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Individuals who have a heartrate of less than 50-60 beats/minute, while awake, and who are symptomatic (weakness, dizziness, unusually tired, lethargic, nauseous, among others), should contact their doctor for further evaluation. Even if you are not symptomatic, with such a slow heartrate, it would be prudent to contact your doctor, as your heart may need only to slow down somewhat more to make your symptoms evident. There are fundamental reasons for the heart beating abnormally slowly. The most common causes of bradycardia are medications the individual takes, the result of heart damage in the past (heart attack), coronary artery disease, a congenital heart problem, and advanced age. The physician/or cardiologist may choose to do both an EKG, and a Holter Monitor (24-48 hour continuous/portable monitoring). These tests can possibly indicate clear clinical/heart rhythm explainations for the individuals symptoms. For some individuals it may be recommended to have a permanent pacemaker implanted to assure that a normal heartrate is maintained. In addition, the presentation details the AV Nodal dysfunction, of 2:1 heartblock.