Bradycardia
Hello everyone. I’ve been dealing with symptomatic bradycardia for quite some time, mainly during wakefulness and at rest. What draws my attention the most is that whenever I stay around 3–4 hours without eating, the bradycardia seems to become much more pronounced and I start feeling lightheaded, mentally “foggy,” mildly dizzy and generally unwell, especially around 11:15 AM and again near 4:15 PM. I’ve noticed this pattern repeatedly over time.
I’m 33 years old, weigh 104 kg, and train at the gym around 3 times a week. Despite being overweight, I still seem to have relatively preserved exercise tolerance. While running on the treadmill, my heart rate can reach 165 bpm without major limiting symptoms, so chronotropic response during exertion appears to be intact. The issue is mainly at rest, especially during fasting or when my stomach is empty.
At rest, sitting or standing still, my heart rate may stay around 55, 53, sometimes even 47 bpm while awake. It’s not constant, but it happens frequently enough to concern me. I already underwent two Holter monitor evaluations, and both confirmed sinus bradycardia. During sleep, one Holter recorded my heart rate dropping to 30 bpm.
Another important aspect is that I seem to have significant gastrointestinal hypersensitivity. When my stomach is empty, the bradycardia and malaise worsen noticeably. On the other hand, when I eat too much or have large meals, I start experiencing bothersome premature beats/extrasystoles. There seems to be a very clear gut–heart interaction in my case, which makes me suspect a strong autonomic/vagal component.
I’m also tapering off escitalopram after approximately one year of treatment. Throughout the treatment period, I subjectively noticed the bradycardia becoming progressively more evident. I don’t know whether this is causal or coincidental, but I believe it’s relevant to mention.
Another strange symptom involves peripheral circulation sensations. Sometimes it feels as if my extremities are not receiving adequate blood flow. For example, when measuring blood pressure, if the cuff compresses my arm for a short period, it becomes numb and uncomfortable very quickly. I often experience a sensation of “weak circulation,” although I understand subjective perception does not necessarily reflect actual hemodynamics.
What worries me the most is the psychological burden this has created. I constantly monitor my heart rate and keep trying to correlate symptoms with food intake, fasting periods, posture, gastrointestinal activity and autonomic fluctuations. At this point, I genuinely don’t know whether this is primarily a functional/high-vagal sinus bradycardia amplified by anxiety, hypervigilance and gastrocardiac interactions, or whether there could be an actual autonomic dysfunction, conduction abnormality, metabolic/endocrine component, or even something partially related to escitalopram use/withdrawal.
I would appreciate technical opinions, especially from people who have encountered similar cases involving resting sinus bradycardia associated with fasting, gastrointestinal hypersensitivity, postprandial extrasystoles and possible autonomic/vagal dysregulation.