Missing beats, early morning.

I am starting this new thread because I didn't want to hijack Lavender's thread below. However, Gemita's response to Lavender touches on a subject that I have woken up worrying about - a coincidence!

Just recently, I have noticed that when laying half awake in bed in the morning, I can hear my heart beating - a shushing sound in my ears. I am not worried about this, but the rhythm I am hearing is unsettling.

After about 10 or 15 beats there is a definite pause before the next beat arrives. As you can imagine, it grabs my full attention. I have not checked this out with my heart-rate monitor to get a fuller picture, but I will.

My question is, could this be a consequence of my night-time HR falling below the 50 bpm minimum set on my PM and the PM intervening? Would such an intervention manifest like that? I wouldn't have expected a delay if it was trying to raise my HR.( For info., I have complete heart block but my sinus node is competent. The PM operates in DDD mode.)

I have searched the forums but could not find this precise issue.


Missing beats

by Gemita - 2024-02-10 05:37:24

Dear Repero, how thoughtful to start a new thread.

The symptoms you describe are familiar to many of us and they can be unsettling, especially when these irregular heart beats continue for long periods and start to cause chest discomfort, breathlessness, dizziness or other symptoms which confirm that the heart rhythm is adversely affecting cardiac output.  One skipped or pausing beat may go unnoticed for many of us, but when these beats become more frequent they can indeed start to cause difficult symptoms which may need treating.

I am not confident that a heart rate monitor will always successfully give an accurate picture of what is going on in the presence of ectopic beats, although a good BP monitor can tell us whether our blood pressure is also affected by heart rhythm disturbances.  I would keep an eye on oxygen levels too and make a note of any symptoms.  I usually feel my neck pulse to confirm the slowing, pausing, irregular heart beats and to get an idea of the speed at which they are coming in.

Yes this could be a consequence of your night time HR falling below the 50 bpm minimum set but your symptoms are not due to the PM intervening, but due I believe to an irregular rhythm, like an ectopic beat which is often triggered either when we are at rest or exerting ourselves.  We don’t usually feel our pacemakers “kicking in”, but we do feel our irregular heart rhythms pausing, skipping, stopping, racing.  I call them my short-long-short thumping beats and they can be difficult to tolerate.

The solution?  Some find raising the lower rate limit helpful, perhaps even as little as 5+ bpm.  I would get electrolytes checked and ask for other bloods to be checked if these disturbances continue or become prolonged.  Make sure you stay well hydrated "during the day".  You may be dehydrated at night which can trigger heart rhythm disturbances.  Above all, please try not to worry about these beats since any stress can make them worse.  They are normal for us all but when they become more frequent or cause difficult symptoms, we may need to control them.  I would speak to your doctors to rule out conditions like sleep apnea, thyroid, electrolyte abnormalities, or ask your team whether your settings need adjusting if your symptoms continue to cause concern?  

Update:  Unfortunately pacemakers are not able to treat abnormal heart rhythms, only slow ones.  Ectopic beats can adversely affect pacemaker timing and can also be responsible for triggering some abnormal heart rhythms, so difficult symptoms should be reported promptly

Resting HR

by piglet22 - 2024-02-10 06:02:48

Again from personal experience with ectopy, if the PM isn't maintaining the base rate and you don't have other rates programmed in, you should not be experiencing what you feel as missing beats.

What I can confirm, though, is whenever I experienced rates below the base rate, it would be either when relaxing or in bed.

If I went to get up from sitting, I had to judge by my pulse when to stand up.

When it was really bad at night, I was apprehensive of falling asleep.

Probably the best course of action is to keep a record of when these events happen and check your rate with a decent BP monitor.

sloshing in the ears

by new to pace.... - 2024-02-10 07:25:00

The ears i can answer, as i was having a similiar problem with my ears.  In fact was also having a hard time hearing.

One morning after cleaning my nostril a drop of blood appeared.  Since i take the supplement for blood thinner was concerned.  Contacted the ENT where he cleaned out my sinuses.  After that could hear better and the sloshing and full feeling in my ears disappeared.

new to pace

Missing Beats

by H van Dyk - 2024-02-10 07:27:25

If I were you I would not worry about the sound in your ears. I think many of us 'suffer' from this. Another matter is your heart skipping beats from time to time. It might indeed help to increase the minimum bpm. Normally this is set to 60 (default). A betablocker like Metaprolol might also help to make your heartbeat a little more stable.

A good thing that the Sinus node is ok. This means that you are not fully dependent on the pacemaker. In case the unit would stop working (for whatever reason), you still have your own heartbeat. It will be somewhat slower, but will give you time to go to a hospital. 


by Repero - 2024-02-12 05:21:51

Thank you all for your contributions here. I am trying to drink more water, in case that helps.

I seem to be noticing that the frequency of ectopics is higher at times when I am experiencing slight abdominal discomfort with wind (stomach gases - to be brutal!) Could there be any logic in this?

Good point

by Gemita - 2024-02-12 05:46:43

Repero, thank you for bringing us back to other factors that could be involved and yes, a gastric cause is exceedingly common and more than possible.  There is a strong gastric-cardiac connection via the vagus nerve.  Gastric causes are my number 1 triggers for my rhythm disturbances.  I attach a link:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7747581/#:~:text=Gastrocardiac, also known as, Roemheld,be related to cardiac symptoms.

I have oesophageal disorders which cause disordered swallowing and high pressure contractions and this can quickly trigger arrhythmias and prior to my pacemaker, a loss of consciousness.

Keeping well hydrated will help with any gastric discomfort

Settle for that

by Repero - 2024-02-12 14:37:35

Thanks again Gemita. I am pretty convinced that vagus nerve pressure is behind it. My own doctor said that this can happen when I went to him some years ago (pre-PM) with mealtime palpitations. I will relax and stop worrying about it unless it gets a lot worse.

So sorry to hear about your oesophageal disorder. That sounds very difficult to deal with. I am glad that the PM has at least removed a big risk factor for you.

Normal... for me.

by R2D2 - 2024-02-14 13:23:53

I have NO idea what is normal for everyone else, but I get missed beats every day, sometimes for an hour or two at a time. It's draining and makes me feel very lethargic, not to mention the stress from it. My doctors don't seem to care about it though, as I've mentioned it multiple times and they never really even respond... like it's just part of the condition. 

I don't seem to have the options that others do with their devices, like having them change the rate or anything. They set it at 60/130 and that's where it will stay. As for my heart skipping beats, well... I've become so used to it that when it doesn't do it, I'm shocked. Lately it seems to have improved since I started taking more Carvedilol so hopefully I will feel less of those pesky missed beats and get some strength back. 

Keeping your electrolytes in check is super important though. Make sure you get plenty of water each day because my heart will definitely get all "wiggy" when I am not drinking enough. Don't eat larger meals either, that seems to make my heart upset. You will find out the "triggers" for your heart condition, and when you do, follow your body's lead. Do what feels the best for you. It's different for everyone. 

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