#141 What Should Your Resting Heart Rate Be?

What Should Your Heart Rate Be?

What should your resting heart rate be?  This is a question I am asked everyday as a cardiologist.  Can your resting heart rate, also known as your pulse, predict just how long you will live?

A fascinating study was just published this past week on resting heart rate and lifespan.  In this article, I will share the latest research on how your resting heart rate may predict how long you will live.

Michelle’s Experience

Michelle was a 42 year old woman who recently came to see me for a slow pulse.  Her resting heart rate was 46 beats per minute (bpm) and her doctor was worried that she might need a pacemaker.

“Have you ever passed out?” I asked.

“Nope.” Michelle said.

“Do you ever get dizzy or lightheaded when your pulse is below 50?

“Nope again.” Michelle said.

In Michelle’s case, her heart rate of 46 bpm was because she was very physically active and healthy.  Contrary to popular belief, if you are healthy and your resting heart rate is below 50 bpm it is generally a good thing.

Pacemakers are only indicated for people with an abnormal heart rhythm (arrhythmia) which causes their heart to beat to abnormally slow.  Michelle’s heart rhythm was totally normal.

What is a normal resting heart rate?

If you consult online with the Mayo Clinic, they will tell you that a normal resting heart rate is 60 to 100 bpm.  While this may be a typical resting heart rate, it is certainly not an optimal resting heart rate.  Read on to find out what your goal resting heart rate should be.

How do you find out what your resting heart rate is?

To check your resting heart rate, simply find your pulse in either your wrist or neck.  Then, count the number of heart beats you have in one minute.  This is your heart rate in beats per minute (bpm).

Alternatively, you can also use a blood pressure machine.  Blood pressure monitors will give you your heart rate in addition to your blood pressure.

Whales vs. Mice

In 1928, Dr. Raymond Pear proposed the “Rate of Living Theory.”  One implication of this theory is that each mammal is given a certain number of heart beats for their life.  If your “rate of living” was faster, he predicted that you would die younger.

For example, the mouse can have a resting heart rate faster than 600 bpm.  However, at this fast of a resting heart rate they typically die after two years.

In contrast, the resting heart rate of a whale is about 10 beats per minute and some whales can live up to 200 years.  In each case, the total number of heart beats is remarkably similar.

In humans, studies suggest that the average person gets 3 billion heart beats.

Heart Rate and Lifespan Study

This past week, media headlines loudly proclaimed, “Slow Heart Rate Doesn’t Mean Early Death Risk.”  As a cardiologist knowing that a slow heart rate is actually protective, I was quite surprised to see these eye catching headlines.

Despite hundreds of studies showing that slower heart rates are associated with longer lifespans, every day I see patients who are worried that their heart rate is too slow.  Let’s take a look at the scientific data from this latest study on heart rate and lifespan.

In this study, researchers enrolled 6,733 mostly middle aged people.  Everyone’s resting heart rate was recorded at the beginning of the study.  These study participants were then followed closely for 10 years to see who died and who was still alive 10 years later.

Here is what they found:

1. If the resting heart rate was naturally slower than 50 bpm, survival was 29% higher.

2. If the resting heart rate was artificially lowered with medications to less than 50 bpm, the risk of death was 2.4 times higher.

3. If the resting heart rate was naturally faster than 80 bpm, there was a 49% higher chance of dying during the study.

4. If the resting heart rate was faster than 80 bpm, despite medications to slow the heart, the risk of death was 3.6 times higher.

Why did people with a naturally slow heart rate live the longest?

While most people would never guess that those with the slowest resting heart rates live the longest, this study is just one of many studies showing that a slow resting heart rate is protective.  Before you get too excited or worried, depending on your own resting heart rate, I need to point out that this was just an observational study.

There is no conclusive proof that a slow resting heart rate will make you live longer.  In fact, a slow resting heart rate may have nothing at all to do with survival.  Any survival advantage from a slow resting heart rate may be do to regular daily exercise or other factors.  In other words, a slow resting heart rate may just be a sign of someone who exercises regularly.

How dangerous is an artificially slow heart rate?

The finding that people with a resting heart rate of less than 50 bpm on heart slowing medications are 2.4 times more likely to die prematurely, is a new finding.  For these people, the slow heart rate may be a sign that they are on too much heart medication.

Common medications that artificially slow the resting heart rate include beta-blockers, calcium channel blockers, digoxin, and anti-arrhythmics.  If your heart rate is artificially slowed to less than 50 bpm, please speak with your physician to see if you should be on less heart medications.

When is a pacemaker needed?

A pacemaker is a small electronic device placed under the skin with wires that connect to the heart.  Pacemakers can speed up a slow heart.

In the study discussed in this article, a slow normal heart rhythm predicts a long life.  In other words, the heart is beating totally normal but just slower than most people.

In contrast, I see patients every day with arrhythmias causing them t0 have an abnormal heart rhythm with a slow heart rate.  Sometimes, their hearts may even stop beating.  For people with abnormal heart rhythms (arrhythmias) causing their heart to beat too slow, a pacemaker may be indicated.

Only your cardiologist can tell you if your slow resting heart rate is from a normal rhythm or an abnormal rhythm (arrhythmia).  To determine if your heart rhythm is normal or not, your cardiologist may have you wear a heart monitor.

In Michelle’s case, she had a slow normal rhythm.  Thus, no pacemaker was needed and the study discussed in this article predicts she will live a long life.

Why is a fast resting heart rate so dangerous?

This study, along with many other studies, have shown that a fast resting heart rate is associated with an increased risk of premature death.  There are many possible reasons why a fast resting heart rate may be dangerous.  Here are some of the many possible reasons:

1. A higher resting heart rate could be from an abnormal heart rhythm (arrhythmia).

2. People who don’t routinely exercise have a high resting heart rate.

3. People under a lot of stress can have a fast resting heart rate.

4. Chronic medical problems can cause a higher heart rate.

5. Being overweight makes the heart beat faster.

What can you do to lower your resting heart rate?

If your heart beats too fast, here are some things you can do to get your heart rate under control.

1. Check with your doctor to see if you have an abnormal heart rhythm (arrhythmia) or another medical problem causing your heart to beat too fast.  Getting these conditions treated can quickly bring your resting heart rate down.

2. Exercise regularly.  Regular aerobic exercise (jogging, swimming, biking, etc.) significantly slows the resting heart rate over time.  Most well trained athletes will have a resting heart rate below 50 bpm.

3. Practice mindfulness techniques.  Mindfulness techniques like meditation, yoga, tai chi, etc. all lower the heart rate and stress levels.

4. Maintain a healthy weight.

Final Thoughts

While there is no conclusive proof that humans are only given a lifespan of 3 billion heart beats, this study certainly suggests that if you can “save your heart beats” with a slower resting heart rate you may live longer.  Certainly, if you feel well and are living a healthy lifestyle, I wouldn’t worry if your normal resting pulse is 49 or 89 bpm.

What are you doing to optimize your resting heart rate?  Please share your experience in the comment section below.

Also, if you have any questions about this article, please leave your questions in the comment section as well.  I will try my best to answer every question.

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19 Comments
  1. I have a rhr of 80bpm. in light of messerli’s studies on atenolol, (can’t stand dreams from lipophilic beta blockers such as bystolic) should I low dose atenolol for 3th line bp med, or accept the 80 bpm. ( i’m not overweight and i do walk).

    • Hi Michael,

      In general, with increasing levels of physical conditioning the heart rate goes down. However, this is not always the case.

      One of the proposed theories as to why beta-blockers help in heart failure is that they lower the resting heart rate. Whether or not a higher dose of atenolol will be helpful in your case is something only your cardiologist can answer.

      Hope this helps!

      John

      • john, your reply is appreciated. sorry, I was so inarticulate. Presently I only take an 100mg cozaar ARB and 5 mg. amlodipine Calcium blocker, my BP is reasonably controlled at about 135/78 with a bpm of 80. I added low dose bystolic, primarily to reduce my heart rate a few beats, but had laborious, vivid dreams. I know that low dose hydrophilic atenolol will lower my heart rate and eliminate the dreams, but after reading franz messerli’s findings on atenolol, it scared me off. so again, should i add a third med with atenolol, or accept the 80bmp?

        • Hi Michael,

          A tough call. Studies show that the optimal blood pressure target should be 120/80 so there is still room to go (SPRINT Study).

          With the exception of treating heart failure, there are no clear data that I am aware of to suggest that artificially lowering the heart rate with medications provides any benefit.

          If you would like to lower your heart rate and blood pressure simultaneously with medications, you could try a different beta-blocker or even a different calcium channel blocker like diltiazem or verapamil.

          Another way to lower both your resting heart rate and blood pressure would be to step up your daily exercise, yoga, or meditation.

          Of course, whether further blood pressure and heart rate reduction should even be considered in your case is something that only you and your doctor can determine.

          Hope this helps!

          John

  2. Interesting article as always.

    I do have some questions. I have POTS and just standing up will raise my HR to 130-150
    Now i ve been told POTS wont kill me, but maybe not immediately, but you can indirect say this might happen if i stand and try to exercise with my POTS? I mean my hr will be way more active than most?
    Thats what i dont get in these kind of studies. How long must the HR be low. How long do we speak about resting HR. My heart rate can be 60-70 lying down. but it skyrockets with movement. Yet i need to try to exercise for my POTS.. even standing and walking is exercise in us POTS patients.. so how does this study relate to POTS patients who have higher HR?

    • Hi Richard,

      You bring up a good point. All of the population based studies linking resting heart rate to longevity, have not specifically included POTS patients.

      If you look at these studies from a population based perspective, the findings make sense. For example, outside of the POTS population, those who don’t exercise have very fast heart rates. People suffering from heart failure have high heart rates. Obesity results in a faster heart rate, etc.

      This study really doesn’t apply to the POTS population. It is just an observational study. It does not prove cause and effect.

      Hope this helps!

      John

  3. Hi, I just wanted to let you know how much I appreciate the time you put into your newsletter. At 70 and 71, we are trying to live as healthy as we can. He is better at exercise…walking at least 8 miles a week, senior swimming aerobics, 3 times a week and often either strenuous snow shoveling (winter)or lawn care (summer) while I am better at mindfulness…..we both wear fitbits to check our heart rate and to encourage us to get as many steps in a day as possible. Throughout each day, however, I get a higher average # of steps in, usually over 12,000. His resting heart is typically a bit lower than mine (lower 60’s BPM). What concerns me is that where mine is not high, it will go to 112 BPM with not a lot of effort or exercise extended, though it drops back down quickly as well. I feel fine but was recently asked by my doctor if anyone had ever mentioned I had a slight heart murmur. The answer was “no”. Should I be concerned?

    • Thank you so much for your kind words! Also, congratulation on your Fit bit and mindfulness commitments!

      A murmur is just blood making noise in the heart. Murmurs can sometimes be heard on one day and not on another. I generally suggest an echocardiogram if someone has heard a murmur just to make sure there are no valve issues with the heart.

      Best,

      John

  4. Dear Dr. Day
    Your article was very interesting. I learned something new about my heart and I really loved your comments about Ben Franklin.
    Your patient,
    M. Patricia Medina

  5. Dr. Day, My husband’s heart rate is very high in the morning (171/91). He uses a C-Pap machine and is wondering if he is not getting enough air through the machine causing his blood pressure to rise. What do you think?

    • Hi Marge,

      It looks like your husband’s blood pressure is indeed very high. Sleep apnea is one of many causes of high blood pressure. Please work with your regular doctor to quickly bring this blood pressure down as soon as possible.

      Hope this helps!

      John

  6. Hi Dr. Day, I appreciate your weekly articles so much. This is a great service that you provide in our community.

    Last summer, I was experiencing a slow heartbeat of between 35 and 50. Two possible reasons were suggested by my doctors. One was dehydration. And one was a daily dose of 150 mg of Flecanide for A-Fib. I also am on a Warfarin diet which has kept my INR between 2 to 3 for the last 2 years with little variation. In the last month, my heart rate has returned to a range of 48 to 72. I am still using the same dose of Flecanide and Warfarin. I am doing much better to keep hydrated. During the last six months I have had no atrial fibrillation symptoms. One other change in my daily activities may be that I have stopped using an annoying CPAP machine. However, I am quite careful to sleep on my side. Side sleeping produced much lower sleep apnea problems in my sleep study. My current weight is hundred and 54 pounds and I am 5 foot 9 1/2 inches. I do get at least three days a week of exercise, walking uphill for about 45 minutes.

    Does any of this suggest why my heart rate has returned to normal? I am delighted but I am still confused about what effects my Heart Rate.

    • Hi Leon,

      You are correct in that flecaininde can lower the heart rate and that milder cases of sleep apnea can be treated with side sleeping.

      It is unclear from your post as to why your heart rate has increased. I suspect this likely is due to some sort of a change to your autonomic nervous system as the autonomic nervous system plays a major role in setting the heart rate.

      John

  7. This is good to know. I’m on Bystolic and Corlanor. Maybe I’d be better off with pacemaker/defibrillator, but the docs don’t think so. Personally, I’d rather have the device to protect me than be on medication.

    • Hi Gina,

      Thanks for reading the article. All great points. As you know, pacemakers/defibrillators are not without risk and there are extremely strict criteria as to which people qualify.

      Best,

      John

  8. Thanks doc…. At 75, I developed A-Fib 2 years ago, had 2 cardioversion attempts, each successful but short-lived,(nasty pun) apparently caused by sleep apnea which is still a problem… Also weigh about 210 lbs at 5 foot 8″…. Is that it? Any chance of reversing it?

    • Hi John,

      Great question.

      Yes, there are a lot of data suggesting that treating sleep apnea can reverse Afib to some degree. I have seen some cases that actually go into remission for a period of time with aggressive treatment of sleep apnea.

      Even better than treating sleep apnea would be to reverse it with weight loss. Yes, there are many studies showing that even as little as 36 pounds of weight loss in overweight people puts Afib into remission 46% of the time.

      The sooner you can reverse your Afib risk factors the better your chance of beating Afib.

      One other thing to remember is that the longer you are in Afib the harder it will ever be to get you out. Thus, while you are working with your doctors to treat sleep apnea and get the extra weight off, ideally you also need to be in normal rhythm if your goal is to beat Afib. This may require antiarrhthmics or even an ablation.

      Of course, this also brings up the point of should beating Afib even be the goal? Not every case can be “beaten.” In general, for people in their 70s I only recommend aggressive Afib treatment if symptoms are significantly interfering with your quality of life. The “rhythm control strategy” with antiarrhythmics or an ablation are certainly not without risk.

      If symptoms are minimal and cardioversions have not worked, perhaps the goal might be to just prevent Afib strokes and keep the Afib heart rate in check (“rate control strategy” to managing Afib).

      Please talk with your cardiologist to find out what treatment option is best for you.

      Best,

      John

    • I have the same problem only 3 oblations the last one last almost a year. I WAKE UP AT NIGHT HAVING FAST HEART BEAT ANF HARD TO BREATH. I am overweight can’t exercise because of knee. I S THEREE ANY HOPE DFOR THE NEW PACE MAKER?

      • I am assuming your 3 ablations are for Afib. If so, unfortunately, pacemakers don’t correct Afib. All pacemakers do is speed up a slow heart.

        Yes, there are new “wireless” pacemakers in clinical trials. However, these pacemakers are only very rudimentary in what they can do. For example, the current generation of new wireless pacemakers in the US can only pace the bottom half of the heart (the upper 2 chambers are completely ignored).

        In the future, the wireless pacemakers will be able to do everything a traditional pacemaker can do.

        Hope this helps!

        John