Low pulse Rate

Classic fit

by piglet22 - 2024-05-14 13:34:22

Hello

You are describing exactly the effects of ectopics on the pacemaker function.

I was in the same boat a year ago with a PM set to a base rate of 60 BPM, then raised to 70 BPM to no avail.

My ventricular ectopy was interfering to the extent that I was blacking out, blood pressure very low measured the way you have except no Fitbit,

The PM technicians said the PM was fine, which it was, but I had suspected that the ectopics were upsetting the PM timing and were being included in the sensed pulses.

Eventually, if you get a string of ectopics, the PM doesn't kick in when it should and you end up not feeling very well.

The consultant I saw confirmed this and prescribed a 10-mg dose of Bisoprolol to calm the ectopics, which has worked for several months now, but at the cost of physical exhaustion.

I've cut the Bisoprolol down to 7.5-mg daily and may go to 5-mg if I can tolerate it.

Your PM, if set up, will record ectopic episodes.

I would recommend seeing your pacing people sooner rather than latter before the symptoms get any worse.

It's a common problem and confusing when the PM apparently isn't doing the job.

I understand that there is no quick software fix available, but it shouldn't be too difficult to filter out beats that are clearly out of kilter with the rest.

Edit

I didn't add.

It took 18 years for ectopics to surface.

You ask if the PM is functing correctly. The answer is probably yes, but get it checked. Mine is Medtronic too, different model 2016, second PM, first fitted 2005

Thanks

by Rose56 - 2024-05-14 14:36:23

Hey, thanks for the info

Pacemaker  recorded lots of ectopics. Can't get in to see EC doc until June. An ECG at the cardiologist recorded frequent PVCs including ventricular couplet that appear to be fused with paced beats.

I'm getting an event monitor soon.  I've had PVCs for years.  Never had is lower my heartrate.  PVCs seem to be less frequent in the last 2 days but resting HR still low l, last night it was 45.

ectopics

by Tracey_E - 2024-05-14 16:10:13

Paced or not, ectopics and pvc's will throw off a manual or oximeter count. My dad recently had sustained readings of 30 on both oximeter and bp machine, got to the ER and he was in the 60's with a lot of extra beats the home monitors were missing. 

Doyou have a home monitor that you can send a download? 

Reply

by Rose56 - 2024-05-14 17:09:06

No home monitor. When I count my pulses, I can feel long pauses between heartbeats.  Sometimes my Fitbit picks up beats that I can not feel. Usually we are in agreement.

I understand that my pacemaker could be counting beats that I can not feel.  

Low Pulse Rate

by AgentX86 - 2024-05-14 19:21:40

The PVC happens fast enough after the normal beat that it doesn't allow the blood to completely refill the LV.  The arteries will try to keep the blood pressure constant so won't transmit this to the arteries at the extremities. You'll then feel the PVC as a skipped beat.  It's not skipped, rather to faint to detect in the radial (wrist) artery.

Check your blood pressure in a major artery. The neck is the best place.  The carotid arteries are very large, needed to deliver any blood possible to the brain. You will feel the full beats, then a random faint beat.  This is the PVC. Counting the heartbeat here will give a better indication of the real heart rate.

Further, pulse oximiters and similar detectors don't know what to do with highly irregular heartbeats. They don't count beats over a minute, or even 30 seconds, so the "random" beat tends to confuses them.

The basic operation of a pacemakers doesn't set a rate, per se, rather the time between beats (ideally the inverse of the rate). When a pacemaker delivers a beat, a timer is set, and it starts counting down to zero. If the timer gets to zero, a pulse is generated to start the next beat, and the timer reset. If a beat is detected, the pulse is "inhibited" and the timer reset. A PVC is interpreted as another beat, so the pacemaker won't insert a new beat where it would have.  If it did, both beats would be short and deliver little blood. Some can feel one "missed" beat but two ineffective beats in a row would be quite noticeable. If PVCs come together (a couplet), this is exactly what happens. Add a few more into the run and you have NSVT (Non-Sustained Ventricular Tachycardia).

When you measure your heartbeat in the neck, don't let anyone else do it for you. It can be dangerous because they can't feel any side-effects.  You can.  Do it yourself.  Oh, and don't use a blood pressure cuff around the neck 😁.

A word of warning

by piglet22 - 2024-05-15 05:35:41

June is a way off.

An episode can come without any prior symptoms.

I got up from sitting and didn't make three steps. Total shutdown, didn't remember falling and came to on the kitchen floor surrounded by broken glass and crockery.

The same thing at the top of the stairs could be curtains.

It scared me so much I changed all the breakables to toughened hotel ware.

Where there were symptoms, it was head crushing dizziness grabbing hold to anything until it passed.

Reply

by Rose56 - 2024-05-15 12:14:50

I can't feel the extra beats in wrist or neck.  I can see the extra beats when I do an ECG with my Fitbit, they are about the same height and follow almost on top of a regular beat.  Assuming that's what they meant by fused in my ECG report.  Guessing my pacemaker counts them as 2 beats and I only count one. I can get 40 extra beats a minute.   

I am getting a doctor ordered monitor to wear for 3 days. Waiting for it to be delivered.  Then maybe they will move my appointment up.

Good to know that pacemaker is probably working "properly".  It's been 11 years since it was installed, so wanting an upgraded model.

Pacemaker "working properly"

by AgentX86 - 2024-05-15 14:09:15

You'll learn to dislike that phrase.  It becomes the equivalent of a pat on the head and "now go back and play with the other children".  Nope, not an acceptable answer.

Of course the pacemaker is working properly but why am I not working properly with my pacemaker? I really don't care about finger pointing.  I just want it fixed or at least a plan to get it fixed. Now, please.

Working fine

by piglet22 - 2024-05-16 07:04:49

I get the feeling that the technicians I occasionally see are working to order and have been told to say no more than necessary.

At times, it is a strained encounter.

I'm not surprised as the main hospital in my health trust has twice now been found to have a toxic culture and bullying by senior staff as well as conflicts between consultants.

At one point, I likened the cardiology reception to visiting Guantanamo Bay.

Rightly or wrongly, the visits seem to be about the object, not the person.

Nothing is offered in the way of basic stuff like battery life.

There's definitely a feeling or suspicion that the way you are treated is down to who you see and at risk of sounding contentious, some of them do not like older men. Cantankerous old git.