Irregular Heartbeat

IRHB

by rmnld821213 - 2020-04-28 20:14:45

I show one occasionally too. Was told it's the machines not really knowing what it's detecting. Best to go with what cardiologist says. good luck to yo . Stay saf . 

Welcome to the real world of pacemakers

by AgentX86 - 2020-04-28 21:15:28

Your pacemaker wasn't implanted to take care of an arrhythmia it was implanted to provide a circuit to bypass your heart block.

Pacemakers do nothing for arrhythmias, with the exception of Bradycardia (technically an arrhythmia).  A paceaker can only start a heartbeat.  It can't stop one once it's started, whether it was started by the heart's sinus node or some errant ectopic site, or a reentrant circuit (flutter).  As we say here, a pacemaker is only an accelerator, not a brake.

So, if you had Afib before you got your pacemaker, you'll have Afib after.  Same with flutter, PACs, PVCs, everything except Bradycardia.  Bradycardia is a heart rate that's too low, so the accelerator is exactly what's needed.

Irregular heartbeat

by Ms Rutledge - 2020-04-28 22:39:01

AgentX86

 I have bradycardia along with the Type 2 AV heart block, so I understand that if my heart rate drops below 50 the pacemaker brings it up to the correct rate,  so  the pacemaker  also detects a missed beat and is able to correct that.  So a blood pressure machine is not able to detect when the pacemaker sends a signal for a missed beat and therefore this is why I see the irregular heartbeat icon when I take my blood pressure?  I do not think I completely understand the the working of a pacemaker.  This was an emergency implant and I was 3000 miles from home at the time.  I do not think I knew or know enough about these conditions and therefore really do not know what questions to ask.  I am not schedule to see my cardiologist  unti Dec since I am on remote transmissions every three months..  Thank you for the insight.

Not quite

by AgentX86 - 2020-04-28 23:40:48

Yes, your pacemaker will supply missing beats and take over if your heart rate falls below the minimum it's set for but it can't delete errant beats.  As I said, Afib, Aflutter, PACs, and PVCs will still get through.  In fact your pacemaker will telegraph them to the ventricles (within its rate limits) just as a functioning AV node would.  It cannot correct an irregular heartbeat.

No, a blood pressure cuff can't tell whether your beat is normal or supplied by the pacemaker.  A Kardia Mobile will show you whether the PM or your heart is supplying the pacing.  With minimal training it'll show a lot and capture an EKG so your doctor can see what you're feeling.  Your PM can do a lot of this too but you'll have to be at home, and initiate a remote transmission.   The Kardia Mobile is about the size of a pack of gum. They're available for about $90.  Highly recommended, particularly if you want to learn about your heart's electrical system.

BTW, welcome to the club.  There are good people here will teach you everything you need to know, to the depth you'd like to go.  You probably won't learn anything from a remote transmission but hang around here and you'll learn enough to talk intelligently with your cardiologist.  They tend to get more talkative when they know you're interested enough to do your research and can talk at their level.

Pacemakers simplified--or why you still have arrythmias

by Gotrhythm - 2020-04-29 16:13:48

I had the same question. Here's how Donr explained why pacemakers don't fix arrythmias like PVCs etc. (except bradycardia.)

The pacemaker doesn't takeover or control your heart. Your heart is still capable of beating on it's own and it's best if it does. So the pacemaker sits and waits for your heart to beat. When it senses a beat the pacemaker starts timing. It "knows" how long the interval should be in order to keep the hr up to whatever the base rate is. If the next heartbeat comes when it should, the pacemaker does nothing. It just starts timing. But if the next heartbeat doesn't come when it should, the pacemaker sends a tiny impulse to the heart to instigate a beat.

Then the pacemaker waits ... 

So far so good, right? But what happens if the beat comes before it's supposed to? That's what a PVC or PAC is. A pre-ventricular contraction is a beat that happens in the ventricle before It's supposed to. Same with PAC.

The pacemaker can only add beats.  The PVC (or PAC or A-fib, or whatever) is a real heart beat (just not a very efficient one.) It's something the heart does all by itself. And the pacemaker always waits to see if the heart will beat on its own. If a PVC happens, all the pacemaker can do is start timing and wait for the next beat.

Since you have heart block, your pacemaker has a more complex timing job, but how it's working is essentially the same.

Does this make sense?

Pacemakers simplified

by AgentX86 - 2020-04-29 16:40:09

That's a good explanation.  I'll add that a pacemaker for a heart block is essentially two pacemakers in series.  The atrial half of the pacemaker works like you say above.  The ventricular half, times from the atrial heartbeat (whether the pacemaker supplies it or the heart does it on its own) and if there isn't a "natural" ventricular beat within some amount of time, it supplies the ventricular beat (what we call a "heart beat".  If something else (a PVC) supplies the ventricular beat first, it doesn't fire again.  So both arrhythmias started in the atrium and those started in the ventricle will be felt.

Irregular heartbeat

by Ms Rutledge - 2020-04-29 19:03:58

Thank you Gotrythm,   I think I understand, however one last question if after exercise your heart rate starts dropping to quickly for example from 135 to 53 beats within a few minutes am I correct to understand my pacemaker will not correct until after it falls below my set rate of 50? 

Pacemaker doesn't "correct" anything

by Gotrhythm - 2020-05-01 16:21:41

It's all about what your settings are, and what your heart is doing on it's own. Without knowing your settings, it would be impossible to say. As long as your heart is beating when, or bfore, it's supposed to, the pacemaker will not institute a beat. It will just do it's waiting and timing thing.

The pacemaker base rate (in your case 50) is the rate your pacemaker won't let your heart rate go below. 

But the base rate is just one of your settings. You've also got settings that determine the upper limit the pacemaker will go to. And how fast it will speed up and how quidkly it will slow down.

The settings are done with fancy algorythms. To tell you the truth, I can't even define the word algorythm. But I do know it's a computer math that allows the pacemaker to calculate in split seconds what your heart is doing and what the settings tell the pacemaker to do. That's so simplied it's probably wrong, but it's close enough to let you get the big picture.

So the question about whether the pacemaker will "correct" something...? The pacemaker doesn't "correct" anything. It' just does it's little mathmatical things it's programmed to. If its settings are programmed to do something when the heartrate is 53, it will. If it's not, it won't.

Does this answer your question?

Irregular heart beat

by Ms Rutledge - 2020-05-02 10:38:54

Gotrythm, again thank you for the information, it did answer my question.  I think I can now try and explain to the Cardiologist that something needs to change in my settings.  As if I exercise and my heart rate is up and is dropping to fast after wards to make me feel uncomfortable he should be able to change a setting.  (Hopefully).  I really dislike this remote monitoring. As you only see the dr once a year (as for me anyway).  I have not even had my pacemaker a year yet.  I am not really sure the doc even reads the transmissions, as I feel as something should look out of the ordinary  on the days this occurs since it does not happen every time.   Thanks again

Irregular heartbeat

by AgentX86 - 2020-05-02 22:30:26

You really need an electrophysiologist rather than a general cardiologist if you have arhythmias, particularly if you're symptomatic (can feel the arrhythmia and it impacts your quality of life). EPs are cardiologists who specialize (two years further internship) in the heart's electrical systems.  It's possible that your cardiologist is an EP but he should be board certified in electrophysiolgy.  This is crucial if you have arrhythmias or need your PM tuned for optimum performance.  OTOH, if you're a couch potato, optimal settings aren't as important but quality of life is.

One more thing...

by Gotrhythm - 2020-05-03 15:25:26

Don't ever accept "Your pacemaker is working fine" as an answer.

It's true, but all it means is, "your pacemaker is working the way it's programmed to." 

What you're talking about is wanting a change in the rate response (RR.)  Changing the settings isn't hard, doesn't require any special equipment. The tech can do it. You might not even need an appointment with the cardiologist. You certainly don't have to wait for the yearly appointment.