Low heartbeat

Had my St Jude’s PM installed 4 weeks ago. My heart rate has stayed at 60 until yesterday when it dropped to mid 5O’s. Bradycardia due to enlarged heart and weak heart muscles was diagnosed. Should I be concerned that the PM is not doing it’s jb properly?


Is the pacemaker pacing when it should?

by Gotrhythm - 2019-07-01 15:43:33

When they check your pacemaker they can see if your pacemaker is initiating a beat (pacing) as often as it shoud.  An EKG will also show the paced beats. So it's really pretty easy to tell if the pacemaker is working as it is programmed to. 

But, here's what you need to understand. The pacemaker doesn't take over the job of causing the heart to beat. It works with the heart. So the heart has to be able to beat at what ever rate the pacemaker is programmed to. In your case, it looks like the pacemaker is doing it's job, but the heart isn't.

I'm a little puzzled by the diagnosis. "Bradycardia" just means slow heart rate or heartrate below 60bpm. It doesn't say anything about why the heartrate is slow. But I presume you got the pacemaker because you had bradycardia. So what's significant is that your heartrate is slow despite having a pacemaker.

I don't have any personal knowledge of "weak heart muscles,"  but if I were confronted with that diagnosis I would have some questions. 

I would want to know what "weak heart muscles" means. What test showed "weak heart muscles?" Are all parts of the heart weak, or just some? What are the other symptoms, in addition to bradycardia, of "weak heart muscles?" What is the treatment for "weak heart muscles?" Is there another diagnosis--other than weak heart muscles--that would account for the symptoms?

Finally, is there any way the pacemaker could be reprogrammed to help your heart have a more nearly normal beat?

Hope this helps.



by crustyg - 2019-07-05 12:14:20

A sudden drop in paced heart rate at the low end - in the first few weeks after your PM + Lead(s) have been implanted - should suggest the *possibility* that the lead has become dislodged.  There's quite a lot that you haven't provided (one lead, two leads) but from the 'doctor speak' in your post it sounds as though you have a low left ventricular ejection fraction from one cause or another.  There's no one single cause for this - could be something that will get better, or not.

You can easily buy a finger pulse-oximeter to measure your heart rate (about $20) if you don't like counting your pulse, or you can buy a little portable ECG machine (about $70-80) which can capture your heart rate, and show you the pacing artefact of your normal PM operation - or not, if the lead's become dislodged.

If you're being remotely monitored they should be calling/emailing you, but if not, perhaps time to call them and bring your six-week check forward a few days.

As a retired physician this is all bread+butter to me, but it sounds as though you need a little more information from your physian/EP and perhaps some leaflets about PMs, your heart condition and a diagnostic label.  Keep asking your medical advisors questions.  The more you show interest and understanding, the more they will be comfortable sharing with you - and if they don't then find someone better.  It's your body, your life.

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