Boston Scientific Pacemaker Questions

Please help. I have had Pacemaker 2 wks and don't know much about all of this. I am set at 60 and 130. Yesterday I got pulse or heart rate readings, don't know which, on our blood pressue machine of 49, 46, and 41. Dr. said to go to ER. ER got readings in the 50's, 40's, and low of 38. Pacemaker guy came out and 5 hrs later read me no lower than 60-pacemaker perfect. He said those low readings are kind of artifcacts or false readings. Does this make sense?

He said I am having a lot of arrythmias caused by something other than pacemaker. PVCs, V tach, etc. Sent home to contact my dr. Said probably not serious.

Nonetheless, I am concerned. Any reason to be?

THANKS!

3 Comments

Heart Rate

by SMITTY - 2009-08-24 03:08:29

Hello JSF,

I'll try to add a little to Tracey's comment, as I have been living with a problem very much like yours for more months than I have wanted.

My pacemaker settings were low 70 and high 110. I would frequently find my heart rate in the mid-40s to mid-50s. When it dropped below 50 I didn't even have to count pulse or heart rate (same thing) to know I was in the 40s because I had chest pain. PVCs, PACs and skip beats that were the real culprit when it came to my pacemaker not keeping my heart rate at least 70 BPM.

I had visits with several doctors and nurses trying to find out why I was having such problem with the low heart rate. Like you I was told more times than I can count "Mr Smith, your pacemaker is working fine." When I would ask why I was getting the low reading I was given several explanations and the gist of them all was I couldn't count heart rate, and the electronic devices I was using were not any better. I'll leave that right there.

By now with a lot of help from members here and some research I learned that my pacemaker, which is an on demand unit, was detecting the preemies (I can't tell the difference in a PVC and a PAC, so I'll call them all a preemie) from a good heart beat. I came to call the preemie as poor heart beats, because they were not causing a good enough contraction of one or more heart chambers to give me adequate blood flow that beat. The low blood flow is the reason I was getting chest pain with the rate in the 40s.

It seems that each time we have a preemie or skip beat our heart sends out a signal that the pacemaker detects and thinks the heart is going to beat on its own therefore the PM does not help out.

In a sense I, Dr., nurses, etc, were all correct. I and my electronic devices were counting only what I call good heart beats, those that pumped a goodly amount of blood but the cardiac experts were counting everything, except skip beats, as heart beats and they were correct, but they were counting some beats (the preemies) that were not pumping much blood. I can't say they were wrong to count them. They were heart beats after a fashion.

What I did was get an appointment with the Medtronic rep and we reached an agreement (the reps, while they do not have a totally free hand, are under fewer constraints than the PM nurses or technicians). The number of preemies or skip beats I was having each minute were about the same regardless of my heart rate. To try to overcome this we increased my PM low setting from 70 to 80 and my high setting from 110 to 120 and started my rate response which had been turned off. The result is my heart rate never goes below 50 anymore any and I have not chest pain since the settings were changed.

Going to the PM Clinic that day I was what I call a pitiful specimen of a human. To get from my car to the PM clinic I had to walk about a block inside and A/C building. I honestly thought I would have to sit and rest a couple of times. Coming out I actually felt like running. I didn't because I know it is not smart for old and fat folks to try to run.

But when it is all said done my problem lasted so long simply because of a "failure to communicate." Will what helped me so much help you, I have no idea. But may be something for you to think about and possibly discuss with your doctor.

Good luck,

Smitty

false readings

by Tracey_E - 2009-08-24 08:08:17

It's very possible for the bp machine or a hr monitor to give a false reading when we have a pm. Depending on the type of monitor you have, the pm can interfere with their signal so it misses counts, or it can count the pm spike as a beat so it counts too many beats. The most accurate way is to count it yourself.

Pm's cannot prevent or stop pvc's or tachycardia. A pm can speed up a slow hr, regulate one that pauses, but it can't prevent a beat that your heart does on its own. All it does is add beats. Pvc's are common and annoying but harmless.

Irratic readings

by ElectricFrank - 2009-08-26 12:08:01

As the others have mentioned HR monitors have a lot of trouble with the ECG waveforms produced by pacemakers. Most of the modern monitors in ER though are designed to handle it.

One quick way to tell is to take your pulse manually on your wrist or neck. Compare this to your BP monitor.

When the pacemaker guy checked you out were you still hooked up to the ER monitor? That way they could compare the two readings.

It is also possible that you have a lead problem or voltage setting on the pacer that causes it to loose control of the heart. It is called "loss of capture". I had this happen once and my heart was skipping 4 beats in a row at times. This sort of thing can be intermittent so the pacer guy could have taken the reading when all was working fine.

frank

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