like that YEARS ago...heavy evening weight workout & racquetball combined with no dinner & last meal at lunch...fainted in kitchen near midnight, "came to" staring at the ceiling and needing about 5 stitches in my eyebrow.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 17, 2013
at 01:24 PM

do not confuse resting with min/max.

5b9a25a1a676397a25579dfad59e1d7b

(2318)

on October 17, 2013
at 03:58 PM

I'm getting a copy of the test today -- maybe that can help provide some insight.

0
3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on October 16, 2013
at 06:39 PM

Sounds pretty normal. I'm more concerned that your doctor is concerned. Heart rate varies throughout the day, 40 bpm is not a large variation. Drinking Coffee, Walking up a few flights of stairs, Seeing a Primal-looking dude sans shirt.... There are many things that could cause the heart rate to increase by 20-30 bpm without significant effort. And a heart rate of 40, while low, is not really a concern for a healthy person.

My guess is your resting rate was around 54.

F291857fa12a0291688ea994343156dc

(720)

on October 17, 2013
at 12:06 AM

Combine with the dizziness / fainting a range of 40 to 80 BPM is a bit on the low end and, to me, a reason for some concern.

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