My Dad has had a pacemake for 3 1/2 years, now he has low heart rate

Lower heart rate

by Gemita - 2020-10-24 14:05:41

Hello Berrygin,

It would be helpful if you could find out what your Dad's minimum heart rate is set at. Do you have his pacemaker ID card/details.  It usually gives this sort of information?  

There is usually a minimum setting, below which the heart rate cannot fall.  For example my minimum heart rate is set at 70 bpm.  Others may have a lower setting of say 60 bpm.  If your Dad feels his heart rate is sometimes falling lower than that of his minimum pacemaker set heart rate, then it could be that he is experiencing ectopic beats which are very weak beats that can often be missed by home monitors. They feel like skipped, missed, pausing, slowing beats.  The pacemaker cannot be tricked so easily and will detect these weaker beats and count them as heart beats, so you should be reassured that the pacemaker is working properly.

However, I would go by how your father feels.  If he becomes weak, dizzy or has any other symptoms, then you would be advised to get him seen by his doctors, since he may have developed an arrhythmia, like ectopic beats or something more troublesome and his doctors might want to carry out some checks.  So my advice would be to forget the numbers which do not look too concerning and go on how your father feels and seek help if he continues to feel unwell.  He is after all 89 and deserves the best of care.  I wish you both well.

Slow pulse

by AgentX86 - 2020-10-24 14:08:33

There are a couple of things that may be going on.  You don't say anything about why your father has a pacemaker so it's difficult to say much. 

The most common reason he would have a slow heart rate is that he's having PVCs.  PVCs are an ectopic (coming from somewhere abnormal) beat from the ventricles.  The reason he would have a slow heart rate is that the normal impulse starts a heartbeat then this ectopic beat happens before the heart is reset to its relaxed state.  What happens is, that while a beat isn't "lost", it's so small that it isn't measured by your monitor.  A  blood pressure monitor cen't be relied upon to give the heart rate.  It must be counted manually.  In this case, it should be counted in the carotid or femoral artery.  He must do it on the carotid himself.  One must never palpate another's carotid artery.  It's very dangerous.  If this is the problem, it's usually possible to feel the arrhythmia.

Another possibility is that your father has a pacemaker for something like a heart block and has(had) a normal sinus node.  The pacemaker's function, then, was to bypass the defective AV node to transfer the stimulous from the atriua to the ventricles.  Since the SI node was good, the minimum rate was set low.  Perhaps his sinus node is now failing, dropping his heart rate to the pacemaker's minimum setting.

These are the two possibilities I see.  There may be more.

My Dad has had a pacemake for 3 1/2 years, now he has low heart rate followup comment

by berrygin - 2020-10-24 18:26:14

thanks for the advice/comments. Dad feels tired, was really congested earlier (an issue he has , but worse than normal) not as bad now, after a 2 + hour nap. Still tired. No temp (of course Covid pops into mind with heart weirdness!)

as I mentioned above, he was starting to have his heart rate drop back in 2017, but not enough for our monitor to pick up. went to ER, and that's where we saw that his pulse would be fine, then drop to 40-45 for a few seconds, then right back to 75 on their system. Got worse for the 2-3 days he was in hospital, before they put the pacemaker in

Ok,the card says I have an Advisa DR MRI SureScan Pacemaker implanted. This patient has a Complete MR conditional system implanted, consisting of a surescan device ans SureScan leads.

other side just said Medtronic and the implant date and 3 serial numbers, and 3 model numbers. Sadly, no base pulse rate, drat....

I know next to nothing about these devices (I mean, I have heard the docs talk about them, and have been in with him for the tests, read online on them in 2017) so not sure what chamber, or that sort of thing. Can someone need 2 packmakers? (Upper/lower) again I have been reading up on these a bit, but overwhelmed right now...end up reading about something not really related....

Dad's pacemaker

by AgentX86 - 2020-10-24 19:27:21

Congestion can be a sign of heart failure.  Heart failure means that the heart can't pump enough blood to fully satisfy the body's needs.  One of the first symptoms are fluid buildup in the lungs and extremities (ankles,show first).

The pacemaker card won't have any information on its setup.  The settings can change so regularly that the card would never keep up.

No there wouldn't be any need for two pacemakers.  A "dual" pacemaker (a misnomer)  would pace both the top chamber (Right Atrium) and bottom chamber(s) (Right Ventricle).  Heart faiure is one reason the second (left) ventrical lead might be used.  One pacemaker takes care of all of this, though different models nay be used for various pacing needs.

You are doing well berrygin

by Gemita - 2020-10-24 19:54:00

You have discovered a few more things.  Well done.  My pacemaker ID card/ID sheet provided by my pacemaker clinic certainly confirms my diagnosis and indications for pacing.  My minimum base rate and other essential details are most definitely recorded on this document and updated when necessary.  You might also try to locate any other recent papers from your pacemaker clinic, which might show your Dad's base heart rate, otherwise I would call his clinic and query with them and also explain what is happening.  They might suggest an immediate pacemaker check and may also want to do an ECG to make sure that all is well.

From your supplied info, it looks as though your father has a dual chamber pacemaker - one lead to right upper chamber and one lead to right lower chamber of his heart - and that he can safely have an MRI in the future with his particular model.

I am not sure what you mean by congestion - ?congestion as in breathing distress for example from a chest infection - or is your father having more serious symptoms that could point to heart failure as AgentX86 suggests?  If you are in any way concerned, please see your doctor.  Does your father have any other symptoms apart from tiredness?  Does he feel weak, dizzy or breathless?  Does he get any chest pain for example? These are the symptoms to watch for too.  In any event, it sounds to me as though your Dad needs another health and pacemaker check to ensure that there are no obvious signs of a serious problem.  I hope for the very best

thanks for the kind words and suggestions!

by berrygin - 2020-10-26 17:00:54

Finally, Monday arrived! Went to Heart clinic, as we didn't hear back from call to the...whatyacallit, tech branch of their clinic.

They did an ekg , and the woman commented that his heart rate was all over the place! Doctor came in and said, actually it was "extra" beats. Listened to his heart/lungs. Seemed to be ok, other than the swelling in the feet and lower legs (He takes one lasik pill, 10 mg, needs to now take 2 a day)

so, went to pacemaker testing office, and he tested the PM, and said his heartbeat was actually 67 beats a minute, but there are indeed extra heartbeats, and somehow almost any bloodpressure cuff would not pick those up! Sure never heard of that before!

So, since he's not a PM Doctor, he wants Dad to see one Friday, because of the extra beats. So, we do feel a bit better knowing his heart was not actually super low, but a bit concerned, what can cause this?

and I believe the lowest his heartbeat should get with this device, is 60 BPM.

Extra beats (ectopics)

by Gemita - 2020-10-26 17:49:36

Hello again,

I am so glad you have been seen and that you will see someone on Friday about your Dad's extra beats.  Yes as we said, ectopic beats (extra beats, skipped beats, pausing and so on) can all fool our digital Blood Pressure monitors etc into thinking it is a missed beat and the heart rate will therefore register lower than the minimum set heart rate of our pacemaker. I know it is hard to understand.  I kept querying it with my doctors too and they equally kept reassuring me that these ectopic beats (extra beats) can cause these monitoring problems.  These extra beats (ectopics) are a kind of arrhythmia too, not a serious one but a very common one and they can actually cause symptoms if they are prolonged and frequent.

What causes them?  Electrolyte disturbances, some other illness, like an infection, a heart valve problem, heart disease, thyroid problems and many other health problems.  Even diet and certain foods, too much caffeine, chocolate.  Anxiety, poor quality of sleep and even stress but hopefully your doctor will carry out another ECG and/or echocardiogram + get some bloods done when you see them.  Good luck.  I hope they can reassure your Dad and relieve his symptoms

UPDATE. berrygin if your Dad is taking two Lasix tabs now (which is a diuretic) for his fluid retention in lower legs, this can upset his electrolytes.  I would ask doctor to check his electrolytes for any imbalance as a possible cause for his extra beats???  Also please ask doctor how much water he can safely drink because Lasix may cause dehydration, leading to electrolyte imbalances and this can also cause ectopics (extra beats).  It has happened to me.  Please let us know how you get on