Pacemake not working,

Sorry to read this

by Lavender - 2022-06-30 19:40:23

I'm sure it's causing you to feel unprotected and ignored to be experiencing this. 
 

About three months after getting my device implanted, I was in the yard. I didn't think it was such a hot day but I started feeling weak, woozy and alarmed. I went in and laid on the bed. I felt that my bedside monitor would record anything outside the parameters set. The next morning I called the cardiologist to report, thinking they'll see something on my monitor readout. They said nothing was wrong. They also told me that since I have the pacemaker, I would need to be even more aware of the need to drink more water. I was told I probably was woozy from being outside on a warm day. They also told me if I feel this way to eat a few pretzels and drink water. 
 

I know some folks are not to eat more salt but in my case this was recommended. 

I had another similar event a couple months later. Again, I called the cardiologist in the morning. My monitor report showed that the pacemaker was doing its job. But it was another warm day and I probably needed more water. I also got anxious because I no longer trusted-not only the pacemaker, but also the doctor. 
 

You said this on a previous posting:

"My cardiologist isn't really interested in hearing about my problems any more, since he insists they are not heart-related. The pacemaker showed no problems during a bad dizzy spell that I reported to the cardiologist's office."

I have heard that three times from my cardiologist and I am always told to contact my pcp because it's not heart related. 
 

You could be having anxiety as I did. Maybe dehydrated and a bit too warm as well. It sounds like if you want it further investigated-your pcp might be the place to start. Perhaps a neurologist could check you out to see if it's brain related. Your pcp should be able to direct you as to who to turn to for more answers. 
 

Having said that, it took me a long time to trust my pacemaker. I now believe that they work well and rarely fail. I'm careful to eat and drink properly and stay out of the heat. But I wouldn't hesitate to pursue medical care if I thought something else was going on. 

Reply

by Global - 2022-06-30 20:17:49

You brought up some really good points. I do not drink enough and work outside in the heat all the time. That can certainly cause problems. So I will try to drink much more regularly. But the fact that my pulse was below 50 for almost an hour seems to indicate to me that the pacemaker wasn't working. I will definitely talk to my PCP about it.

Pulse under 50

by AgentX86 - 2022-06-30 22:47:31

Were you having these dificulties when you were uploading your data using your Merlin?

My bet, like it in all of these "pacemaker failure" threads is that you're getting PVCs. They can easily fool a blood pressure monitor into saying anything.  These blood pressure or Pulse/OX sorts devices really aren't a good measure of heart rate.  Measure/time it yourself. 

If you notice that your pulse isn't regular or it seems like you're missing beats, these "missing" beats are PVCs.  PVCs don't really change the pulse rate but will fool monitors.  The "missing" or uncounted beats are there but they're small/incomplete beats.  Since they're small, they don't pump enough blood and you feel like crap. It you want to feel the "missing" beats, feel your carotid artery (neck).  You'll feel not only the real beats but also the PVC and the beat that was missed.  You'll feel something like "beat, beat, beat, tap-tap, beat, beat,...".  One of the light taps is the PVC and the other is the paced beat.

Anyway, the chance that there is something actually wrong with your pacemaker that's causing to beat too slowly is, well, buy lottery tickets.  You'll hit that first.

They're usually caused by dehydration or "electrolyte" shortage but heat will also do it.  Sometimes, for no reason.

Agentx56 comments

by Global - 2022-07-01 00:04:18

I didn't mean to indicate the pacemaker was causing the slow heart rate. I was just wondering why it didn't correct the slow heartbeat because it is set to keep my pulse rate at 60. And I did take my own pulse rate when I first noticed it was so slow. Then when I got to the house I took my blood pressure and it showed an equally slow rate. I agree that it was probably dehydration that caused the original slow beat. But why didn't the pacemaker correct it?

You could ask about increasing your Base Rate?

by Gemita - 2022-07-01 05:05:28

Global, your experience is a common one and a question that continues to come up and quite rightly so.  PVCs (premature ventricular contractions) and PACs (premature atrial contractions) can be really difficult to tolerate and like you, I have questioned why my pacemaker doesn’t step in and override what feels like skipped, missing, pausing, slowing heart beats which can make my home monitor record something like 40 bpm for lengthy periods even though my pacemaker base rate is set at 70 bpm.  But as AgentX86 pointed out, even though it feels like it, our heart during ectopic beats is not actually missing any beats, which is why our pacemaker doesn’t step in.  Our pacemaker senses an ectopic beat correctly, our home monitors often do not, although clearly a 40 bpm home monitor reading for me, together with a drop in blood pressure will be confirmation that I am indeed in the presence of an irregular arrhythmia like an ectopic beat or worse, Atrial Fibrillation.

Like you, I try to check my own pulse manually when I feel weak and I can most definitely feel the irregularity of ectopic beats, the slowing down, the seemingly long, pausing, thumping, the intermittently fast, and then often weak heart beats - sometimes even missing heart beats;  no wonder ectopic beats can adversely affect our home monitors, our blood pressure, our stability.  My home monitor often errors in the presence of an arrhythmia like ectopic beats.   If prolonged, ectopics can most definitely affect my blood flow, blood pressure and cause breathlessness, weakness, dizziness and other difficult symptoms.  In fact for me PACs usually trigger my Atrial Fibrillation, so they definitely need controlling.  

To specifically answer your questions, "why didn't my pacemaker correct my falling heart rate/blood pressure"?   I would answer (1) a pacemaker cannot correct an arrhythmia and an ectopic beat is an arrhythmia and (2), a pacemaker cannot prevent a fall in blood pressure.  However your pacemaker will not allow your heart rate to fall below your Base Rate.  I asked my EP this very question and he confirmed a fall below the Base Rate would not be possible.  Our symptoms would be due to the "irregularity" of our heart beat during ectopics, not due to a failing pacemaker.

Then you might ask “what is the purpose of a pacemaker”?  A pacemaker is far from a perfect tool when it comes to helping arrhythmia sufferers, only meds and an ablation may help, but a pacemaker will effectively treat heart block and sinus node dysfunction/bradycardia and if needed, the addition of an ICD would help to keep us safe by stopping a fast, potentially fatal arrhythmia.  I would ideally like a future pacemaker to be able to prevent a blood pressure fall and to correct any arrhythmia, but there are still things we can do now to help.

Not everyone benefits, but I have found a higher base rate setting of 70 bpm helps to outpace my slow, pausing, skipping heart beats, helping to stop them before they trigger other arrhythmias like Atrial Fibrillation in the case of PACs and Non Sustained Ventricular tachycardia in the case of PVCs.  There are also other programmes and settings that might help so please discuss with your team.  There are always medications you could try too to calm these down like beta blockers, anti arrhythmic meds.   As Lavender has said, good hydration is so important and will help treat falling blood pressure as well.  Also try to keep a diary of any triggers, like caffeine (and caffeine is in many products including chocolate, soft drinks), alcohol, stress, being over tired.  Conditions like sleep apnea, high blood pressure, a thyroid condition, any acute health condition like an electrolyte imbalance, an infection to name a few triggers, may cause an arrhythmia attack.  

Global, I wish you all the very best.  It usually gets better for most of us with time, understanding and some pacemaker adjustments.  Your pacemaker isn't failing you, rarely ever will.