Syncope with a pace maker

Syncope

by Gemita - 2024-04-18 13:26:10

If you are having episodes of syncope or pre-syncope, no one and certainly no caring doctor, would ever say this is okay.  It clearly is not and could lead to falls and other serious accidents around the home and in public places, potentially causing you and others, harm.

When doctors say all looks normal with our pacemakers, they are perhaps saying that the pacemaker is doing what it should be doing, that is, pacing you according to its set parameters.  They might also be saying that there are no events, like high heart rates or a dangerous arrhythmia causing your syncope or pre-syncope.  

Unfortunately blood pressure cannot be controlled by a pacemaker, nor can the reason for a blood pressure fall.  You might need other treatments.

So what is to be done if he says your pacemaker is working fine?  I suggest that you ask politely if he or your pacemaker is unable to help you further, whether he could kindly refer you for further investigations or to see another doctor to determine why your blood pressure intermittently falls and causes you such worrying symptoms?  Explain your symptoms are not acceptable and that you are concerned for your well being. 

In the meantime, please remember to keep well hydrated which will help keep your blood pressure stable.  Are you on any meds that might be dropping your blood pressure like a beta blocker?  If so, they might need reviewing.  You could also ask for another 24 hour or longer blood pressure monitor to confirm what is happening.  Above all, keep up the pressure for some answers and symptom relief.  I wish you well

Syncope

by Lavender - 2024-04-18 15:25:30

I never passed out since receiving my CRT-P, but had a couple woozy times from water intake. Once it was from not enough hydration and once it was from overwatering 🙄

Let us know what your dr says. 

bp

by Tracey_E - 2024-04-18 19:45:39

Syncope can be caused by a lot of things, but drops in heart rate and blood pressure are common. The pacer only fixes half of that problem. It'll make sure your heart keeps beating, but it can't control if your bp drops. There are meds and diet changes that can help with that half of the problem. Good luck.

BP drop

by JaneJ - 2024-04-19 01:06:32

Sometimes raising your lower rate that your pacemaker kicks in it might be enough to help compensate for your low BP.  I had a low BP after a procedure and they increased my lower base rate from 70 to 90 and that made quite a difference with increasing my BP.  Staying at 90 to long is def to high of a lower rate for long term, but if your base rate is 60, maybe raising it to 70 may make a difference with your BP....Could maybe ask your drs opinion next time you see him.  Best of luck, I hope you feel better.  It's an awful feeling to feel like your going to pass out ) :

One cause of Syncope

by Gotrhythm - 2024-04-19 13:33:40

By any chance have you been diagnosed with vasovagal syncope (VVS)? It's entirely possible to have both Sick Sinus and VVS. I do.

As others have said, the pacemaker will keep your heartrate from dropping precipitously, but it won't keep your blood pressure from dropping. Like you, my presyncopal spells happen in the morning, almost always when I'm in the kitchen (standing). Also like you, I don't pass out--I just feel really rocky for a few minutes. I keep a stool that has a back in the kitchen at all times--even though it is in the way--just so I will be able to sit down quick if I start to feel faint-y. In my case, the VVS was diagnosed after the diagnosis of SSS.

The good news, if you do have VVS, is that VVS isn't a sign that anything is wrong with your heart. It is caused by a glitch in your autonomic nervous system. The glitch causes your heartrate to drop at the very moment it should speed up. 

Having a pacemaker removes the danger that your heart will stop during a syncopal spell and may make it less likely that you will actually pass out.

About what you've read that "syncope with a pacemaker is not good." I've had a pacemaker since 2011. I'm not aware of any particular reason that syncope with a pacemaker is "not good." But let's get real: syncope under any circumstances is not good.

Timing?

by Penguin - 2024-04-19 14:39:37

I was interested in when your episodes of syncope occur.  Is there anything else happening around that time?  For example do you take any medication that may lower BP in the morning or do you wake up particularly de-hydrated and drink eat/little in the morning? 

If it's BP related and the pacemaker is trying to help, your pacing or heart rate may speed up as your BP falls and this 'might' give a clue.  

There are quite a few known triggers which may cause your veins to dilate, causing BP to fall - fear, heat, de-hydration, medication - are a few of them. 

Treatments include drugs which swell blood volume, extra salt / fluids, compression stockings and simple things like lying down, cold temperatures applied to your face / wrists, removing tight clothing and avoiding triggers. 

I'd keep pressing for the fainting to be investigated.  

Syncope

by piglet22 - 2024-04-20 05:45:48

Hello 

The short answer is that it's entirely possible to suffer from pre-syncope and full blown loss of consciousness with a pacemaker in place.

Ectopics like the ventricular ectopy I get, can "fool" the pacemaker isto skipping a beat. They are easy to feel or measure by counts at your wrist, BP monitor or oximeter.

The ectopic beats are weak and do not support a normal BP. A string of ectopics together will soon have you feeling lightheaded and end up with you keeling over.

At the time of writing, there is no PM solution.

Triggers can be relaxation or lying down.

Raising the base rate did nothing for me and perversely, the only effective treatment is to add or increase a dose of beta blockers (Bisoprolol is popular).

This leads to exercise intolerance as you fight against the BB.

Ectopics come and go and I had 18 years of CHB before they started.

As Penguin mentioned, it is a timing issue

 The PM is all about timing and like a car engine, if it goes wrong, your heart misfires.

Yes, you can get the "your device is working fine" bit, which it technically is, but they fall to add that the outcome isn't always as expected.

You might be offered a Holter monitor and that can come back as normal.

Keep your own records and don't be afraid to challenge the clinicians.

Do not ignore the symptoms as you can go over without any warning.

On the plus side, since taking a higher dose of BBs, I've  only had one episode in six months and am slowly reducing the dose.

Syncope

by AgentX86 - 2024-04-20 14:42:26

If strings of PVCs happen with no intersticial beat, it's NSVT or, if long enough, VT.  The heart is beating fast enough that there isn't time to repolarize, the definition of VT. This will show up in an interrogation as a VT episode. Yes, this could easily cause syncope (or death).  VT, and the associated Vfib, are the most dangerous arrhythmias possible, and should be recorded. If the pacemaker is set up to call home, sustained VT will set off alarms.

My pacemaker is also set up to "pace into PVCs".  If a PVC is detected, it will start a beat immediately, to make sure there is enough "juice" to make sure both ventricles get the message.  Timing for the next beat starts from that point. I don't know what happens if another PVC comes along immediately after.  I don't know if it paces into that PVC, as well.  The timer would have to be reset, though.

I've been having a lot of problems with PVCs over the last six months, peaking a month or so, when they got up to a 10% burden rate (ugh).  I only had one episode of NSVT, that only lasted a few seconds. My PM won't record any stand-alone PVCs or even bigemini.  They're too common among normal people and would fill the PMs memory, many times over, before they became a serious problem. It takes a Holter monitor or event monitor to find them.

After all that, my guess is that it's something unrelated, or perhaps tangentially related, to your pacemaker.  I'll give odds on the parasympathetic nervous system overreacting, telling the body to shut down (rest and digest). The vessels dilate, causing the BP to fall like a rock. You're still active, perhaps even in "fight or flight" (sympathetic nervous system active).  The body can't have both active at once (no oxygen when it's needed the most), and the brain shuts down. Just a guess. Not a doctor, and all of those disclaimers. 

When I had a similar problem, it turned out to be aura from an impending seizure.  Cardiologists only have a hammer and all symptoms are hit with that hammer, even if it is a screw. The seizure was an "a ha" moment. Call a neurologist, who has a screwdriver.  Now I've got nails and screws covered.  There are still other sorts of fasteners so I have to watch for things that don't fit (a good hint is when doctors start writing off symptoms to fit their nail).

Original Poster

by Penguin - 2024-04-21 04:00:05

We haven't heard back from you BR5 - how did your meeting go? 

To help me and other people viewing this thread, this link explains a bit more about some of the terminology used to describe types of PVC: https://litfl.com/premature-ventricular-complex-pvc-ecg-library/

This excerpt explains PVC 'types': 

''Bigeminy — every other beat is a PVC

Trigeminy — every third beat is a PVC

Quadrigeminy — every fourth beat is a PVC

Couplet — two consecutive PVCs

NSVT — between three and thirty consecutive PVCs'' 

When is a PVC not a PVC?

''Definitions vary regarding 3 or more PVCs

Some authors define three PVCs as a triplet of PVCs; whilst others describe this as a ‘short burst of VT’; but more commonly as NSVT

A consensus definition would be: 3-30 consecutive PVCs with a rate >100bpm described as non-sustained VT (ventricular rhythm if rate <100bpm)''