tach or fib

help pls. pacemaker 2 yrs. kept having what i call tachycardia. wore monitor for 3 weeks and sent to hospital to start sotalol and predaxa because, as i understand it, v tach and a fib. 6 week out having longer episodes of what i call tach. i typically have pulse of 60. suddenly without cause my pulse will jump to 100 - 120 and last for several minutes. the sensation really takes me aback. went for pacemaker check today and nothing detected, at least tech told me no signs of v tach in past 6 weeks. tech said that pacemaker was pacing occasionally in the lower chamber and that i did not need that so he turned that part off. he thought that was 1% chance that the pacemaker was causing the sensation i am having. i was really frustrated. he said he would talk to my cardiologist and to call tech in few days if this tach or fib or whatever it is continues. any clues? i feel so stupid to know so little about what is going on, causes, whether this is of concern, etc. feel stupid to feel something and then it cannot be detected by pacemaker read out. pls help or offer suggestions! thanks. john

6 Comments

Sensation

by ElectricFrank - 2011-08-31 01:08:15

How are you checking your HR. Some HR monitors will respond to the pacemaker spikes in the ECG and read double the actual HR. Your description of a jump from 60 to 120 would fit this effect. There is the possibility that the pacer kicks in for some reason that gives you the sensation. then your monitor reads the pacer and shows double.

The best way to confirm your HR is to use the old "feel your wrist pulse and check it against a clock" method. You don't have to be real accurate to tell the difference between 60 and 120.

might help,

frank

pulse calculation

by JSF - 2011-08-31 09:08:20

Frank, thank you for looking at my notes and for commenting. If I am out and about and this happens, I do check my wrist pulse against the clock. I have only used the blood pressure monitor a couple of times at home. Whenever I am having these sensations, whatever they are, the pulse rate has been as low as 90 and as high as "in the 120's". Usually it is about 100. My usual pulse rate is below 60. My understanding from yesterday is that 95% of the time the pacemaker is keeping me at 60. These sensations or episodes that I am talking about do not occur when I am at the gym or exerting but merely when walking across the kitchen, getting up out of chaier, etc.
I don't like not knowing the pacemaker jargon, the arrythmia jargon, whethere these are flutters, fibs, or tach, etc.
thank you.

Rate Response?

by jenny97 - 2011-08-31 12:08:22

Do you have a rate drop response mechanism on your device? If you do, it might be causing these sensations. My rate drop is set so that if my heart rate drops so many beats in a certain period of time, it kicks in at 95 bpm for two minutes. Then my pulse slowly comes back down to a more normal rate. While this is good for me, raising the blood pressure and (theoretically) keeping me conscious, it can be annoying when it kicks in unnecessarily. And if you don't need this function, then it would probably always be annoying. You might ask your tech about it.

Good luck!

Jenny

PS I agree with you on the jargon. I sometimes wish I could just let my dr. FEEL what I am feeling and then see what words he uses to describe it.

what is purpose of check up?

by JSF - 2011-09-01 02:09:27

May I please keep asking questions? I am an educated person but I guess I do not even understand the basics.

Frank and Jenny, thanks again for the comments you have made.

I am not sure of the purpose of the pacemaker check up other than to be sure it is still working. My concern when I go to the clinic or when I phone it in, is to find out more about the arrhythmias that I feel, either the erratic heartbeat or the rapid heartbeat. This is what I call tachycardia.

When things are checked in the office, the nurse runs a strip, kind of like and ekg strip. it seems to be checking things since the time of the last strip readiing.

My last check up was Tuesday. At that time, i assume that no arrhythimia events were found. The nurse told me that he did not see any v tach events since my last check up. When I asked about the problems I did have and showed him my documentation (date, time, pulse etc), he started asking questions and thought that perhaps the pacemaker itself was causing these problems. he turned something off related to the bottom chamber.

the dr has told me a couple of times that these pacemaker strip readings might not show the kind of events I am feeling and describing, that they might not have been of a long enough duration to pick up on the pacemaker.

I believe these events last several minutes.

Does anyone know why these would not be picked up on these strip readings? is a pacemaker strip test supposed to show arrhythmia events? of all kinds? top and bottom?
tach? fib? pvc? whatever pvc is?

i believe sinus node dysfunction and bradycardia are my diagnoses - that is what i have written down.

I do know that after getting the pacemaker, I still had these events. Nothing was picked up until I wore a monitor for a month. At that time the dr said I was having v tach and a fib and put me in hosp immediately to start sotalol and pradaxa.

I do not like the feeling of these episodes - it makes me stop in my tracks and sets me back for several minutes. I also wonder if these are atrial or ventricular in nature and if I should be concerned - like pending stroke.

then, there is super frustration that they cannot even be picked up when a strip reading is done - to help determine what they are.

do i just chill and let it go? easy enough to do until the events happen again. i also just like knowing what is going on in general, all aspects of life. this is one thing i cannot figure out.

any comments are so appreciated and welcome.

thanks again all.


PS Check your meds too...

by jenny97 - 2011-09-01 03:09:13

They can sometimes have cardiac side effects that no one tells you about. Particularly if you accidentally skip a dose, or if you are taking them in combination. My heart starts doing flips about 18 hours after I forget to take my beta blocker...

Please do...

by jenny97 - 2011-09-01 03:09:31

asking questions is how you will learn. And I don't know about you, but it's how I comfort myself when I am experiencing things I don't understand. I might suggest, though, that you start a new post every so often, as people may not come back and check on this one. (I might be wrong though. After all, I did :) )

I know PM settings is the number one answer on this site, and it can be frustrating when you don't know what PM settings you have, what PM settings you've had in the past, and what PM settings you need. It's a factor in our various conditions that we have very limited control over - which is frustrating.

I am no expert (even though I've had a PM for about 10 years - this is my 2nd), but my understanding is that PMs pick up a variety of arrhythmias, but that they don't pick up everything. A few months ago I started having serious heart palpitations, high heart rates, and flutters after a fainting episode and my cardiologist put me on a holter monitor. I was surprised because I thought the PM would take care of all that stuff. But I guess it doesn't. The fact of the matter is, you have to get comfortable with your cardiologist/ep specialist and the techs that work with you. You can always get a second opinion if you feel like you aren't getting the help you need.

Please keep in mind that sometimes our own anxiety can exacerbate our symptoms. You start to feel something funny in your chest, you stop and concentrate on that feeling, and suddenly you feel way worse. It's important to pay attention to the signs and symptoms, but it's also important to stay calm. So, for myself, when I start to feel weird uncomfortable feelings, I stop, take my pulse and blood pressure, breathe deeply, and try to disconnect from anxious feelings. I also drink some water and, if it's been a while since I've eaten and I'm not nauseous, I'll eat a little something. In my case, if my pulse is in a reasonable range and my BP is generally ok, then I don't worry too much. In most cases it's probably a PVC which is not dangerous but is dang annoying and uncomfortable. The problem with PVCs though, is they proliferate, especially if nerves or anxiety get the best of you. So I try to stay as calm as possible.

If my pulse is beating at 95, I assume that my rate drop response kicked in and that's what I'm feeling. And I say a little thank you to the PM that's helping me stay conscious. If my pulse or BP is outside of the ranges that I've set for myself in sane, non-anxiety-ridden times, then I follow the action plan I created at the time I set the parameters. What can I say, I'm a planner! and planning helps me stay calm, which helps keep my heart quieter.

I figure this - my life might be short, but at least it will be quality. I have enough limitations from my own condition, that I refuse to set more on myself by binding myself with fear and anxiety. I do what I can to figure things out and then I just let go. (Or at least, that's what I try to do. Some days are better than others, of course.)

So, long story summarized:
1. Check PM settings
2. Work with dr. If he refuses to work with you, get second opinion.
3. Stay calm.
4. Plan, if it helps you.
5. Live life.

Good luck!

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