Pulse Oximeter Update

glad to hear

by new to pace.... - 2023-12-23 16:27:08

good that you are finally getting the better readings.  I too look at that pulse oximeter once in a while, Generally after having a food reaction or going from one chair to another.  At that point shows 84 then it goes down.

Glad you are feeling better, that really is the key to everything.

new to pace

Success with Flecainide

by Gemita - 2023-12-23 17:01:24

Forget about the oximeter, what about the Flecainide!  What a response to treatment.  You have steadied the PVCs so everything works better now and both your pacemaker and home monitors have no problem reading a steady pulse. With a steady pulse, of course everything works normally, even the patient.

How do you find the 100 mg Flecainide, twice daily.  Any side effects?  

I don’t think we can ever say with certainty that rhythm disturbances like PVCs have gone away, but we can say that they are well controlled on Flecainide for the moment.  You might still get the odd one or two but they should largely go unnoticed.  Flecainide is certainly a very effective anti arrhythmic medication for some of us

I hope these results continue.  Happy Christmas Andrew

PVCs

by piglet22 - 2023-12-24 08:43:10

Hello

Interesting to read your account as it pretty much reflects my own experiences.

In a nutshell, I was fine living with heart block plus pacemakers for 18 years until the PVCs started early this year.

This is the double whammy. You have something like heart block which is bad enough, then the ectopics come along to mess things up again.

I started to notice the odd sensations, the pre-syncope’s, the erratic pulse, the low blood pressure and eventually, the passing out and the falls.

In some ways, this was worse than the pre-pacemaker symptoms. With heart block, I just felt unwell, but hitting the floor seconds after getting up from sitting was a different story.

It's taken nearly a year to get back to some sort of normality. Normality means 10-mg Bisoprolol a day to calm the PVCs. Specifically, the consultant prefers to call the problem VE or Ventricular Ectopy.

I have two tools in the armoury at home to manage what goes on.

The blood pressure monitor is invaluable and more recently I added the self-contained pulse oximeter.

When I feel - it still happens - that ectopics are getting through, I go to both instruments.

The oximeter in my view is the least reliable. It starts well and you can see something isn't right and the figures aren't right. Even the pulse profile trace looks odd.

But after a while, it seems to get stuck and the figures don't fit with what I can feel. I put this down to its inability to average out the erratic pulse, but it certainly says something isn't right. It's the same model as the GP uses. Great for normal routine use, not so good for PVCs.

The blood pressure monitor (Omron MIT-10) fares much better, but during bad sessions, it just throws up errors. It consistently reports the low blood pressure and the heart rates well below the IPG base rate. It also correlates well with my radial pulse.

This is where you get the "pacemaker working fine" thing.

Technically, that's quite true, but it needs the additional proviso that it can't cope with PVCs.

I've given my view on this several times before and always welcome any other views.

It comes down to how the pacemaker times the intervals between pulses. To time pulses, it must have a starting point. This can be the end of the last IPG base rate pulse, or a proper AV pulse, or a PVC.

The first two work well, but the PVC is rubbish at pumping and still tells the pacemaker not to bother stepping in. You feel the skipped beat - you can't detect the PVC - you get the symptoms, but the pacemaker is working as it should.

If this interpretation is correct, then I'm surprised that we still report problems of pacemaker support when PVCs add to the mix.

I'm surprised with my rudimentary knowledge of coding that it hasn't been fixed in the algorithms.

Plainly it hasn't or you and I wouldn't be on the additional medication.

Maximum dose of beta blocker doesn’t come without it’s side effects. It can wear you down.

What I would quite like is for normal service to be restored. I don’t expect the PVCs to disappear and the medication is a stopgap.

The best hope lies with the unstoppable improvements in pacemaker processing power and hopefully its ability to recognize these abnormal patterns.

Oximeter readings

by ANDREW75 - 2023-12-24 13:38:25

Hi new to pace,

Thanks for your reply, I will also use this device sparingly. Readings are what you get from a $20 device. For my case it did not read well until I was put on Flecainide. Previous to this as with my two watches that I had to return the readings were erratic. The readings now appear very quickly. I think the result is an average of the last 5 beats or so. I no longer have to take a deep breath when standing up or going up the stairs and I now have a sense of calmness.

Andrew

Flecainide success

by ANDREW75 - 2023-12-24 14:04:01

Hi Gemita

Thank you for your kind comments, my outlook is one of relief and I can get back to being active again.

As my doctor commented, I had no side effects from the Flecainide. A few days into starting I became faint while doing a Costco shop, this turned out to be a low sugar issue, it was hours past breakfast. I fixed this in the Costco parking lot by attacking a box of pastries without shame. I have a very high metabolism. To be on the safe side my wife drove home.

The strange thing is I have never actually felt a PVC, even when the Technician showed them to me on the monitoring screen. I feel incredibly lucky to have found them and being under the careful watch of my doctors.

Andrew

Oximeter reading PVC's

by ANDREW75 - 2023-12-24 16:04:53

Hi Piglett22,

Thank you for your thoughtful comments.

So after 18 years of monitoring you suddenly attracted PVC’s. This is our “old age nemesis” catching up with us. Who knows whether caffeine, lack of electrolytes or anxiety is the cause. In my case I think anxiety plays a part, I run at 110%, slightly higher than most. Did you suddenly give up bananas or increased coffee consumption? With all medical monitoring I find it difficult attributing cause. In your case you have Heart Block, but did you suddenly start falling coincident with new PVC episodes?

I think you said in a past post you had a very high PVC burden 2,400 per day. It’s a mystery why you had falling down episodes and I had none with 9,400 per day with my Linq monitor. Perhaps the following link might shed some light as to the different types of PVCs.

https://www.ccjm.org/content/83/7/524

We can only trust our meds, you with Bisoprolol and me with Flecainide, when my doctor said to “try” this prescription, I thoughtfully considered myself a “lab rat” for a split second.

I was surprised when my Oximeter started working properly, unlike your's it responds after 5 or 6 pulse average readings. I can repeat this over and over, and verify with my BP monitor. I also do this at different times and daily activity, a little science is applied. I was on the verge of giving it away.  

I can see your frustration in both your pacemaker and equipment. I see you are an engineering tinkerer. I am an electronic packing designer, isn’t it difficult having a questioning mind, we are never satisfied with answers? It might be a tall order to expect a pacemaker to correct PVC’s, but then again I saw first-hand the technician turn them off. I knew they were still present but just not displayed. The need for an “arrythmia ignore” patch is probably in research presently. The more I read the more complicated it gets. Yesterday I discovered how the “Purkinje” network works, too much information I think.

I don’t like taking drugs either, my wife takes Metoprolol a sister drug to your Bisoprolol. As far as my taking Flecainide I am looking forward to my EP’s comments in February.

Thanks for chatting, happy holidays

PVCs

by piglet22 - 2023-12-26 05:22:18

Hi Andrew

I always prided myself on carrying on life as normal despite the rather alarming diagnosis of heart block.

Very active, regular cycling, hardly noticed any difference with the pacemaker in place.

Then came the PVCs.

Absolutely nothing to attribute it to. No changes whatsoever.

The information that I even had ectopics didn't come from the cardiologists directly but had to be dragged out of them by the GP.

This reflects the breakdown in the pacemaker service which might be hard to appreciate if you are used to regular personal contact with the technicians or even a consultant.

For nearly 10 months, I had nothing of any use from cardiology and despite tests and promises, have had nothing. No results, no Holter.

Only the Bisoprolol which may now be making life difficult by suppressing my heart rate to the point I struggle up hills I never gave a second thought to before.

You said earlier that you couldn't feel the PVCs. That's the point. They aren't doing anything other than interfere with the pacemaker. You will feel the effect in your pulse and occasionally the floor.

Your burden at 400 per hour is a lot. Mine at 100 was described as significant. 

It depends how and when that average is delivered. I certainly felt the effects almost immediately after relaxing.

The reality irritating thing is that cardiology must have known but took a chance by by not telling me.

You'll probably gather that I don't think much of how the service has been cut to the point where they don't even phone you after they request a download of data once a year.

Regards the oximeter and BP monitor.

Both are useful and essential parts of being a cardiac patient.

They, including the cheapest ones, work well when things are normal, but struggle when they aren't.

But they will still tell you things aren't right. It doesn't surprise me that your oximeter is working again.

I think you mentioned a figure of 84. I'm presuming this is 84% saturation.

That would worry me and I've been on oxygen for higher levels than that.

I would certainly be getting that checked out.

The Bisoprolol isn't affecting my oxygen levels, but it possibly is affecting the delivery.

What I don't understand is why the pacemaker struggles with PVCs at all.

There must be a signature signal or waveform that distinguishes PVCs from a normal signal and could be used to filter out PVCs, but that might be pushing current capabilities.

Here's another irritation.

The cardiologist prescribed 10mg Bisoprolol, maximum recommended dose according to the leaflet, but no-one has bothered to do a follow up on how it might affect me.

As another contributor here said, it's benign neglect.

Good luck with your own condition.

PVC's hopefully gone.

by ANDREW75 - 2023-12-26 18:26:15

Hi Piglett22,

                   I am getting back to normal myself. I followed my EP’s orders exactly for the first five weeks or so. I am  12 weeks behind with yardwork and have procrastinated with just about everything that I had to do.

I have done loads of reading however and feel happy with my research. I backtracked my hospital records to find my low pulse started in 2022 with no record before then. One of the heart tests this time referred to Sinus bradycardia with 1^st degree AV block as well as Incomplete right bundle block. I don’t know how to interpret this, and will leave this with my EP.

With my reading, I agree I had a large number of daily PVC’s, these were last stated as % at 25% of the whole count of heart beats. According to the article I attached in my last post this rather high as you stated. and treatment should be enacted. (it was with Flecainide). I am sure my EP also took note when I stated I had no symptoms and no knowledge of my PVC’s, unlike yourself.

Since my 9,410 bpm was mentioned, I have had a pacemaker which reduced the PVS from 36% to 25% and now with this new drug I am hoping to reduce this to less than 10%. I feel really good these days, and hoping to get back to windsurfing this May. By the way re the Oxygen reading of 84 this is not me, mine is in the mid-nineties for the most part.

I really hope the NHS situation improves, I have a niece who is a GP, and we hear horror stories that make you shudder.

Happy New year Andrew