need advice please confussed :(

Hi everyone not been on for a while been ticking along nicely but im struggling to get my head round my little pacer friend im fine but on and off when im using the gym especially the cross trainer i get fluttering and bouncing in my chest that catches my breath my heart feels like it gets out of rythem i slow down and it passes so when i get going again some times it can return or disappears i did get this on and off but not as bad before my pm. ive got second degree block with slowing and pausing thats what the pm was inplanted for. Now i rang pacing clinic today and asked what my settings were set at and she said lower 60 upper 130 DD mode i use the pm on demand and dont need RR as my heart rate can climb on its own should my upper limit be higher seems low to me for someone quiet active and how does the 60 to 130 threshhold work am total confused can anyone shine a light on how this lot is supposed to work???

thanks Kimbo

4 Comments

Re

by billylittle - 2013-07-17 05:07:19

I was doing the same thing. A interrogation of my PM shown PAC's. Dr prescribed Atenolol and has helped some. I am set at 70 to 150 with rate response on.

A wild Guess based on...

by donr - 2013-07-17 07:07:00

...incomplete data:

Kimbo - you are asking all of us to GUESS what is happening to you. You did not tell us what your HR is when it starts to "Flutter." You talk about being "...quite active..." but who knows what that is?

Here's what it SOUNDS LIKE to me: You get on an elliptical & start working out. Your heart can apparently increase its rate by itself, so it does so as you increase the load on it through vigorous activity. You hit the top & perhaps go over it in HR, meaning that your PM starts working in 2:1 pacing since the ventricles cannot follow the Atria at extremely high rates. What this means is that the PM starts monitoring the Heart pulses & only sends a pacing signal to the ventricles every other one. NOW this ASSUMES that your PM REALLY is set in the DDD Mode, meaning it monitors & inhibits both chambers. (You said DD Mode in your post.) Apparently, you instantly sense that something is going wrong & slack off on your exercise, allowing the heart to slow down because you do not demand as much oxygen to the muscles at lower loading. You muck along under some discomfort till the HR drops below the upper limit, the PM starts working at every beat & you feel OK again, so start exercising again. It sounds like the 130 is a bit low for you - but you have to hash that one out w/ your EP.

It would help if you got hold of a finger tip Pulse-Oxymeter so you could check your HR while exercising. Then you could tell exactly what was going on w/ some HR numbers to back up your narrative.

Your last question - here's how it works: You have 2nd degree block w/ slowing & pausing. The PM better be working in DDD Mode (D=Dual chambers) - meaning it can PACE in both chambers; can SENSE what both chambers do; & can INHIBIT both chambers from sending pacing signals, based on what the two sections of the PM senses. You are going along, living your life w/ the Atria being sensed so the PM knows when they are contracting as a reference for the ventriclular section. The Ventricles, w/o the PM functioning, slow down from beat to beat, eventually "Pausing" & restarting the sequence. The PM keeps the ventricles on schedule by sensing the extending delay of the ventricles to contract & supplies a pacing signal at the appropriate time to keep you working at a normal, constant HR.

The PM is able to follow the HR as it increases , thus keeping you out of the block. BUT...you hit the upper limit & it stops pacing, but continues to monitor & allows the ventricles to do what they want again, but eventually it will slip into 2:! pacing to give you some decent blood flow to the body.

Hope this helps.

Don

Don!!

by kimbo - 2013-07-18 03:07:55

Thanks for the info and think i get what ya saying in your last bit about hoe this pm works you ask what my HR is when it starts iv not a clue all i know is that its starts about 5 mins in to my workout on the cross trainer the lady at the clinic wants me to take my pulse to see what its doing but am guessing its hitting above my upper setting i had a excersice test before pm and was told my max HR was 160 so why didnt they set my pm to that??. Im quiet active as i work out 5/6 times aweek and never sit still when at home doing chores and running aroud after an autistic son. Im set def in DDD mode as my cardio said this will best treat my symptoms that i had the pm fit for. Thanks again Don i'm gunna see how things go and maybe book in before oct when im due to go back and have that upper limit raised. I'm pacing about 50% of the time in both chambers or at least i was the last 3 times ive been interigated but know this can change due to the demand could be more or less next time.

Kimbo

Smart Lady at the clinic!!!!!

by donr - 2013-07-18 08:07:34

Kimbo - even the clinic lady is guessing w/o data on what your pulse history is while you are exercising!

It sounds like you just plunged into your routine after the surgery w/o working back into your routine slowly to find out how exercise affects your heart/PM combination.

You need some data - HR DATA on how it all reacts during the exercise program. Then an intelligent decision can be made o what is happening to you.

Doesn't sound like you are panicking, however - that's a good sign.

Yes, based on the 160 BPM you got from the exercise test before the PM, your guess that your upper rate is set too low makes sense - BUT - you need HR data to know IF it ios a correct guess. You don't want guessing when it comes to affairs of the heart!

Don

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