Skipped Beats 6 weeks post pm

Posted this as a comment but decided it should be a new Post instead.
I've had the PM for 6 weeks now. My 6 week check was scheduled at 7 weeks so I have to wait the extra week.
Everything has been really fine up until today. I'm running a Wilderness First Aid class and though I'm busy I'm not doing anything strenuous. I started feeling funny and checked pulse- slightly fast and not pounding, but skipping a beat every 6-8 beats. This has continued on and off for several hours but now that I'm home and relaxing it's stopped.
I thought the skipped beats would be taken care of by the PM. Thoughts????
Harry

14 Comments

skipped beats

by Pookie - 2010-11-06 07:11:33

Hi:)

I know they can happen as they have happened to me and I still get them every so often after having my pacer for 6 yrs this week!!!!

There are other members that can explain it much better than I, but sometimes our heart and our pacemaker have a little competition....our pacer is sitting there waiting for our heart to beat on it's own, and if doesn't, our pacers do it for us - well, what can happen is this....just as the pacemaker is doing it's thing, our heart beats as well, sometimes that can be felt as a skipped beat. It's like 2 cooks in the kitchen:)

Sometimes after having mine this long!!! - I can be laying in bed watching TV and all of a sudden my heart will do what you explained or sometimes it races, then I automatically become a tiny bit panicked or alarmed and that makes it even worse!!!!!

I've often mentioned this to my doctors and they say it is perfectly normal. The thing to look out for is: if and when something abnormal lasts for a long time. If your heart seems to be racing, anything under 100 doesn't seem to alarm the doctors - unless, of course, this happens for hours and hours or even days.

Sometimes some of the meds I take make my heart do weird things too. Sometimes when I'm upset or worried or stressed, my heart will flip-flop. When I first got my pacer I freaked out at every odd beat and was determined something really bad was happening, but given time, I just take notice and continue what I'm doing. I truly believe that after we receive our pacemakers, it makes some of us very sensitive to every beat. Heck, I can take my pulse just by sitting very quietly - meaning I do not use my fingers on my wrist or neck - I can just sit and count the beats just by feeling them!!!!!!

But definitely tell your doctor about what happened today and perhaps it was recorded. Everyone has a few PVCs or PACs even if they don't have a pacer.

You did say you started to feel "funny"....what did that feel like????

Take care and remember, you can always go to the ER if this starts again and won't stop.

At 6 weeks I totally remember remembering every little beat if it felt "off". Sometimes it's just our bodies getting used to our little buddies.

Electric Frank, Smitty, and a slew of other people will be able to explain it a heck of a lot better than I....lol

Take care,
Pookie

Creaky.......

by Pookie - 2010-11-06 08:11:00

I think you may be right.....you're just 6 weeks post op and I think your day was a bit too busy:)

Although your scar may be healed and you felt good enough for the challenges of your day, perhaps you over did it just a bit??? You still have a lot of healing to do underneath as my doctor told me many times....so take it easy.

Cheers,
Pookie

Thanks Pookie!

by Creaky - 2010-11-06 08:11:20

-:)

It felt like...

by Creaky - 2010-11-06 08:11:58

Pookie- thanks for the response. Well when it started it just felt like my heart was racing and with not as strong a pulse as I am used to. Then it started being more of the 6-7 beats-skip-6-7 beats-skip kind of thing. I felt the skips or was it the stronger beat after the skip.
When I finally relaxed on my sofa at home it calmed down and has been fine for 3 hours now. Could be anxiety of just getting everything done that I had to while not being able to eat lunch or drink anything on schedule.

eating and drinking

by Tracey_E - 2010-11-06 09:11:20

re: not eating and drinking on schedule, I've gotten in the habit of carrying water and protein bars in my car. In the summer when it's hot, I keep a powerade or something else with electrolytes handy. I feel too bad when I skip meals or get dehydrated, it's well worth the trouble of feeling like a traveling grocery store from time to time!

skipped beats

by Tracey_E - 2010-11-06 09:11:35

I can think of two things it might be... if your heart is beating faster then the minimum, the pm won't add beats. So if you're set to a min of 60, or 1 beat per second, but you're going at 120, the pm will let you skip a beat because you're nowhere close to your minimum. Also, it can do heavyheavyweak which will feel like a missed beat when it's actually a smaller beat you aren't counting.

Racing can happen sometimes, from overdoing it or from things like caffeine, or stress and anxiety can do it also. If it just happens once or doesn't last long, I wouldn't be too worried about it. If it's a pattern or doesn't slow down then I would call.

Possibly PVC's

by ElectricFrank - 2010-11-07 01:11:26

PVC's are a good possibility. They can be triggered by stress, allergies, viruses, and who knows what else. They feel uncomfortable, but in most cases aren't anything serious.

The simplest description of a PVC is that something irritates the ventricles to contract early which results in poor filling and a weak or undetectable pulse. Then there is a longer than normal pause while they get back in sync.This longer time interval allows the ventricles to fill more than usual and when they contract it produces a whopper of a pulse. All this gives the feeling of a missed pulse followed by a heavy thump.

They can come in singles or in runs where every other beat is a PVC.

The report generated during your checkup will likely show the number of PVC's and runs since your last checkup.

To put things in perspective I've gone through times of having as many as 2500 PVC's/day and it wasn't considered serious.

frank

PM for 7 weeks

by RetCop - 2010-11-07 02:11:40

I'm feeling things too. My EP says it sounds like I am sensitive to the wires. I know when my heart slows down because I can feel the PM keeping it faster. I feel it for about 15 to 20 seconds and than the feeling is gone. It is very annoying. I do still have PVCs every once in a while.

My PM is set for 70 to 130 bpm. What happens if you are exercising and the heart goes over 130. What does the PM do?

Thanks

Over the Upper Limit

by Creaky - 2010-11-07 03:11:42

This is what I've gleaned from reading as many threads here as possible-
The PM may become confused with your heart wanting to beat faster than the setting and cause irregular HR. I'm set at 60/130 and have already experienced this effect. When I go in next week, one of the things I will insist on is that they raise my upper limit to 160, or at minimum 150. I know that when I'm hiking a mountain my HR is frequently 140-150 for extended periods.
The other settings, such as rate response, may also play a roll and I have a batch of questions ready to ask about that as well.
Harry

PVC

by biker72 - 2010-11-07 07:11:39

I've had PVC's since 1987. They were documented during a couple of stress tests.

They come and go but proper hydration is he key for me. My PM of course does nothing to fix this problem.

Thanks to All

by Creaky - 2010-11-07 10:11:51

Thanks for all the responses. I'll be having my 6 week check this Friday. From what you've all said, it feels like PVC's are the likely explanation. I will report next week.
Harry

Good Lesson!

by donb - 2010-11-07 12:11:16

Hi All, There's real good info in the above postings. Even for an old timer everything above is very familiar to me also. I've learned to not get worked up when irregular HR shows up under stress. It certainly helps being able to understand what's going on being able to relax & cool it. Pookie,Tracey, & Smitty you really nailed this one, excellant. donb

Great Info

by Creaky - 2010-11-08 11:11:02

Thanks Frank. Your description is excellent. It's especially interesting regarding the skipped ventricular beats. That must impart a "funny" feeling in the chest. I don't intend to exceed or even approach 160 HR but as you said, I don't want to bump into it- especially if facing down a bear (not entirely out of the question here).
You are definitely a great resource on this panel! Thanks!
Harry

Upper Limit

by ElectricFrank - 2010-11-08 12:11:20

The pacemaker actually doesn't measure the HR. It measures the time between beats on a beat to beat basis. So a HR of 60 has a beat to beat interval of 1 second.

This is important in understanding what happens when we reach the upper limit. When the time between 2 successive beats is less than the upper limit interval the pacer doesn't pass on the current beat to the ventricles causing the beat to be skipped. The next beat measured from the last ventricular beat will be long enough to be passed on. Heart beat intervals are never completely consistent so right at the limit beat skipping is erratic. Then as the rate rises even more every other beat is skipped giving a ventricular rate half the atrial rate.

So the bottom line is that with a Upper Limit of 120 (to make it simple) as we increase exercise level our HR will slowly rise to 120, start skipping random beats, and finally drop to 60. If we keep on pushing it will again start to rise always at 1/2 the atrial rate.

The exception to this is if the block is not 100% and lets some natural conduction come through. In this case the rate can exceed the Upper Limit, but not reliably.

From my perspective the only reason low Upper Rate settings are justified is to prevent atrial flutter from driving HR excessively high, or to prevent high HR from inducing vtach or vfib.

Harry, I agree with the setting you propose. I have noticed that my HR tends to overshoot for a minute or two when I stop an activity. If I ride the exercise bike to a HR of 130 and then stop, my HR will usually go on up to maybe 140 or so before starting back down. (My guess is that when the pumping action of my leg muscles on the blood vessels stops the heart has to pick up the load.) So to keep from hitting the limit I take this into account. It is interesting to insist on an upper limit of 150 when I am 80 yrs old.I don't intend to go that high but I want the head room. Like I told the cardiologist, if I'm being chased by a bear I would rather die of cardiac arrest than to be eaten!

As for rate response the best way to tell whether you need it is to look at the rhythm strip part of an ECG during exercise with RR off. Watch the little bump on the trace that is the atrial wave. If it responds appropriately to your activity then RR isn't needed. It is always best to have it off if you can.

good luck on the checkup,

frank

You know you're wired when...

You always have something close to your heart.

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