Questions for my Cardioligist

Pacemaker Questions for “Docky” and “Tim the Tech”.      Feb 5th 2024. 

DDD-CLS -                   Take Thumb drive.

Hi everyone, I am hoping to get an appointment before Christmas to get my very first adjustment, I do not want to wait till February. Are these questions phrased correctly? I am new to all the terminology. Any comments would be appreciated. Thanks Andrew

1/      Do I have Sick Sinus OR Heart Block OR both?

2/      Are all my PVCs “married” to my Low Pulses?  Ref: 36% findings for both.  

3/      If this is so, perhaps means my 30bpm pulse Bradycardia increase to 60 bpm min will fix some PVCs, Yea.

4/      After 4 consecutive days of attempting Cardio runs and failing I felt terrible and took a whole day to recover. I believe I am “hitting the wall”. I eat well before exercising so do not think this is glucose depletion. I do not get lactose spasms, just leg weakness.

5/      Do I have Chronotropic Incompetence? This definition describes my recent cardio intolerance well. Ref collapsing after ½ jog around a football pitch. Also before Pacemaker last summer “Exhaustion story summer 2023” and recent “Exercise log”. OR

6/      Does my max pulse setting need increasing higher than 130bpm?

7/      What does “% paced Atrium and Ventricle” mean? Is this a CLS setting or my body? Is this important? Just for interest.

8/      My Rate Response included in CLS mode is “Medium”. I seem to have a lag and have to take more deep breaths than usual. If this was increased would it solve my maxed-out exhaustion issue? OR should my upper rate 130bpm be increased?

9/      What is Rate Adaptive Pacing? Just for Interest.

Since Pacemaker installation viz:

Incision much improved and flattening out, a little itchy at 9 weeks.

Cardio Intolerant. Max out at 130 bpm as above.

Much better sleeping, I wake feeling refreshed without fuzzy head and less body aches. Ref more Oxy with min pulse at >60bpm, regenerative body and brain repair perhaps.

Low - Med Yoga and Exercise machines and swim, I am OK with, no problem.

Don’t relish Ablation or Chems.. Can I fix with Lifestyle and Diet?

Relate trip Thanksgiving trip altitude issues 5,800 FT.


7 Comments

questions

by new to pace.... - 2023-12-02 15:21:28

You have to many questions.  You should narrow them down  to may be 5. Some of your questions would be answered from  your 3 month remote transmission report.  At that time would be good to ask  some of those questions.

new to pace

Q's for Docky

by ANDREW75 - 2023-12-02 15:28:50

Thanks new to pace, I agree too many, I can delete two "Just for Interest Q's".

I have a Biotronik pacemaker. What is a "three Months remote transmission report"? please. I take a thumb drive to get my report.

Thanks

3 month remote transmision

by new to pace.... - 2023-12-02 16:52:29

I have Medtronic and they gave me a bedside monitor.  Does send nightly checks and so the heart center can get paid  by  medicare a quartely one is done.  I contact the heart center and ask for a copy of the report with the log events and summary page.  It tells me how many episodes  of AF, Vf  etc. what type and the log events has the time and duration.  Along with battery life remaining.  Percentage that i use the pacemaker.  the low  rate and high rate.  Does have graphs but i do not understand them.  So just ask for the log events.  Does not give me all.  So the total does not match the few that are on the log report i get from them.   From that information i can base my questions or concerns. 

I do sometimes jot down when i think i might have an AF episode as for me sometimes happens when i have a food reaction.

Some people use their phone app. for all this , bluetooth stuff.

If i need to can call an say am sending a transmission if i have a concern about what is happening.  One time they wanted me to send a transmission cause they saw something.

I go into the heart center once a year and they then download all that has happened for the past year.  Also look to see if the wires are still good.

new to pace

Questions for your doctors

by Gemita - 2023-12-02 19:34:45

Hello Andrew,

I give below my version of your questionnaire for “Docky” (your Electrophysiologist (EP) - a cardiologist who focuses on treating problems involving irregular heart rhythms).  I have left your comments mostly intact:-

1/      Do I have Sick Sinus Syndrome OR Heart Block OR both? 

2/      Are all my PVCs “related” to a slow pulse?  Ref: 36% findings for both.  (Andrew, PVCs can be triggered by a slow heart rate or by exercise or by some health conditions like a thyroid problem, electrolyte disturbances.  Increasing our lower rate limit and heart rate can most definitely help overdrive pace the slowing, pausing PVC heart beats).

3/      If a slow pulse is causing PVCs, would increasing the lower rate limit to 60 bpm help?  (Andrew with a pacemaker you shouldn’t be getting low rates, not even at night.  This setting would be too low, even when we are at rest.  Did you really mean 30 bpm?  It looks as though your lower limit might be set at 60 bpm and yes, this higher rate should help treat PVCs).

4/      After 4 consecutive days of attempting Cardio runs and failing I felt terrible and took a whole day to recover. I believe I am “hitting the wall”. I eat well before exercising so do not think this is low glucose. I do not get lactose spasms, just leg weakness.  Is a pacemaker setting causing this?

5/      Could you please confirm whether I have Chronotropic Incompetence? This definition describes my recent cardio intolerance well. Ref collapsing after ½ jog around a football pitch. Also before Pacemaker last summer “Exhaustion story summer 2023” and recent “Exercise log”. OR

6/      Does my Upper Rate Limit setting of 130 bpm need increasing?

7/      What does “% paced Atrium and Ventricle” mean? Is this a CLS setting or my body? Is this important? Just for interest. (Andrew % paced Atrium and Ventricle is the % time the pacemaker paces us in the atrium or ventricle.  Your % upper or lower chamber pacing will be the amount of time you need pacing support due to your heart condition.   Some members may need pacing in both the upper and lower chambers.  I am paced 100% in the atrium due to Sick Sinus Syndrome.  Some members may even be paced 100% in the upper and 100% in the lower chamber.  How we feel is what is important, not those percentages).

8/      My Rate Response included in CLS mode is “Medium”. I seem to have a lag and have to take more deep breaths than usual. If this was increased would it solve my maxed-out exhaustion issue? OR should my upper rate limit of 130bpm be increased?

9/      What is Rate Adaptive Pacing? Just for Interest.  (Andrew, Rate-adaptive/responsive pacing adapts the pacing rate to changes in the patient's physical activity.  An activity sensor is used to measure the patient's movement and to determine the appropriate pacing rate.  It can be difficult to get this optimised for our personal needs).

I see you don’t want an ablation or to take medication and asked whether you can fix your heart condition with lifestyle and diet.  How about fixing with the pacemaker if you have simple Block or Sick Sinus disease?  It looks as though you have the latter.  Arrhythmias?  These cannot be fixed by a pacemaker although optimal settings and lifestyle changes can certainly help.  I am on minimum meds and chose not to have an ablation for my arrhythmias. 

What altitude issues did you have Andrew at 5,800 ft?  That is extremely high.  Where were you?  High altitude triggers my Atrial Fibrillation.  I am glad your yoga and exercise machines and swimming cause no real problems.

Agree with new to pace.  Beware of long lists.  You might put your doctors/technicians off.  Better to take a few questions and to get them “well answered” rather than coming back with all your questions “poorly answered”.  Hope you are doing well otherwise and that you will not be disappointed in your first meeting with your EP.  

Newtopace and Gemita

by ANDREW75 - 2023-12-02 20:52:11

NewtoPace, Gemita

 Thank you so much for the long and informative answers, I can reduce my questions and make them concise.

Regarding the Home monitoring I am also monitored daily, and the results go directly to my Cardio Dr. I believe he bills Medicare. Presently I have a 20-day pdf report that Tim the tech gave me. I am really impressed with it having been involved with documentation all my working life.

I looked into the Patient Apps from Biotronik, two are available for apple iPhone and Google.

First glance I notice conversation between Dr and Patient is available. I will see if this is feasible with my Dr. if needed.

As far as my monitoring at this point I do not know what to ask for. I would like to see real BPM and not corrupted as with my finger pulse Oximeter. I would also like to see the reduction of Pesky PVC’S, wouldn’t we all?

One of the Biotronik apps had low reviews and I moved on.

Both you and Gemita have given me “overload”, I need to sit down and respond to your comments with a beer.

Kiding apart I will answer you both, and I think you are right I need just one question. “Why do I need a pacemaker”?

I’ll have the shortened list ready in my back pocket. My Dr and his side kick Tim are especially fun people, and we tend to wonder of to other topics like the stock market, bike riding and Golf!

why do you need a pacemaker

by new to pace.... - 2023-12-02 21:02:16

generally one gets a pacemaker if your heart beats slowly or is below 60 beats a minute. Or you have pauses.  I got my becuase i had pauses and at time it would beat slowly.  Also i would fall.  Discovered it was from the pauses.  Since my pacemaker implanted no falls and beats regularly. 

You might ask a different question maybe why you had problems with the change in the elvation.  or number 3 in Gemita's answer to what you should ask.  I have never seen my EP since my implant.  Have a yearly visit with my cardiologist.

new to pace

Revised Questions for my EP

by ANDREW75 - 2023-12-03 02:24:08

Pacemaker Questions for “Andrew’s EP” and “Tim the Tech”. Feb 5th 2024. 

Biotronik DDD-CLS, with Adaptive Rate Response turned on.                      

Andrew’s questions for his EP

Hello Gemita, thanks for highlighting everything, I am learning as we speak! From now on its “EP”. I have narrowed the list down to six questions with some chit chat if time permits. Doingmybest has also helped with a long post to my private message. Both your help and New to Pace is really appreciated since I am in a hurry and want to go windsurfing next May.

Gemita: I give below my version of your questionnaire for  (your Electrophysiologist (EP) - a cardiologist who focuses on treating problems involving irregular heart rhythms).  I have left your comments mostly intact:-

1/      Do I have Sick Sinus Syndrome OR Heart Block OR both? 

1/      RECOMPOSED: Why do I need a pacemaker? As best described what are my issues? Do I have Sick Sinus Syndrome OR Heart Block OR both, or another condition? 

2/      Are all my PVCs “related” to a slow pulse?  Ref: 36% findings for both.  Gemita: (Andrew, PVCs can be triggered by a slow heart rate or by exercise or by some health conditions like a thyroid problem, electrolyte disturbances.  Increasing our lower rate limit and heart rate can most definitely help overdrive pace the slowing, pausing PVC heart beats).

2/     DELETED, I agree they don’t seem related, my 36% comment is confusing!

3/      If a slow pulse is causing PVCs, would increasing the lower rate limit to 60 bpm help?  Gemita: (Andrew with a pacemaker you shouldn’t be getting 30 bpm, not even at night.  This setting would be too low, even when we are at rest.  Did you really mean 30 bpm?  It looks as though your lower limit might be set at 60 bpm).

3/   DELETED Also confusing 30 bpm was before Pacemaker. Low setting is now 60. Low Pulse and PVC’s are not necessarily concurrent.

4/      After 4 consecutive days of attempting Cardio runs and failing I felt terrible and took a whole day to recover. I believe I am “hitting the wall”. I eat well before exercising so do not think this is low glucose. I do not get lactose spasms, just leg weakness.  Is a pacemaker setting causing this?

4/        Stays

5/      Could you please confirm whether I have Chronotropic Incompetence? This definition describes my recent cardio intolerance well. Ref collapsing after ½ jog around a football pitch. Also before Pacemaker last summer “Exhaustion story summer 2023” and recent “Exercise log”.

5/        Stays

6/      Does my Upper Rate Limit setting of 130 bpm need increasing?

6/      DELETED, covered in other questions.

7/      What does “% paced Atrium and Ventricle” mean? Is this a CLS setting or my body? Is this important? Just for interest. Gemita: (Andrew % paced Atrium and Ventricle is the % time the pacemaker paces us in the atrium or ventricle.  Your % upper or lower chamber pacing will be the amount of time you need pacing support due to your heart condition.   Some members may need pacing in both the upper and lower chambers.  I am paced 100% in the atrium due to Sick Sinus Syndrome.  Some members may even be paced 100% in the upper and 100% in the lower chamber.  How we feel is what is important, not those percentages).

7/     RECOMPOSED:  Does my body choose the % pacing or is this a pacemaker setting. I see the graph on page 12 shows a 24-Hour period Aorta paced dramatically 12% to 99%  while Ventricle  hardly at all. Does my pacemaker respond to demand?

I MIGHT DELETE 7/ ALSO since it is obvious my body demands the % it needs, and I discovered the graph. Thanks Gemita.

8/      My Rate Response included in CLS mode is “Medium”. I seem to have a lag and have to take more deep breaths than usual. If this was increased would it solve my maxed-out exhaustion issue? OR should my upper rate limit of 130bpm be increased?

8/ Stays

9/      What is Rate Adaptive Pacing? Just for Interest. Gemita:   (Andrew, Rate-adaptive/responsive pacing adapts the pacing rate to changes in the patient's physical activity.  An activity sensor is used to measure the patient's movement and to determine the appropriate pacing rate.  It can be difficult to get this optimized for our personal needs).

9/ Stays. This sounds more important than I thought and might be my area of concern!

Gemita: I see you don’t want an ablation or to take medication and asked whether you can fix your heart condition with lifestyle and diet.  How about fixing with the pacemaker if you have simple Block or Sick Sinus disease?  Arrhythmias?  These cannot be fixed by a pacemaker although optimal settings and lifestyle changes can certainly help.  I am on minimum meds and chose not to have an ablation for my arrhythmias. 

Andrew: I imagine one day I will have to have an ablation, for now I will forget it and get the Pacemaker tuned.

Gemita: What altitude issues did you have Andrew at 5,800 ft?  That is extremely high.  Where were you?  High altitude triggers my Atrial Fibrillation.  I am glad your yoga and exercise machines and swimming cause no real problems.

Andrew:  My wife and I had a Thanksgiving trip to a wonderful Lodge in Yosemite National Park, booked up before I was paced. This turned out to be 5,800Ft (Same as Denver CO). I immediately got short winded  just pushing the suitcases and  opening our room door was an effort. It got better on the third day. I will mention this if time permits.

Gemita:  I agree with New to pace.  Beware of long lists.  You might put your doctors/technicians off.  Better to take a few questions and to get them “well answered” rather than coming back with all your questions “poorly answered”.  Hope you are doing well otherwise and that you will not be disappointed in your first meeting with your EP.  

Andrew: The list is now shorter, but I will take advice re the new settings if any change.

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