Heart block?
- by sputnick
- 2009-03-19 10:03:20
- General Posting
- 1258 views
- 11 comments
If your heart is pacing 99% of the time Ventricular but only 2% atrial, dies that mean that you have 3rd degree heart block?
Also, I have read that if your natural heart rate is 50 or below, that is pretty low. Does that mean that if you pace at the above rate that your heart is beating to slow?
If so, why was it not upped to 60 minimum at my 1st check-up last week!
I am confused!!
11 Comments
Glad I could help
by maryanne - 2009-03-19 03:03:35
Jan ....
Just a couple of other things to think about...or maybe help you understand. SSS(Sick Sinus Syndrome) by definition(taken from MayoClinic.com)"Sick sinus syndrome is the name for a group of heart rhythm problems (arrhythmias) in which the sinus node the heart's natural pacemaker doesn't work properly." and "In sick sinus syndrome, the sinus node beats abnormally causing slow heart rate (bradycardia), rapid heart rate (tachycardia) or alternating slow and fast rhythms."
In your case you mention that while you were wearing your holter monitor it registered pauses of up to 10 seconds....this can be called a "Sinus Arrest" which is an arrhythmia caused by failure in the automaticity of the SA node, which results in bradycardia, asytole, or both. In Sinoartrial(SA) exit block caused by a block in the "electrical" impulse from the SA node to the atria...resulting , like sinus arrest, in bradycardia,asystole or both. Now I am referencing the Sinus Node....when you get into AVB and all the degrees of block that is a completely different ball game, although they both relate to electrical impluses being delayed. Bascially what I am trying to say is you can have SSS(a sinus arrhythmia) with an AVB either 1 degree 2nd degree or 3rd degree.
It will be interesting to hear what they tell you at your check up....please keep us posted...and all the best!!!
Mary Anne
Pacing and 3 degree block....
by maryanne - 2009-03-19 12:03:57
There are so many variables to the settings of our PM's that it is hard to say whether you experience 3 degree block. What have they told you your intrinsic(own rhythm) is? Do you have and underlying block? I am 100% ventricularly paced and currently 30% atrial paced. My underlying rhythm is 1 degree AVB but I can have intermittent 3 degree blocks. I do not do well on the AVRI settings as it fluctuates to much for me...I feel far more comfortable with the DDRI settings and with a longer delay hence making me more PM dependant. But that is what works for me. Still need some tweaking.
As for the rate...a Sinus Bradycardia is defined as an arrhythmia originating in the SA node, characterized by a rate of less than 60 beats per minute. But many people walk around with a bradycardia and are not symptomatic at all. It is when you become symptomatic that things must be done. HR rates less than 50 generally do not promote enough cardiac out and hence the individual can become lightheaded, nauseated, or in some cases black out.
My PM is set at 50...they wanted to put it at 60 but I had them change it as my resting heart rate is generally 50 - 55 bpm....so if I let them set me at 60 it would be pacing all the time. This is what has worked for me. Everyone is different and hence the variety of settings.
Question to you: do you still feel symptomatic with the lower setting of 50? If so then yes you may want to talk to them about adjustments.
Right now for me we are doing a few things to find out what is my best setting for when I run. Hence I am going to be wearing a Holter monitor and go for a run...this will determine my theresholds, and adjustments for activity...I am really excited about this as then I hopefully will be getting the optimum use of my PM.
I hope I haven't made this sound to complicated...if you would like to leave me a message I would be happy to answer any questions I can.
Block?
by ElectricFrank - 2009-03-20 01:03:58
The 99% ventricular and 2% atrial is almost certainly and indiction of AV Block. (I don't like the term Heart Block as it doesn't describe the condition. Your heart isn't blocked, only the electrical pathway between atrium and ventricles). If you had SSS you would be pacing much more in the atrium.
Natural heart rate below 50 isn't all that uncommon. It occurs more often in athletes who have very well developed hearts. The bottom line issue is the amount of blood the heart is pumping. A low HR, but a large amount of blood each beat, or a higher HR and smaller amount per beat each result in adequate blood flow.
What happens with AV block is that the atrium continues to beat at the normal rate and responds to exercise. The ventricle doesn't get the message so beats at a fail safe rate on its own, usually in the range of 25-40bpm.Depending on the rate and the individual this may result in either feeling tired and low energy, or lightheadedness and passing out.
Fortunately, this is one of the easiest conditions to fix with a pacer. The pacer has a lead attached to the atrial wall which senses when it contracts, and then through a second lead attached to the ventricle wall delivers a small current that causes it to contract. Another way to look at it the pacemaker wires around the blocked circuit. With this in place your heart has normal rhythm and responds to exercise.
The lower limit of 50 you mentioned only has an effect if your natural HR goes below 50. Then it kicks in and keeps your HR at 50. There is also an upper limit that keeps the pacer from being able to pace you faster than its setting. If you are very active you want this to be set high enough not to get in your way.
As an example I am 79, but have my lower limit set to 55 and upper to 150. I rarely hit either one of them, which is a more natural situation. By the way the night before I had my implant my HR was Down to 26 (I have AV block) and I was still able to walk into the hospital without passing out. I jut felt lousy. With the pacer I don't have any limits on my activities other than are natural at my age.
One last suggestion. At your next checkup ask for a copy of the pre and post programming reports. They show how well your heart is responding to the pacer and what settings have been programmed. The information can be very helpful if you have any questions or problems.
best and enjoy,
frank
It's not necessarily 3rd degree HB
by JoelyM - 2009-03-20 05:03:48
It could be first degree, second degree or even 3rd/complete HB. The only way of knowing is to ask your pacing physiologist or doctor. It will have either shown up on the ECG before your pacemaker implant or they can slow the pacemaker down to look at your underlying heart rhythm.
Heart block is the medical terminology used to describe the ECG which is why people refer to it as 'heart block'.
lower rate
by Tracey_E - 2009-03-20 06:03:09
Mary Anne and Frank said it beautifully so I don't have much to add. If you have AV block, it doesn't much matter what your lower limit is because your hr is set by your sinus rhythm, which appears to be perfectly normal 98% of the time.
I have 3rd degree block and am paced 100% ventricle, 4% atrial. My lower limit is 60 but I rarely go under 80 because my atrial rate is higher than the min setting of 60, the pm is there mostly to make sure the ventricle beats when the atria does. The minimum setting is more important if you have sinus issues, such as SSS.
Understanding more!
by sputnick - 2009-03-20 06:03:13
Thanks to everyone for helping me to understand better how the heart works with a pm. I was forgetting that if you pace ok in the atrium, then your ventricle follows at that rate, not the minimum rate set (50). My higher rate is set at130. When I have checked my printout Ihave just noticed on it that most of my heartrate is 50-60 bpm, then nearly as many at 60-70 slightly fewer at 70-80 then about 10% at 80-90bpm. I'm still getting used to reading the data on it!
You should all be cardiologists or technicians you know sooo much about it all, and you xplain it so that it is easily understood. I don't know what I would do without this site, it's brilliant
Hope you all have a great weekend best wishes Jan x
You are getting good at it.
by ElectricFrank - 2009-03-21 12:03:30
As they would say at NASA "Your read back is a go".
It sounds like your settings are in a good range for you. I would normally have felt that an upper rate of 130 would be limiting, but since the chart on your report only shows activity up to around 90 it should be fine.
As for the degree of block I would agree that only the doc can diagnose that. However, my reasoning might be a bit different. Its that the distinction between them is vague and the designation is more political than medical. It has very little influence on how the pacer is set up. I'm wondering if it doesn't date back to the days before pacers and was more an indicator of how long a patient had left on this earth.
frank
hey are you me???
by Hot Heart - 2009-03-29 03:03:35
hi there, think our probs are really similar, I'm 5 months pacing now and feeling good. Perhaps I'll bump into in the chat room sometime, i'm from midlands, uk, age 55, total heart block 100% pacing.
Take care
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not sure!
by sputnick - 2009-03-19 01:03:15
Hi Maryanne,
Thanks for the reply!
I was given just ! days notice for the pm. I had been feeling lightheaded and faint occasionally for a while, and in view of the fact that my Aunt and her mum both had pm's my G.P. made an appt. for me to have a 24hr ecg monitering. When this was run through the computer it set alarm bells ringing cos my heart was stoppimg for up to 10 sec's at a time, sometimes in a run.
I haven't seen a cardiologist since my pm was fitted & weeks) but am xpecting an appt any time soon. I heard heart block mentioned, and the tech said it had SSS in my notes, but that is all I know up to now. I am still trying to understand it all and will know more hopefully when i see the specialist. I have had no dizzy or lightheaded feelings since, and feel really well in myself apart from some heavy thudding!
Jan