Low Heart Rate


Hello Friends,

I guess it is time to give what may be my final report on my low heart rate complaint. To refresh any memories that need it, I have been complaining since February 2007 about a heart rate that drops into the mid-40s about 90% of the time with physical activity in spite of me having a pacemaker with a low set point of 70. Then there are times when it will just up and drop into that range when I am doing nothing more strenuous than pecking on this keyboard or watching TV. So far I've under gone about every noninvasive test you can name and had three stents implanted to alleviate my problem, (For those of you that wonder, welcome to my club because I have no idea how the stents were supposed to help.)

Today I had a visit with a Physicians Assistant in lieu of the EP I've been seeing and he told me - now I am going to quote him and so help me God this is true - Your heart rate isn't really that slow. You are having PVCs and that is what you, your wife and four different electronic devices were counting." That was when I asked about the pain that occurs when the low heart beat occurs and the reply was something to the effect that your heart is not pumping enough blood meet the needs of my heart and body. I had the greatest desire to say "Einstein do you really mean that?" But my wife was sitting beside me and she gets up set when I do things like that so got a reprieve today.

He did go on to say that the only thing they could do is try to locate the spot in my heart that was causing the PVCs and then do a catheter ablation. I declined the offer. He then offered the alternative of increasing the dosage of beta blockers to try and make my heart rate go down to the low thirties and let the pacemaker take over and maintain a steady rhythm of about 70 BPM. When I said beta blockers make me feel as if I have the flue, his reply was something to the effect it is either that or continue with what you have.

So I'll live with my PVCs and quit tormenting myself by going to see that bunch at the Pacemaker Clinic at Scott & White Hospital in Temple, TX. Now don't get me wrong, I'm not condemning the treatment all of their patients have received. I have talked to several by the staff at this hospital and they are extremely pleased with the results. But about all my treatments have gotten me is misery and disappointment.

As for what my next step will be, I really don't know. I'll be 80 in a few months and maybe this just one of those things that go with getting old and you live with it or else. My wife and I will be discussing what, if any, options we have left that over the next few days.

I do thank all of you for the support and kind words you have offered over the last few years.

I wish all of you the best,

Smitty

8 Comments

your update

by Pookie - 2008-09-24 07:09:57

I sent you a private message.

Pookie

nothing but the best with your decision

by aldeer - 2008-09-24 08:09:05

Hi Smitty.... I am sure you know that what ever your decision will be is that you will be in our thoughts and prayers. Hey, 80 isn't that old... I will be 81 in Dec... and have always so much appreciated your advice in the past and will look forward to it in the future... aldeer

second opinion?

by Tracey_E - 2008-09-24 08:09:14

I'm sorry you didn't get better news! Have you thought about getting another opinion just in case someone else can come up with a brilliant suggestion?

Correction

by SMITTY - 2008-09-24 09:09:35


Hey Folks,

Let me correct something. If I sounded depressed or that I was giving up (as one of our very good friends here suggested) I am not doing either. I do feel I'm at wits end right now because it has been such a long time and was such a waste of time to see this fellow today.

I now realize that I'll have to go elsewhere to pursue this further, but I've had to travel that road before and I'll do it again. That is what I meant by Dottie and I will be looking at our options over the next few days. But since writing my message, we are now talking about probably heading for far off places next week. I can always think better and smarter over a couple of margaritas.

I thank all of you and I'll keep in touch.

Smitty

good plan

by Tracey_E - 2008-09-24 09:09:36

I'm a big believer in tequila therapy!

good for you smitty

by jessie - 2008-09-24 11:09:19

good attitude smitty. i hope you find answers elsewhere. jessie

PVC's or low HR

by ElectricFrank - 2008-09-25 01:09:36

Smitty,
With all your knowledge on the whole issue of arrhythmia's and HR I would trust that you know the difference between PVC's and low HR. It seems like the issue is how to convince the docs that you know what you are talking about.
The thing that seems strange is that the pacemakers data storage doesn't show the nature of the HR drop. If the pacemaker has a lower limit of 70 set then the only way your HR should be able to drop below 70 is if your heart isn't responding to the pacer pulse. This could happen if the pacing voltage is marginal or if a lead has come loose and is flopping around in the chamber.
When I had my episode of intermittent capture last Dec my ventricles capture threshold went up to where the pacer was on the verge of total loss of capture. We turned the voltage up to 5V at 1ms temporarily and regained normal capture. After a few weeks we were able to turn it back down. The problem was verified on an ECG.
One thought would be to ask for a Holter monitor which should show what is happening.
One other thought is that the pacer is either defective or not programmed to an absolute lower limit of 70.

By the way, I have recently started giving myself vitamin B-12 injections as a way to increase energy and mental function. Interestingly, my PVC's have dropped dramatically as well. I have no way of knowing, but really wonder if the B-12 is related. B-12 deficiency is common in people our age and affects nerve conduction. Just a thought.

Am I anywhere near on track??

frank

Hi Smitty,

by Gellia2 - 2008-09-25 10:09:24

I agree with Frank, as your pacemaker should have caught the low of 40 on your read outs. Just a thought. For what is is worth, I told my doctor that many times I could feel a "double pulse". One would be a very strong slower "thump" and then one that I was barely able to feel at all coming in between the heavy thumps. My doctor told me these were PVC's that I felt and the small teeny beat was the pacer properly functioning in between.
Is it possible that this is what you are feeling? Only your "teeny" beat isn't being felt by you at all?

I had my problem corrected by having my rate response turned off (with Frank's help - thank you Frank!) and have felt 100% better since.

A holter monitor where you record the episodes yourself may help.

Best to you Smitty. I always enjoy your very thoughtful posts.

Gellia

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I, too, am feeling tons better since my implant.