What are you supposed to feel when PM "kicks in"?

I have a holter monitor on right now because while i was at the cardiologist today, I experienced sustained PVC's ( what I felt) that lasted a minute each (episode). I told the cardiologist though they stopped when he went to check me. Soooo he fitted a Holter Monitor on me. I've since then had around 8-9 episodes of sustained ( by that i mean each single beat is ectopic, no "normal" one in between) lasting at least 5 mins each and max 12 mins.

Is this the pacemaker pacing me that i feel? I mean, I thought you're not supposed to feel the ongoing pacing of a PM. Plus, my pulse was in the 80's and seemed to be fixated at that rate during the episodes. My PM is supposed to kick in at 60.

Could these possibly be true arrhythmias and not my PM?

9 Comments

PM Kicks in - Hardly

by donr - 2012-11-17 07:11:29

Girl: Your PM does not just "Kick in." It is there every instant of every beat of your heart, monitoring what it is doing; sensing it for its voltages that tell the PM what the heart is doing & when.

Let me dispel a couple myths - there is NO Santa; there is NO Easter Bunny; there is NO Tooth Fairy; there is NO such thing as a Heart Rate! At your age, you are old enough to be told!

But we talk about the HR all the time, you say. Yep! I say, but it is a totally false concept! OK, so please 'splain what that thing is that I feel when my heart beats, you demand.

OK, here goes!!!!!

What you sense when your heart beats regularly at a nice, smooth "Rate," is a whole string of exquisitely timed individual beats that are so precisely & accurately timed that you think there's a "Rate" to it. We even go so far as to call it a "Rhythm," & when it goes south on you, you call those beats that are askew an "Arrhythmia." Keep the terms, keep using them, otherwise the cardio world will think you are some sort of weirdo, like me. In the secret world of cardiology, there is a bulletin board w/ a black silhouette in place of my photo (They don't know what I look like - heh, heh, heh!) on it & labeled "Wanted! Dead - skip the alive! Guilty of heresy! We will provide the D-Handled shovels & a crew to bury him in a lonely swamp in south Georgia."

Oh, back to my tutorial on HR. So what happens to generate this pretty, regular thing we call a heart rate?

Let's start by looking at the SA Node - the body's own pacer. It is nothing but a master timer & signal generator. Dunno if it's digital or analog, but it counts time somehow. It starts a beat w/ a thingy on your ECG called a "P Wave." That's a rather innocuous little blip of voltage that tells the Atria to contract, which in normal hearts they do - roughly 2.5 million times per month. (Reliable little bugger, isn't it?) Electrical activity travels down a bunch of fibers from the SA node to the AV Node, but is delayed a bit to allow the Atria to complete its contraction & for the ventricles to fill w/ blood. IF the delay is correct & the AV Node works properly, it gives the Ventricles the "High Sign" in the form of a pulse that makes them contract, pumping all that blood throughout your warm, quivering body. On your ECG, this is the dominant appearing, most dramatic wave of all (the QRS Wave) - as it should be, because that is the MAJOR physical effort of the heart & takes a rather large, powerful muscle to do its job. But, wait, all is not over yet. Ther is one more insignificant appearing wave on the ECG, called the "T Wave" It immediately follows the QRS, & represents the period when the Ventricular muscles are recharging themselves, getting ready for the next beat. The SA Node senses all this going on & does nothing - till the T wave ends, then it sends out another P wave, starting everything over again.

Long winded & over simplified, but it points out that each beat is a totally independent event, w/ every action independently occurring. Were there really an HR, there would be some master timer generating a pretty wave that synchronized every act of the heart.

It is a testimony to the Reliability, Precision & Accuracy of the heart's various parts that you get such a regular beat!

Go back to my 2.5 Million beats in a month - that's about 30 Million beats in a year; about 150 million by the time you reach puberty; 400 million by menopause & 2.1 BILLION by age 70.

You accept the Hostess job for a PM. What you have just made a home for is FAR more Reliable, Precise & Accurate than your native heart! It now monitors EVERY action, every timing function your heart performs.

But there are limitations on what a PM can do!!!!! It cannot predict the future! Meaning that it is a GAS pedal, not a BRAKE pedal. It can SPEEEEEED your heart up, but it cannot SLOOOOOOOW your heart down!

Take the unloved PVC, for example. That is an event happening prematurely. No way can the PM know that is going to happen & stop it. So, in spite of your new found lil' buddy, you WILL still suffer & PERHAPS sense PVC's.

Now you reported that you had several "Runs" of PVC's today, recorded by the Holter. You are NEW at this game, so I have to ask if you have a confirmation that they were indeed PVC's? It sounds like you know what you are sensing. One lady member thought she had a string of "Runs" of PVC's & was embarrassed to learn that her PM had only recorded 2 individual PVC's during the period.

Your PM will record "Runs" when they occur. Eventually, you will become so accustomed to them that you will not sens them unless you do have a run that affects your breathing or makes you feel drowsy. PVC's do NOT have to have the classic "Pause-THUMP" Pattern. Why? because every beat is an independent event & your heart can screw up that part of the timing that causes a PVC in successive beats.

Now back to paragraph 1! Why do I say your PM does not "Kick In"? Because it monitors EVERY beat & is prepared to act during every beat. The PM senses the O Wave & starts counting down, using its digital clock. After a delay that is programed into its memory if it does not sense the Ventricles' QRS wave start, it sends a pulse to the muscle that starts one. Then it is timing for the next P wave - if it does not occur on time, it sends a pulse to create an atrial beat.

BTW: you should NOT sense when any of these PM generated pulses is generated. That is unless the PM puts out too high a voltage in its spike. THAT, BTW, is adjustable.

The reality is that the PM functions based on a series of time delays that would give you a rate of 60 BPM & applies them to each individual beat. So, it does NOT wait till your HR drops to 60, it corrects every time something is too late.

OK, wake up, now! Sermon is over.

Hope i've helped you in some small way to understand why you do & don't feel things.

Don

Hi Don

by girl dreamer - 2012-11-17 07:11:53

Thank you for the sermon.

However, I'm not really new to this game. I've been seeing a cardiologist ever since I was 10 with recorded PVC's , PAC's and others of which the doctor did not give me the name of.


On my previous-to-last pacemaker check, the PM recorded 132 single PVC's and 11 PVC runs in 3 days.

Now, the ones I'm feeling today are different than the ones I felt during the previously mentioned. But don't get confused, they're very similar. however, my heart goes into a PVC and doesn't come out of it until minutes later, appearing sustained. Hopefully, my cardiologist can tell me all that's happening when he reads what's being recorded.

Arrhythmias have been a part of my life ever since the age of 10, notably of course. I'm sure of what I'm feeling and it is something causing me shortness of breath. The cardiologist believes the electrical system in my heart is degenerating.

BTW, of course there is a rhythm. Have you not heard of normal Sinus rhythm? But I understand what you are trying to convey.

Thanks

by girl dreamer - 2012-11-17 09:11:40

Thank you for all that information, Don. :)

I wish we would never have PVC's.

About the SOB, I've never complained to any doctor of such symptom cus I 've never truly had it. However, when I get the runs, I don't know to explain it but they don't let me breathe normally and I feel very very strange.

Yeah, they've told me that my PM does nothing for arrhythmias. I'm just praying that on Tuesday, I'll find out what type of arrhythmias I'm having and what the next step would be.

I'll update then.

Wish you'd told us that...

by donr - 2012-11-17 09:11:42

...in an earlier post.

Thanks for clearing up the point about whether or not you are correctly recognizing PVC's. I've been bitten by others who say they have, but really aren't.

Of course I've heard of a NSR - who hasn't? But, it's a fiction, born of ignorance (Not the insult kind, but the kind that means lack of knowledge.) Back when the EKG was born just before the turn of the century, the cardio world knew NOTHING of the electrical system of the heart. Then they could measure it grossly w/ the humongous EKG machines developed to explore the phenomenom.

If you are an engineer (Like me) you wonder why those little blips on the EKG trace are called waves - when in reality, conceptually they are "Pulses." Well, the word "Pulse" was already taken by what was felt at the wrist w/ fingers. So, they called them "waves." Since no one knew all the small things that took place in the heart, or how it controlled itself, they called all those repeatable things that seemed so regular, "Rhythms." We are stuck w/ those terms - everyone of them.

I guess that we are lucky that the science world was able to get over "Phlogistone"!

I've been the host to PVC's since about 2003, if you are talking countable numbers of them. I wound up in the hosp
because I was having them at a rate of about 50% in fairly long runs that incapacitated me. A few days later I was hosting a PM.

I can still recall my first sensible one at 9:20 PM, 15 March 1977. That dramatic. The "Pause-THUMP" scared the daylights out of me. Now I do not even sense them unless there is a long run.

That 3 day recording must have had some bodacious long runs in it for you to notice them. I can truly believe that a 15 min run would get your attention!

I have often wondered out loud & to myself what new wonders of the electrical system we will find when higher bandwidth ECG machines are developed. I commented to my wife today that there are a lot of rational people who complain of SOB & get blown off by their cardio. Maybe the secret is buried in seeing more in the squiggles in our ECG traces that we cannot see now.

One of the unfortunate characteristics of the PM is that it can do nothing during a run of PVC's to help you. IT can sense that the Ventricles are functioning, just that they are early, so it makes note of that.

Hope you learn what is causing your discomfort.

Don

To JJ and Don

by girl dreamer - 2012-11-18 03:11:36

JJ: I've been thinking about that, believe it or not. Everything's been deteriorating since yesterday and I can barely do anything. My doctor is nice and at least hut put a holter monitor on me and let me keep it during the weekend until I come back.

Don:

I understand completely. Everything that's been happening confuses me so. My heart starts with a PVC then continues with consecutive PVC's that have lasted maximum 12 mins with no pauses of sinus rhythm in between ( sometimes that happens). I was thinking of V-tach but when I check pulse rate, it was in the 80's.

During the episodes, i first get SOB, then nausea, then dizzy feelings. Sometimes I get scared because I don't inform anyone and if i do, they just dismiss it cus they don't really know what's going on.

Aside from the runs, I get the usual single PVC's, couplets , trigeminy and quadrigeminy.

I counted 3 runs that lasted 2 minutes, 1 run of one minute, various of less than 30 seconds, and a few lasting 5 + mins. I believe this really is not the PM.

SOB Redux

by donr - 2012-11-18 06:11:08

Girl: Your comment just above brought to mind another issue - the psychological one. Panic, anxiety, stress, whatever you choose to call it.

You pile that on top of true physical symptoms & all Heck breaks loose.

One of the things I learned through 35+ yrs of PTSD was that anxiety symptoms can perfectly mimic heart electrical problems. I had the PTSD for 20 yrs before my electrical system went south on me, so I had a lot of practice at knowing exactly what they felt like when they arrived - unfortunately, I did not realize what was happening to me at first.

I never did figure out whether the PTSD may have caused the heart problems - stress is a causative factor in heart problems. I'll let the VA sort that one out.

It sounds like you are NOT getting much familial support just when you need it. That adds to the stress levels you suffer. Can't help you w/ that one. My guess is that they probably pass you off as a typical teen looking for attention.

BTW: The sequence of symptoms is exactly what anxiety does to you - so add that to the same thing coming from something physical & you have a real vicious cocktail you are drinking!

Question: Do you hyperventilate when you get SOB?

Watch for a Pvt Msg in a few minutes.

Don

To Don

by girl dreamer - 2012-11-18 10:11:06

I've just replied to your Private message.

I'm amazed at how you of my familial problems.

I do remind myself of the psychological effect on the physiological.

No, I do not hyperventilate in the sense that I lose all control of my breathing rate. I try my best to stay calm and take nice breaths.

Heart flutter and atrial fib

by jimkirschvink - 2012-11-18 12:11:17

There are some things that a pm can't cure. if your heart continues to misfire, you may need an ablation. I had one last winter and my stamina increased to the max! Keep up with things. Your doctor needs to pay attention to what's going on.

Good luck!

JJ

Difficult breathing

by donr - 2012-11-18 12:11:30

Girl: Consider the following hypothesis for having abnormal breathing/feeling strange:

You hit a long run - multi minutes - of PVC's. The efficiency of the heart as a pump now falls significantly. The brain & all the muscles begin to feel the effects of hypoxia - shortage of Oxygen. The signal to the breathing apparatus is to increase the breathing rate; for the heart to beat faster. Since you are NOT doing anything that would normally lead to this condition, it is sensed as "Strange" by the mind.

Don

You know you're wired when...

You trust technology more than your heart.

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