Settings and New

Hi, I'm new and confused. Everyone is telling me I will feel so much better now that I have my PM. I was having a lot of faint, dizzy spells, passed out once at home, no energy, fatigue, etc. I went for a tilt table test and my heart flat lined and they had to pace my heart or whatever you call it to start back up. I was told I had to have a PM. Three weeks ago I had a dual chamber pacemaker put in. The DR said the settings is set to kick in when my heartbeat falls below 40. So I take it that as in other words...it isn't going to have any affect on me unless my heartbeat falls below 40. I don't understand how the PM is going to give me more energy & help my little spells if it isn't functioning unless my heartbeat falls below 40, wouldn't that point be when I am passed out on the floor? That is where I am confused. I don't know. Any advice from people who have been here would be great! Thanks!

9 Comments

Some questions...

by donr - 2013-07-02 10:07:46

& some answers.

First - welcome aboard. I am working as the Wal-Mart Greeter tonight. Sorry, but we are out of baskets & electric carts.

You did NOT tell us why you have the PM - please do not make us GUESS at your diagnosis.

Did they hit you w/ the defibrillator paddles to get your heart started again?

I agree w/ you that 40 is a pretty low base rate for the PM, but that depends a lot on your diagnosis.

BUT...have you passed out since getting the PM? How have you felt ? Any better? Fatigued? Any of the other symptoms.

Now for some answers (If I don't know them, I'll make some up!)

1) There is no Santa, Easter Bunny, Tooth Fairy, Jack Frost, Mother Nature, Man in the Moon, Sand Man, Bogey Man, etc. There also is no such thing as a HEART RATE! Gasp, how can I say thay? everyone knows you feel your wrist & you feel your heart rate. WRONG!! What you feel is a bunch of very precisely & accurately timed individual beats of your heart. We call it a HR because back before we knew anything about the marvelous inner workings of the heart, that's all we could sense & so we called it a HR. Then some Dutchman (or was it a German?) discovered the electrical activity of the heart & built a very crude EKG machine. You had to sit w/each foot in a bucket of salt water (No more need be said) for it to measure electrical activity & we were off & running toward where we are today.

2) We learned that there are two nodes in the heart that time things - the SA & AV Nodes. The SA (Sino-atrial) & the AV (Atrio-ventricular) nodes generate electrical pulses according to a yet to be understood timing system, with the AS node being the master timer - our natural pacemaker. Now that AS Node is so precise ( meaning the number of digits after the decimal place in measurements) & so accurate (Meaning repeats very precisely) that it seems that there is a master electrical wave controlling your heart. If you've ever seen your ECG print out, you realize that there are a whole bunch of humps on it. The cardio community calls them "waves." They start w/ the "P" wave issued by the AS node, which starts the chain by telling the Atria to contract. The P Wave gets to the AV node, that DELAYS it a set amount, counting the same way the AS does to start things. Then the ventricles contract ; that is the great big wave that has three parts, called the QRS complex. AFter the Ventricles finish contracting, the heart starts to get ready for the next beat & there is a very low wave called the T wave, where all the tissue in the ventricles is recharging itself so it is ready for the next beat when the signal comes. Now the AS node starts a count down for starting another P wave.

3) Next time you get a chance, when they stick a pulse oxymeter on your finger to get your blood oxygen saturation, watch the pulse number - how it jumps around quite frequently, varying by a beat or two per minute. That is showing you the variation in how the nodes count time while generating the individual pulses. They are not PERFECT, but darned close to it.

4) So what has that to do w/ you & your PM??? Your PM sits trhere & monitors both atria & ventricles, looking for signals that tel it that your heart is working normally & all the nodes are working. The PM has set in its memory times when things should happen Like there is a delay time for the Atrial pacing section to wait before it sends a signal to the heart to start the atria beating. Naturally, that delay time is slightly longer than the time the heart takes in order to let it do its thing naturally. It doesn't - the PM pulls out its own cattle prod & sends a signal & the beat starts. Likewise, the Ventricular section of your PM has a delay stored in it. IF the Ventricles are not showing a QRS complex at the right time, the PM does it after a short delay.

5) so where do these delay times come from? HMMMMMM? They are calculated based on your PM's BASE RATE. Lessee, now, a base rate of 40 BPM means that your heart beats every 60/40 seconds = 1.5 seconds. So appropriate delay times corresponding to a 1.5 second period for a heart beat are stored in memory.

6) Picture this - your PM sits there in ambush, just watching & timing your heart. As long as each beat fits inside the stored delay times. it does nothing. BUT - let a single beat be a bit late POW! the PM takes over makes the heart beat.

7) Each & every beat is monitored against a pair of set times CORRESPONDING to a HR of 40 BPM.

8) If you only have occasional beats that are slow or late, no big deal, you will NEVER feel the effect. But supposing you have a whole STRING of beats where the nodes lose count - then you'll have a pulse rate that is low & you'll feel yucky. That's why I asked how you've been feeling .

Hope this helps you understand what & how your PM helps you out.

Don

Hi Everyone

by nanatej - 2013-07-02 11:07:31

I'm new also, had pacemaker implanted 1 month ago and I have also been so confused by term, etc. Thanks so much for the explanation Donr, it really helped me.

Howdy TE

by sunny@heart - 2013-07-02 11:07:56

I'm new to this site too, but you dive in, come up for air, & you are surrounded by so much support & knowledgeable people! no wonder you are confused, I've been confused since 2004 when I had a CRD ( cardiac resynchronization device) implanted. The docs don't usually explain things very well; it's almost as if they figure we will get confused if they tell us what is going on & so we are confused about what's going on!!
Don's explanation was fantastic! if I keep reading it every day, I will be a lot smarter... some day.
And that's how your confusion will lessen, keep reaching out for answers & you can learn form those who have been there, done that, got the t-shirt.... ( I know... old & corny. But then again, I am old and corny.)

Like drinking from...

by donr - 2013-07-03 01:07:25

...a fire hose, isn't it? Know exactly what you mean. The day my cardio's head nurse walked into the room & told me I needed a PM, I freaked out. I was so bad she had to order 10 step ladder from hosp maint so she could climb up to the ceiling & drag me down from where I was swatting flies.

There are so many nuances to diagnoses that it pays to get it exactly correct.

Nah - the world has not collapsed - just paused a bit while you re-group & hit the start button again.

I would recommend against the kickboxing - unless you get a heavy pad to protect your PM. Getting kicked in the PM will not necessarily damage the PM, but would probably hurt you pretty badly.

All the rest of the stuff you mentioned is just fine.
]
There are very few restrictions on what you can do. All you have to do is recover physically from the bad cut you received then come to terms w/ the mental aspects of hosting a PM. Just be patient & do not give up hope. You are not alone.

Don

hi TE

by lubro - 2013-07-03 04:07:08

just want to add my name to the list of well wishers...

I have only been a member for a short while, but this club has been a tremendous help to me.
The very best reason for coming here is that the club members here are not only the nicest group you'll find, but the most informed and caring people around. Of course the 2nd best reason, and only 2nd by a slim margin, is to read Donr's posts.
Don... thanks for being you...I know I speak for many here when I say...You never cease to amaze us...
TE... I think from what you've read so far...you must surely agree...
Hang in there...It gets easier ...
Stay tuned...
there's more to come...

Best wishes

Lubro

Hi all

by johnl - 2013-07-03 05:07:16

Just come for a catch up on this great club site and wanted to say " well said " to lubro on his last post. All the best. Johnl

Thanks for all comments

by TE - 2013-07-03 11:07:04

Donr Thank you for all the info...I will definitely have to reread it later this evening and get back with you. They said I have bradycardia and something with the SA & AV what you mentioned above my natural. I think they rattle so quick I miss it everytime exactly what my condition is called. My brain and heart was not communicating or something like that. So my pacemaker is put in to send the electrical pulses when my body doesn't function like it is supposed to is what they told me.
They had pacers already attached to me before the testing started and had to start the "pacers" they said.
I will call and get an exact diagnosis on exactly what they say I have and get back with you. Thank you again so much!! I just feel so lost and confused.
I'm 39 and I feel like the world has just stopped at times. I know I am in recovery now but I feel like I am done. I am a very active person. We have horses, I love to be outdoors, hiking, kickboxing, jogging, we have active kids and we are always on the go...sports everything. And I just want to be able to continue with everything as before.

Yes exactly!

by TE - 2013-07-03 11:07:28

You hit it perfectly Don! It was a blow from left field & I never saw what hit me. Just trying to deal emotionally. Good thing it happened during the summer & I work with school board so I have summers off. :)
I believe my diagnosis is called sinoatrial node dysfunction.
Thank you for all the comments, advice, support. I love this site. It is helping me very much!

Hmmmmm - the old SND trick, eh?

by donr - 2013-07-04 01:07:19

Also called Sick Sinus Syndrome (SSS).

Sorta a big horse blanket that covers a multitude of of malfunctions involving the SA Node.

It can come on suddenly, or kinda creep up on you, but either way, it shocks you when you have to face the reality that you have an electrical control problem that requires a PM.

As I said, the first thing you have to do is get over the physical part - a gash across the upper chest. Then, when you feel better, sort out the settings so they are right for you, than face the mental parts.

For some of us, the two issues are rather non-starters. I was fortunately one of those - got over the discomfort of the cut in a few days - was back out building our house literally three days post-op. (I now know how a one-armed paper hanger functions!) The mental part I never felt.

Dunno why, but I am an EE & am right at home w/ electronic devices & this to me was no big deal. I got an intro to bionics back in 1987 when I wound up wearing hearing aids. I saw (actually heard) what electronics can do for the body w/ certain disabilities & it was good. I had two other associations w/ bionics for hearing 1) Way back in 1963 I was working on an MS in EE & believe it or not a question on a final exam was an essay question that went something like "What could electrical circuits do for physically disabled people?" Well, I was at the very beginning of my hearing loss & I wrote a paragraph about compensation circuits for the hard of hearing that could match exactly their loss as a function of frequency - so they could once again enjoy hearing all the nuances of music like normal people. Transistorized hearing aids had not even been developed at that time - a typical hearing aid was the size of a pack of cigarettes & worn inside the shirt w/ a wire running up to the ear. I got a C for my effort, w/ the comment that I was crazy - that would never be possible. Today I wear a pair of hearing aids that do just what I predicted - match amplification for my losses as a function of frequency & feed it into my ear. 2) in 1981 I was at a conference on solid state electronics research in Vienna. I met an Austrian researcher who was developing a gizmo called a "Cochlear Implant" that was created using micro electronic semiconductors smaller & faster than any in existence at that time. The implant was a wire that was inserted into the cochlea of an ear & it directly stimulated the remnants of the destroyed nerve ending hairs & restored a person's hearing. Not perfectly, but they could once again understand.

ET, I entered this world of bionics w/ a distinct advantage. I'd sure like to be able to prepare a vaccine of it & share it w/ every PM host known.

We found out about two months ago that my wife gets a PM next Mon - but for her BLADDER!!!!! Medtronics has developed one to help people w/ bladder control issues. Works pretty much the same as for the heart, but is planted in the buttocks area & runs a wire into the sacral nerve.

All sorts of wondrous electronic devices are either here or on the way to sort out all sorts of maladies for us.

Well, so much for the rah,rah, inspirational pep rally. If you have questions about the mental issues of PM's I'll be glad to help you out.

Don

You know you're wired when...

You prefer rechargeable batteries.

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I wouldn't be alive if it wasn't for pacemakers. I've had mine for 35+ years. I was fainting all of the time and had flat-lined also. I feel very blessed to live in this time of technology.