Newbie with ?s

Hi there everyone!  I'm so grateful to have found this forum.  By reading your posts I've already had lots of my questions answered over the past couple of weeks,  
My story: Several years ago I was diagnosed with pvcs. No big deal and quiet honestly I didn't even notice them anymore,  In May I was at a routine doctor's apt to get allergy meds ahead of an overseas trip.  My doctor detected an abnormal heart beat & did an ekg which showed LBBB. I was shocked but an  echocardiogram showed my heart to have good function so I was cleared to go on my trip,  Other visits to various doctors & even a minor hand surgery over the summer showed the LBBB would come and go.  
 Fast forward to the day after Thanksgiving when I had a sustained episode of an odd heartbeat. As goofy as it sounds I didn't really know what I was having, a-fib, flutter, rapid heartbeat?? It was enough to spur me to see my doctor a couple of weeks later,  My ekg at that visit was normal but I had a somewhat rapid ( for me) heart rate. My doctor said "because women's hearts can be wonky" and they don't alway have the "typical" cardiac symptoms he wanted to have me wear an event monitor  & have a stress test. The stress test indicated a blockage in one area so my doc referred me to a cardiologist for a heart cath.  A couple of days after the stress test my event monitor  alerted my doctor I had  a pause while sleeping. This caused the cardiologist to move up the stress test to the following Monday, Dec. 23.  The cath didn't show any blockages.  They did have an electrophysiologist come in for a bedside consult. I thought this was due to my LBBB and rapid heart beat issues. I found out later this was  because I'd experienced a pause during that cath that I had been totally unaware of. The EP doc scheduled me for a stress echo in about 2 weeks.  However, on Jan. 2 I had a 9 second heart pause in the morning while still in bed but while in a semi-awake state.  At the time I didn't know what had happened to me, all I knew is that at about 5:30am I felt like someone had shot me out of a cannon. I was literally propelled out of bed, landed on my feet, and was was walking.  I immediately hit my event monitor but didn't really know what had just happened to me,  In a very stupid move, less than a half hour later I was driving to take my dog to an appointment 2 hours away,  My heart felt wonky but I didn't know what had happened. Definitely not my smartest move. While on the road the event monitor company called me and said they'd reported an event to my doctor's office and they said I could go to the er if I wanted. By that point I felt fine and the company wouldn't tell me what had happened so I just proceeded to the appointment  Later in the afternoon I found out about the heart pause during a series of calls trying to straighten out some appointment times with the heart center.  Two hours after finding out about the pause event I was in a hospital and the following morning the pacemaker was implanted.  
Everything happened so rapidly & honestly I was too shocked and unprepared to even know what questions I should be asking. 
I was sent home a few hours after the implant was done.  The next morning I was in our local er because I'd felt faint.  Everything checked out ok and it was decided I'd just overdone it that morning  and I had t eaten. 
I've been getting along pretty well and finding answers on this site to questions that have come up. I still have a pretty fast heart rate at times (100-122 bpm) but the EP doc doesn't seem too concerned. 
Yesterday I had something come up and I couldn't find a post about it yet so I thought I'd ask. 
I experienced a kind of rapid heart beat (based on how I felt and my fitness tracker) off and on most of the morning and afternoon. After work I was tired and spent most of the evening plopped in my recliner. My heart rate lowered and I was feeling pretty good. But at one point I felt my heart rate slow up considerably and I felt faint for a few seconds. It went away pretty quickly but when I checked my fitness tracker app it said my heart rate had  dropped to 45bpm. My pacemaker is set to pace at 60bpm.  So how could that be?  Did my pacemaker not do it's job?  I know trackers are not completely accurate but that would be a pretty big amount for it to be "off"  The tracker reading along with  how I felt left me concerned  I did a self interrogation of the pacemaker but with it being a Friday evening I was doubtful anyone would be looking at it over the weekend.  
I had my first visit to the device clinic this past Monday, Jan. 20.  Everything checked out fine. They told me my pacemaker is pacing my heart at less than 1%.  I asked about the irregularities in my fitness tracker showing my heart rate to be below 60 bpm from time to time (it shows mid to high 50's occasionally). They just said the trackers aren't super accurate. 
Has anyone else experienced having your fitness tracker show your heart beat to be  lower than what you are supposed to be paced?  Have you felt your heart rate drop and felt faint even when the interrogations all show everything to be working properly? I also ccassionally feel a slight and brief "burning" sensation under my left breast, over my heart, and in my implant site. The device clinic and nurse don't seem too concerned about that either. They say I'm probably just being hyper-aware of everything right now.  Has anyone here experienced this feeling?  It's brief and doesn't happen often.
Adding - While typing " book"I  did call the heart center this morning & basically the on call doc said if I was concerned I should go to my local er.  I feel fine this morning and am sure any testing they would do would show "normal" results.  I texted my local general practitioner and he called me back.  He gave me some reassurance and said he didn't think I needed to go to the er but to call him again or go to the er if i kept having the feeling of a dropped heart rate and or light headednes.  

Hoping someone here can shed some light or give me more reassurance about this issue. 
If you made it through this lengthy post "thanks" for sticking with me. I'm only about 3 weeks out and this past week I felt like I was getting back to my normal life  But then something like last night happens and I'm feeling knocked to my knees realizing my life is dependent on this little machine in my chest.  ðŸ™‚
 

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3 Comments

I will attempt to answer one or two of your questions . . .

by Gemita - 2020-01-25 21:14:59

since I occasionally experience similar symptoms and I have questioned whether my pacemaker lower setting of 70 bpm is really being maintained?  I try to count my pulse manually when my symptoms occur as well as using a good blood pressure monitor to get as accurate a reading as possible.  I find I am sometimes dropping to the mid 40s range and staying there for what seems like 5 mins or so.  I did try asking my EP but he said my pacemaker wouldnt allow my heart rate to fall below 70 bpm and he told me it was due to ectopic beats.

It could well be that you have started getting PVCs again and if they are frequent and prolonged they could be causing these sort of symptoms. I can feel dreadful with them because they are inefficient beats and my blood pressure and blood flow can be poor during episodes.  PVCs seem to fool my pacemaker into thinking they are normal heart beats and the PM doesnt always appear to assist my heart with a beat when they occur, at least that is what it feels like to me.

If you are really having awful symptoms I would ask for some monitoring or are you being automatically monitored (by nightly downloads) by your pacemaker clinic?  I used to trigger an immediate download when I got symptoms so my clinic could see what was happening.  Sometimes though the pacemaker is doing what it should but the heart is not responding well to being paced and this would need to be evaluated by your doctors.  I also believe there is more going on than PVCs/ectopics since you are clearly getting tachycardia as well so this could point to other arrhythmias, perhaps Atrial Fibrillation/Atrial Tachycardia, so monitoring would be helpful.

I hope you can get some answers quickly and that you will feel better soon.

oximeter

by marylandpm - 2020-01-25 22:03:56

   You could buy a oximeter at a drug store to check you O2 level and pulse rate. 

Pacemaker not doing its job

by AgentX86 - 2020-01-26 00:47:10

Gemita has the answer.  You're getting some sort of arrhythmia (usually PVCs or perhaps PACs) that happen before your pacemaker triggers a heart beat, so it resets its timer to start the next.  This PVC (usually) is shortly after the previous beat so the ventricle isn't full of blood yet, and you get an inefficient beat.  You may not even be able to feel this beat in your wrist.  Your watch certainly won't see it, so it "undercounts" (not really since this inefficent beat didn't do your body any good) the number of heartbeats. An pulse oximiter or blood pressure cuff will likely have the same problem.  Take your pulse by hand in the carotid artery, if necessary (if there is any arrhythmia).

Yeah, PVCs are pretty awful.  There is a good chance that your PM will completly ignore them so they won't be reported in a normal interrogation.  The suggestion to initiate a remote interrogation is a good one. That was the only way they found my bigeminal PVCs.  My PM wasn't able to capture them (no setting to record less than five in a row).

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The experience of having a couple of lengths of wire fed into your heart muscle and an electronic 'box' tucked under the skin is not an insignificant event, but you will survive.