Pacmaker Mediated Tachycardia

PMT

by Cabg Patch - 2016-12-19 17:18:14

Yes I've had it, PMT, and while uncomfortable it is not dangerous even though it typically does cause a heart rate at or near the threshold. They can either change the timing or lower the sensitivity settings for rate response. Not a biggie. May take a couple attempts to get it right. In my case it just kept me awake at night listening to my pounding heart race and waiting to hear skipped beats.

Give me info

by Gotrhythm - 2016-12-20 14:35:26

I don't have panic disorder but I'm the same way about information.To my thinking all data is good data and even scary data is easier to deak with than no data.

For some reason, cardiac professionals seem to think it's best not to tell the patient too much about his/her condition. I had to practically swear on a stack of bibles that I would not get upset before a tech would give me a copy of my interrogation report.

In my opinion, you're lucky. The doctor is aware of the problem and working to resolve it.  I had PMT and it took two years to find a doctor who could diagnose it. During that time it was suggested to me repeatedly that I must be having panic attacks, becuase--wait for it-- "your pacemaker is working perfectly."  Ultimately, the EP decided to turn off the ventricular lead, thereby eliminating any possibility of PMT occurring. Turning off the lead was an option since (at that time) I had ho heart block issues.

Since then, I'm fine. You will be too. But don't be shy about asking anything you need to know.

A bit more on PMT...,

by donr - 2016-12-21 00:11:30

...hopefully for the cowboy, not the engineer!

All physical things obey the laws of physics, mechanics & electricity.  The human body is no different - EXCEPT in one itty, bitty way - it has a thinking mind that is capable of doing all sorts of wild things to its electo-mechanical host that exists below the ears.  It does it through IMAGINATION - by envisioning all sorts of horrible things that could happen & then doing something to cause them to happen - or at least to SIMULATE them happening!

Thou spaketh a bookful (To quote a line from an ancient Donald Duck comic book of the early 50's) when you mentioned anxiety causing you grief & misery, but KNOWLEDGE easing the problem.  Yes, Knowledge IS power!  I know whereof you speak, suffering nearly 40 yrs of lingering PTSD brought home from Viet Nam.  My particular symptom just happened to be chest pains mimicking a heart attack, (I'll throw that in, just like in a game of horseshoes), loss of sleep, nightmares, hypothermia & a few other minor issues.)

Anxiety comes out of the sub-conscious mind - an evil, conniving, sadistic bit of the human psyche that God gave us as a reminder that we were created in his image, but not perfect copies.  It sits there and just surveys what is happening to us, searching for some incident to magnify all out of proportion to cause us misery.  Patch mentioned one occurrence that caused him misery - a "Skipped Beat."  I can see it now - his S-C Mind sitting there, feet up on it's magnificent mahagony desk, sipping a cup of hot yarb tea, watching all the reports coming in of how the heart was functioning.  Suddeny it sees a really minor glitch - like a premature heart contraction - & it lets out an evil, rasping cackle echoing through the snow-covered hills, like the Grinch heading for Whoville to sabotage Christmas.  In this case, the S-C  sends a signal to the endocrin system (Usuallly the Adrenal Glands) telling it to release all sorts of hormones to put the body on high alert to be ready for disaster - you know the feeling - "Fight or flight."  Then it sits back again, a sadistic grin smeared across its face (Remember the Batman's nemesis, The Joker?) like it's watching a train wreck & enjoys the chaos it has created.

Then the SC finds the conscious, rational, Goody Two Shoes mind , nudges it in the ribs & says "Have fun putting THAT fire out!".

So, old GTS flails around searching for an expanation to quell the confusion.  Here's where knowledge becomes power.  Napoleon Bonaparte said it in about 1806 - "In battle, the mental is to the physical as three is to one."  True of things medical, also.  Understanding your situation can lead to peace & tranquoility in the face of confusion & pain.

Now, you asked about the PMT being dangerous.  Depends.  PM's have all the vbariable settings just to compensate for these type problems.  We mention "Retrograde conduction" from the AV backwards to the SA node.  As long as that conduction & the timing of the retrograde wave fall within certain limits, the HR stays in a fast, but stable & safe rate, hence is classified as Tachycardia.  If the timing & magnitude of the retrograde are such that the HR goes out of control - just like the squealing speaker BillH mentioned, itr can slip over the threshold into Ventricular Fibrillation - an uncontrolled, wild, uncoordinarted beating, & that is definitely dangerous. 

Sounds like yours is controllable & your settings were just off by a bit - a tweak fixed it all.  Now you know where to guide the discussion next time you see your EP.  .

The best to you in your quest for knowledge.  Also a Very merry Christmas to all of you on the great frozen high plains.

Donr

Can I say "Wow" again?

by verne8 - 2016-12-21 00:55:46

It will take me quite a few reads to digest all of this. Straight A student all my life but your posts definitely keep me humble. I LOVE THEM!

I was thinking back to old Native American's that when they reached a point in their lives---a point they decided on----they would have a ceremony, take a blanket, go to their favorite spot in the woods, by their favorite tree, and sit down----and will themselves to die. And...they succeeded.

On the flip side of that coin, I work with a man that has had 18 -- not a typo--- heart attacks, a heart transplant, liver cancer---twice---kidney cancer and cancer elsewhere that, at the moment, escapes me. This is a man that is so brilliant that he keeps his doctors at one of the major medical centers constantly on their toes just to keep up with him and he's never spent a day in medical school. I want to say he's at least 7 years post transplant and, I dare to say, in better health...despite it all...that most people even close to his age. What do the doctors attribute this to?  His mental state. When they give him a new diagnosis, glitch or whatever there is no "woe is me". The first words out of his mouth are, "How do we fix this?"

So---the mind heals and the mind can kill. Which will ours, individually, do? That seems to depend on a couple of factors. For me, personally, God is the center of my life. He is the hub around which my life revolves. In my belief system I'll be here until He decides I won't be. However...I do have choices. I can be here as a shaking, quaking invalid with my index finger ever on a Life Alert button or...I can live each minute of my life as if it were my last---because it might be. For those who do not have such a belief system the process is not a lot different.

The fly in the ointment appears when we have things like short circuits in or brain that decide to pump out fun things like cortisol and adrenaline when a certain smell or sound or memory triggers a time when panic and/or anxiety was called for. Most of the time we are not even consciously aware of "why" we are panicking.

There is endogenous and exogenous anxiety disorder. With exogenous we only panic in the presence of a known stimuli---fear of flying, public speaking, snakes. No stimulus...no panic. However, endogenous is that total mystery disease---and, yes, it is a disease. Getting a grip on the imbalance of chemicals in your brain when you can't tolerate the medicines is, indeed, a God sized order. I stand in awe as those who make a valiant go of it on their own. I know well enough, at 67, that on my own I'd have been the old Native by now that look ago panicked myself into my grave.

I will fret over this PMT for awhile and, as long as there is no new signs of it rearing it's ugly little head, I'll slowly stop taking my pulse every 30 seconds and I'll get back to normal life. The mind is willing...it's the doing that oh so often fails.

Perhaps figuring out even half of what you had to say will distract my mind a bit. I love a challenge an you've now given me one. Again...thank you. I deeply appreciate your wisdom, your sense of humor, your knowledge and you taking the time to reflect, share and care.

My new Electrophysiologist fixed PMT

by TJ319 - 2016-12-22 11:23:41

I experienced PMT for over a year. My original EP doctor did not pay much attention to it.  He put me on a Beta blocker which was helpful for a while.  After a  year, I was experiencing PMT daily and, while not life threatening, it was very unnerving. It became increasingly difficult to sleep.  A pacemaker technician in my Cardiology group referred me to another Electrophysiologist, who took my case seriously.  He did an EP study and made major programming changes to my Pacemaker with great results.  I have been free of PMT for 1 1/2 years! It took a lot of work during that study, over 3 1/2 hours to get things right. I am very grateful for his diligence and tenacity!