The Paced heart

I'm an A-V Node ablated dude w/pacemaker................recently, I noticed that after taking my AM dose of carvedilol (6.25mg), I feel sluggish and tired. BP hangs around 80/56 pulse 58.  PM is set for a mid-80's pace...................shouldn't it come into play?  In other words...........can a beta blocker like carvedilol create a bradycardia event regardless of what the PM is programmed to do?



Something isn't right

by AgentX86 - 2019-05-13 15:46:34

Did you check you pulse rate manually? PVCs? You should send your EP a remote interrogation and see what he has to say about this.


by Dave H - 2019-05-13 16:01:40

Yes, I check my pulse manually, and the PVC's are there.  Usually, I can feel the weak bigeminy "pulse" between the stronger beats but, this AM, I couldn't.  Just a slow 50 BPM. I noticed the pattern of within an hour of dosing the carvedilol, this type of event erupts. Can a drug override a PM setting?  Sent out a couple messages to EP and other cardio guy  --- haven't heard back yet.  Slept well last night, felt great upon waking, had breakfast, then took my AM meds and the BLAHS showed up!  Maybe a test tomorrow, if I don't hear back from anyone ----I'll skiip the carvedilol dosing.



by ROBO Pop - 2019-05-13 19:48:53

I'm just guessing but suspect you haven't heard back from the doctors yet because they can't stop laughing.

Don't you think its unreasonable to think a medication is affecting the performance of a pacemaker.

As spy man said download an interrogation to the dr. I fully expect you are relying far too much on your skills as a nurse. My Cardiologist once told me even doctors have a hard time checking the pulse of psced patients

I don't see how

by AgentX86 - 2019-05-13 19:57:21

I don't see any way drugs, any drugs, could affect your heart rate. You're paced VVIR, I'm sure, so your sinus node has nothing to do with it. I could see how bigeminy could half your measured or perceived rate but you seem to have that covered. I'd be transmitting data to my EP, pronto. Something is wrong. It's like your PM isn't working and an escape rhythm has taken over. This wouldn't be good. I'm really surprised that you doctors haven't gotten back to you. I'd be camping in their living room. This one would freak me out.

Please let us know how this turns out. At the minimum, you have a teachable moment here (you seem to have a lot of them ;-). I'm stumped, that's for sure.


by Dave H - 2019-05-13 22:36:17

Yeah, it's been 12 hours since messaging my Docs with no respnse.  Where do I check my pulse? Wrist? - Nope...............Both carotids and both popliteals. Matter of fact, I'm in a brady thingy right now. Finger on crotid shows a 48 pulse, BP device shows "ERR" - (bigeminy in action).


Atrial voltage low ?

by marylandpm - 2019-05-14 08:49:26

  Could your atrial lead voltage set to low and it's not pacing.  It happens. 

call them again

by Tracey_E - 2019-05-14 10:11:37

Either your lower limit isn't what you think it is or you have a lead not pacing. If you have a home monitor, send a download. 


by Dave H - 2019-05-14 13:30:06

From my device clinic nurse: "The only entity that can change your PM rate control is ME!  - But PVC's and PAC's can cause the rate to drop." 

I'm curious..can PVC's be so sutle as to be somewhat undertectable when one is checking their pulse?


PVC's and PAC's are the culprit

by Swangirl - 2019-05-14 13:56:45

When you are throwing PVC's and PAC's the PM sometimes registers these as a beat and doesn't activate.  In my case my rate response can also be affected negatively.  To get to the bottom of it my cardiologist and St. Jude rep worked together with me on the treadmill to see what was going on.  


by Tracey_E - 2019-05-14 14:45:35

It's entirely possible to have PVC and PAC you can't feel to count. 

Bigemini will do it

by John@PC - 2019-05-23 14:31:43

When I have bigemini my resting heart rate (measured by Oxymeter or BP gauge) is always 47 (I'm set to a lower limit rate of 75). If you're LLR is mid 80's a resting pulse rate of 58 sounds about right if you're having bigemini or very frequent PVC's.  

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Today I explained everything to my doctor, he set my lower rate back to 80 and I felt an immediate improvement.