Heart rate dropping on home b.p. monitor but clinic says that it would have alerted them if it did

Drs nurses dont believe me

by Persephone - 2022-10-30 16:52:57

I understand the struggle, Nancy, and truly hope you are able to join that sky-diving club as well as joining here.

So you're going back to your clinic this week - you've probably already considered this, but taking your home devices for comparison with the clinic's devices would be helpful. A written log of your home readings including date and time would be helpful.

Let us know how it goes.

And WELCOME! It's a safe place here :)

HR mismatch between BP monitor and pacer monitor

by Julros - 2022-10-30 18:51:51

Hi Nancy. I understand your frustration. I really like my doctor but I feel like the clinic nurses dismiss me as someone who couldn't possibly have their level of knowledge or experience. But I do, actually. I have 14 years of experience as a cardiovascular nurse and have a masters degree in the same. I am not longer working in this area, so I am not as up to date on meds as I wish I was. 

I am going to make an educated guess as to what is happening, but of course, I am not there, so this is just a guess. 

It is not unusual to have an early, extra heart beat. Let's say your low rate is 60 beats per minute, or 1 beat per second. If you get an early electrical impulse, your pacer will reset it's timing so the next impulse comes 1 second after the early one. But if the extra impulse comes soon enough, there is no beat at all because the heart hasn't completely reset. This can cause a pause greater than 1 second. Automatic bp cuffs, pulse oximeters, and many cardiac monitors calculate your heart by counting only 2-3 seconds of your pulse and then averaging it. So if you have a few extra impulses with no actual beat, whilst the bp is being measured, then you can get a low reading. Technically, a heart rate should be measured for an entire minute, but very few machines or clinicians actually do this. My guess is your heart rate of 41 is not sustained for more than a second or two. 

You may be experiencing premature atrial or ventricular contractions. If you have electrolyte disturbances, this would not be unusual.  If you are not feeling palpitations or weakness, there is likely little to be concerned about. You may benefit from an ECG in your office to see if you are having early, extra beats. For the most accurate pulse, you should count for a full minute, feeling your wrist or neck and using a watch with a sweep second hand. 

adding to what Julros said

by Gotrhythm - 2022-11-01 15:07:15

It's important to remember that all our home monitors are getting their results by reading at different parts of the body. That's why they can all be accurate, and yet sometimes seem to disagree.

The pacemaker is looking at the heart's electrical activity right at the heart. The little pulse/oxymeter is reading the blood flow at your fingertip. The heartrate count of the blood pressure monitor is reading what's happening at the arm or wrist. Watches, and other gizmos are also reading from different body parts.

In addition, no matter what the heart is doing, the pacemaker records only what it is programmed to record. So your watch or aifb monitoring device might show afib but your pacemaker will record it only if it meets certain parameters. Same with PVCs.

So, even if everything is working as it should, it's possible to get contradictory readings.

Your experience isn't uncommon. When I'm having a run of severe PVCs, I have recorded on home devices a sudden drop in blood pressure and heart rate. And no, the pacemaker report didn't show anything. In the doctor's office, the automatic BP monitor sometimes suddenly shuts off and give ERr reading at the same time I'm feeling the PVCs.

It's frustrating to be brushed off by the medical people.Been there. But what really matters if that you get the attention you need. So use your home monitoring equipment. Keep a record of your results. Remember that one "off" reading doesn't mean much. So always take another about 10 minutes later. What's significant is a pattern. If you can equate your symptoms, like feeling faint, with a reading so much the better.

You can't make a diagnosis from your home equipment and neither can the doctor. But if you can show a record, it can help the doctor know where to look to figure out what's going on.

Passing out is always serious. You did the right thing to call 911. When you feel like you're in trouble, that's always what you should do--whether the doctor's office is taking you seriously or not, and no matter what your home monitor says. Always remember, what/how you are feeling trumps everything else.

Hope you can get to the bottom of what's going on soon, and feel better.

PS. If you are having heartrate irregularities, a pulse oxymeter will give more useful data than the BP monitor. Innovo makes one I like.