Why am I having high bpm?

High BPM

by Gemita - 2020-02-27 07:52:20

Hello Cagedliberty,

In my opinion, it is "symptoms" that would determine whether or not I raise the issue with my EP.  If my symptoms are affecting me and are a cause for concern, then yes, I would contact my EP.  

I found that for some months after PM implant I was running at high rates and having more than usual palpitations.  I put it down to trauma of implant, attachment of leads, being paced for the first time and my heart being angry with me for putting it through all this !  In fact I posted here on this site about nocturnal tachycardia.  Within a few months and with a change/reduction in medication, it became less of a problem.

Chest pain, if new, should never be ignored, that is what my doctors keep telling me and should be reported.  If it seems to be coming from the PM pocket alone, then this may be normal, although if you notice any redness, oozing from the wound area, or unusual burning this could indicate an infection.  I can still get chest pain (mainly mid central) from my arrhythmias, especially when they cause high heart rates.  I need to rest when this occurs to help bring my rates down, although my beta blocker is on the whole effectively doing this now without any input from me.

Monitoring during arrhythmias can be very hit and miss in accuracy, especially with BP monitors.  I usually manually check my pulse for irregular rhythms, speed of arrhythmia.  But on the whole I can tell when my heart is speeding and whether the arrhythmia is regular or irregular.  And my symptoms alone will tell me whether there is anything concerning going on.  If I become breathless, dizzy, get chest pain and feel weak I immediately know my heart is really struggling to pump blood to my organs.  Conversely if I feel my heart speeding up, then slowing but have no other symptoms, I can usually ignore it and carry on as usual unless the tachycardia becomes prolonged and deteriorates into an "irregular" heart rhythm.  That usually affects me and I need to slow down, lie down or fall down.  I too have syncope (swallow syncope mainly).

I was thinking about getting the new 6 lead Kardia monitor but it hasn't been fully tested for patients with pacemakers.  Some say it still works very well (if we can learn to read our own ECG).  In the meantime I follow my instinct and trust my own body to tell me when it is time to act.  Good luck

Vasovagal syncope.

by Graham M - 2020-02-28 18:30:04

As you probably already know, vasovagal syncope is not a primary heart problem, but a problem with your vagus nerve.

If the heart did not have any nerves attached to it (as in people who have had heart transplants), it would beat naturally at around 100 bpm.  In normal people, however, the vagus nerve acts on the heart to reduce the resting heart rate to about 60 to 80 bpm.  Other nerves, together with the vagus, act to control your heart rate so that it can increase and decrease when necessary.

In vasovagal syncope, the vagus nerve is over stimulated and this causes the heart rate to drop significantly (bradycardia), and it also causes dilatation of peripheral blood vessels so that blood pools in the legs.  The overall result is that there is not enough oxygen reaching the brain and you faint.  The nitroglycerin they gave you during your tilt table test was not to increase your heart rate, but to dilate the peripheral blood vessels and simulate a vasovagal episode.  They then used atropine to reverse it.

There are several triggers for vasovagal syncope, and anyone can have an episode, but some people,  are unusually prone to attacks, or may have attacks in dangerous circumstances (e.g. when driving).  Treatment is needed in these situations, and the best form of treatment is a pacemaker to prevent the bradycardia.

You may not have had anything wrong with your heart to begin with, but you now have two electrodes screwed into your heart muscle, and its not surprising that you are having rythm disturbances - it takes several months for your body to adapt to having a pacemaker.

I wouldn't worry too much about your heart rate - a resting rate between 60 and 80 is normal and 110 is not dangerously high unless it is continuously at that rate.

I have had a PM for just over 6 months now, for bradycardia due to Type 2 AV block, and for the first few months, my heart rate was quite high - 80 to 85 at rest and well over 100 after the slightest exercise. After about 6 weeks, I had an episode of palpitations that lasted for about 10 minutes and scared the life out of me. I am pleased to say that it has now settled down so that as I write this, my HR is 74bpm.

As usual, if you have any concerns, then the best people to ask about them are your cardiologist and EP.

Best wishes

Graham.