Bradycardia (brad-e-KAHR-dee-uh) is a slow heart rate. The hearts of adults at rest usually beat between 60 and 100 times a minute. If you have bradycardia, your heart beats fewer than 60 times a minute.

Manifestations of the condition include: marked cardiovascular signs and symptoms; atrial fibrillation; occasionally congestive heart failure; and worsened angina pectoris. Signs and symptoms of hyperthyroid heart disease may occur as a result of thyrotoxicosis which may include: palpitations, tachycardia, and increased differences between systolic and diastolic blood pressures.

The functional abilities of cardiac patients can be classified in terms of metabolic equivalents (METs). The classification is generally as follows:

• Light to medium housework is 2 to 4 METs

• Heavy housework or yard work is approximately 5 to 6 METs

• Strenuous activity would be 7 to 10 METs, etc.

An electrocardiogram (ECG or EKG) is the main test used to diagnose bradycardia. An ECG measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the results. An ECG can show if the heart is beating too slow, too fast or not at all.

Because an ECG can't detect bradycardia unless the slow heartbeat occurs during the test, your health care provider might recommend a portable ECG device. Portable ECG devices include:

• Holter monitor. Carried in a pocket or worn on a belt or shoulder strap, this device records the heart's activity continuously for 24 hours or longer.
• Event recorder. This device is similar to a Holter monitor, but it records only at certain times for a few minutes at a time. It's worn longer than a Holter monitor, typically 30 days. You generally push a button when you feel symptoms. Some devices automatically record when an irregular heart rhythm is detected.

An ECG may be done with other tests to understand how bradycardia affects you. These tests include:

• Tilt table test. This test may help your health care provider better understand how your bradycardia causes fainting spells. As you lie flat on a special table, the table is tilted as if you were standing up. A tilt test is done to see if a change in position causes fainting.
• Stress exercise test. An ECG may be done to monitor your heart's activity while you ride on a stationary bicycle or walk on a treadmill. If you have difficulty exercising, a drug may be given to stimulate the heart in a way that's similar to exercise.

A sleep study may be recommended if your health care provider thinks that repeated pauses in breathing during sleep (obstructive sleep apnea) are causing bradycardia.

Treatment for bradycardia depends on the severity of symptoms and the cause of the slow heart rate. If you don't have symptoms, treatment might not be necessary.

Bradycardia treatment may include lifestyle changes, medication changes or an implanted device called a pacemaker. If an underlying health problem, such as thyroid disease or sleep apnea, is causing the slow heart rate, treatment of that condition might correct bradycardia.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

Notes

• Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.

• One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, a medical examiner may estimate the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms.

• For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

• Bradycardia (bradyarrhythmia) refers to conduction abnormalities that produce a heart rate less than 60 beats/min. There are five general classes of bradyarrhythmia: Sinus bradycardia, including sinoatrial block; atrioventricular (AV) junctional (nodal) escape rhythm; AV heart block (second or third degree) or AV dissociation; atrial fibrillation or flutter with a slow ventricular response; and, idioventricular escape rhythm.

• Asymptomatic bradycardia (bradyarrhythmia) is a medical finding only. It is not a disability subject to compensation.

• For DCs 7009, 7010, 7011, and 7015, a single evaluation will be assigned under the diagnostic code that reflects the predominant disability picture.

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122.  The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.