To Electric Frank & Smitty.....

Hi Fellows: I have a question for you two experts! I've had my 2 lead PM since May '06. My ventricle paces 100% and the atrium 54% at last check. I'm due next month for a PM check. Recently when I check my BP, my HR is fast up to 108 on one occasion. This evening, for example, my HR was 101 one time, and when I rechecked it was 89. I have confirmed this with a Pulse Oximeter. I take atenolol (beta blocker) 50 mg daily and have permission to adjust the dosage if I feel the need so have been taking only 25 mg a day. My PM is set at min of 60 but I don't remember the upper setting. Back to the question: what do you think would cause this recent increase in HR? I don't feel any different and other than the BP monitor could not tell my HR was elevated. I know I will get a better answer from you guys than I will from my cardiologist or his staff. I know you are doctors but I trust both of you implicitly. Thanks in advance for any assistance you can give me. I don't login much anymore but knew this was a time when I needed you!

4 Comments

Another question?

by auntiesamm - 2008-09-08 05:09:18


Thanks, Frank. My question is: why would this happen more than 2 years after PM placement? Since then, until just a couple of weeks ago, my HR never was higher than 78-80 regardless of activity. What would cause it to suddenly become rate responsive? Is it anything to be concerned about? I know I should be asking my cardio these questions when I have my next interrogation but everyone involved have created such an "assembly line" it's tough to get a word in much less a question that needs a good answer! Heaven forbid - it might take another 5 minutes! I know I can depend on you and Smitty. My money says you know more about the guts of the PM than the physicians do in many cases. Thanks again for taking the time to answer my questions. All the best.....

Sharon

Oops!

by auntiesamm - 2008-09-08 05:09:51

I just read my original post. Third line up from the bottom I intended to say " I know you are NOT doctors, but left out the NOT. Oops is right. Sorry if I confused anyone other than myself. LOL

HR Change

by SMITTY - 2008-09-08 11:09:59

Hello Sharon,

I haven't commented because after I read Franks comments, there was not much I could add. Except, if my heart rates are any example, a HR can vary from one extreme to the other any time. But if your HR stays up, I hope you can see a doctor as a sudden increase in a resting heart rate can be a signal that something needs to be checked. Especially if the increased rate is continuous.

I will add one thing to what Frank said about twiddling the PM to make your HR go up. When my rate response was on and I got bored I would reach up and lightly tap my PM to watch my HR. (My wife would tell me, you are just like a kid playing with a new toy.) This would make the rate response think it was time to go to work and up my heart rate. How many taps or how long I continued the tapping would determine how high my HR would go. However, although my PM range is 70 to 120 I never got my HR above the mid-80s.

Of course, my HR has been going in the opposite direction for too many months. Today for example I have had 10 or 15 episodes when it would go down into the mid-40s for 1 to 5 minutes then go back up to 70 for a while. If physical activity had any effect it would make it go up into the 80s and then right back down into the 40s. I'm very much aware of the 40s rate because I have chest pain at that rate. I have an appointment for a routine checkup tomorrow and I will tell the tech about it and have him or her mumble something with I have come to recognize as "I don't know."

Again though, if your HR stays high continuously, see your doctor.

I wish you the best,

Smitty

Comments

by ElectricFrank - 2008-09-08 12:09:44

Hi,
Your atrial pacing is an indication that rate response is activated. With this in mind you might watch what sort of activity you have been doing just before taking your pulse. The rate response senses movement and adjusts atrial pacing from it. If you pacer is implanted just under the skin you can confirm this easily by "twiddling" the pacer while you are sitting quietly. If this increases your HR it almost has to be rate response since you aren't doing anything physical to cause it. Back before I had my rate response turned off I could drive my HR up to 130-140 that way.
The other thing to keep in mind is that our HR is quite variable over time and responds to a lot of things. For me a glass of wine with a meal of Mexican food will drive my HR up into the range you are mentioning. But I seem to cycle from as low as 58 on up.
At that next check ask if rate response is turned on and if so, why. There may be a very good reason for using it, but if not it is best be left off. An alternative I use is to have rate response off, but a lower limit set at 55. In theory this protects me from severe bradycardia, but lets my own natural pacemaker handle things. The cardiologist resisted the change, but now that I have gone for 3 years without ever hitting the lower limit he is relaxing a bit. I just tell him that I am willing to have the lower limit set to treat his anxiety!!

best,

frank

You know you're wired when...

You play MP3 files on your pacer.

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