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confused!!
I have a single chamber boston scientific PM and I wasn't feeling the best at work the other day so since I work in a hospital I was able to hook myself up the tele montior. My settings are set at 60/130 but what I don't understand is I thought that it would only pace if I went under or over my settings but it was pacing 100% alot of the time even if my heart rate was in the 70s and a couple of times my rate was 130 and even 150 once for a short time. Anyone have any suggestions?
3 Comments
PacerRep
by daisy0388 - 2012-09-20 10:09:28
The tele monitors that we have at work on the screen one of the options that we can click on is so we can see how much is being paced, it gives a percent, most of the time it was 100 but sometimes it might be 10, 50 or other numbers and it also shows when you have pvcs it acutally counts them, at one point when my heart rate went up i had 30 pvcs
Try this as an...
by donr - 2012-09-21 03:09:24
...explanation of why you are being paced nearly 100% while the monitor shows 70 BPM & your lower rate is 60 BPM.
There is no Santa Caus, Easter Bunny, Tooth Fairy or Heart Rate. Sorry to have to be the one that tells you that at such an early age. Please don't tell all your little friends, we don't want them to be disappointed, do we?
Having a true Heart Rate would imply that there was some nice, periodic wave generated in your SA node that the heart followed in beating. T'ain't what happens. In actuality, each & every beat is an individually timed event, w/ the timing coming from the SA Node. It is a tribute to the accuracy of all the many events that are required to generate a heart beat that the variability beat to beat is as low as it is. we are talking milliseconds variation - that's pretty darned small!
Your PM paces at the rate the heart is working w/in the boundaries of your upper & lower limits. If your heart is beating at 70 BPM because that's what the body demands, the PM is adaptable enough that it follows. Suppose for example, that your heart was pumping along at its upper rate very nicely at 130 BPM & your PM sensed that a beat was going to be missing. It would try to insert a pulse to trigger the missing beat - IF it only worked at the lower rate of 60 BPM, it would try insert its signal 1 beat too late because the heart is going twice as fast (roughly). This supposes that your RR is not fuctioning to drive the PM.
The PM functions the same way the heart does - it times things for each beat independently. It will sense the various waves that make up the trace on an ECG & it starts timing from when it senses one & if the appropriate next event does not happen w/i its prescribed interval, it provides the signal. F'rinstance -the PM senses a P wave; it starts counting time & if a QRS complex does not occur w/i the appropriate time interval, it sends a signal to initiate one.
So, back to your reality: If your heart should be pumping at 70 BPM, it may be malfunctioning "a lot of the time" & generating a near 100% pacing rate for short intervals of the time, requiring a signal from your PM. From your description of varying percentages of PM functioning, it sounds like either your SA node is sick & not being accurate in its repeatability OR your AV node is not giving you accurate repeatable delays for firing the ventricles. You did not say which lead you have so I had to guess. Sorta sounds more like an AV node malfunction to me.
Don
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Need more info
by PacerRep - 2012-09-19 11:09:27
The easy answer is that you have rate response turned on. Do a search on this site there is a ton of information about it. But my question to you is, how do you know you are pacing 100% of the time? Can you tell the difference between a paced beat and an intrinsic beat on the monitor?
How short was the "short time" if it was just a second or 2 then you probably had a PVC and the monitor read it as a fast rate momentarily.