Causes of a Slow Heart Rate; About a ‘PANDAS’ Diagnosis

Dear Dr. Roach: I am a 65-year-old male in fairly good health. I do a bit of running. I’ve checked my blood pressure and pulse lately and have started monitoring it. My pulse is always in the 40s or low 50s. I went to the hospital to get some blood work done and have an EKG. They almost didn’t let me go home. My pulse was reading 35, so the doctor sent me to the outpatient department. I wore an all-day heart-rate monitor. It did register in the 30s overnight. I eat right, don’t smoke and am athletic, so my doctor couldn’t recommend anything. Is there a problem with a low pulse? When I get older, how low will it drop? — C.W.

Answer: Bradycardia (“brady” for “slow,” “cardia” for “heart”) usually is not a problem in people who have no symptoms. However, heart rates in the 30s make me nervous, and they make most cardiologists start thinking very seriously about pacemakers. My colleague, Dr. Rob Campagna, a cardiologist at Weill-Cornell, tells me that at heart rates in the 30s and below, most people have symptoms, even if they are subtle. He also reminded me that sleep apnea, a condition I have written about several times, is a cause of bradycardia and ought to be considered in people with slow rates at nighttime.

Dear Dr. Roach: I have two grandsons that have PANDAS. Nobody knows what this disease is. We are having a very rough time. The boys are 13 and 15. Could you please tell me where they can find help? — B.L.G.

Answer: “PANDAS” stands for pediatric autoimmune neuropsychiatric disorder associated with group A streptococci. This is a controversial subject, but the best study suggests that it is a rare but real diagnosis. It is generally agreed by experts that the neuropsychiatric disorders known as obsessive-compulsive disorder and tics (including Tourette’s, which involves chronic motor or vocal tics) can be exacerbated by group A streptococci, such as the familiar “strep throat.” In PANDAS, the exacerbations are severe very quickly after strep infection.

Experts recommend that children with abrupt onset of OCD or tics should be evaluated for group A strep infection. In a study of children with new-onset OCD or tics, treatment with antibiotics resolved symptoms in a short period of time.

Neurologists and psychiatrists are the most likely specialists to help with neuropsychiatric disorders. A support group is at

Dear Dr. Roach: I get a severe reaction to bee stings. The last time, my arm became swollen to the size of my leg. Is the next bee sting likely to be fatal? Do I need an EpiPen? — N.N.

Answer: Bee stings (or any of the family Hymenoptera, including wasps, yellow jackets and hornets) cause local reactions in the majority of people. About 10 percent of people have dramatic local reactions. Fortunately, the risk of anaphylaxis — the severe systemic reaction that is responsible for 100 deaths per year in the U.S. — is very low in people with local reactions. However, it is still worthwhile to discuss with your doctor or an allergist, because the symptoms of anaphylaxis are sometimes missed. Anyone with a history of systemic reaction should carry (and know how to use!) an epinephrine injection.

Removing the stinger as soon as possible, preferably within seconds, is a good idea to prevent the full injection of venom.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to or write to P.O. Box 536475, Orlando, FL 32853-6475.