Increase rate on occasion

Hi again,

Trying to get some ideas on why my heart rate would suddenly shoot up from about 50 bpm to 80 bpm or more (these are only approximate numbers). I have both rate response and CLS turned off. Everything was fine for the first 2 months (after turning off RR and CLS), then on the third month I've had 3 of these episodes. Each time it happend while sitting at my desk at work while concentrating on the computer screen. I first felt an irregular heart beat as if it skipped a beat and then the rate goes up suddenly, it is the same sensation as when the rate response was turned on, where I feel like I need to relax and take deep breaths in order to get my rate to come back down. It does this for about 10-15 seconds, I know it's not that long, but it makes me feel uneasy/stressed out afterwards.
If anyone has any ideas about any pm setting that would cause this please let me know.
I'm meeting with the cardiologist in a few days to go over this, but it helps to have some ideas ahead of time.
During my 3 month pm check they said everything looked great, and I mentioned the episodes, but they were not able to see them looking at the pace maker data, the pm did not register any dangerous events. I asked if there were any settings that would cause this problem, but they were not aware of any, but I still suspect that some setting or settings could be causing this. They also indicated that I was paced 19% on the atria and 0% on the ventricle.

My pm lower rate is set at 50. I'm not exactly sure when the episodes happened if it was going below 50 as my normal resting rate is in the 50-60 range. I wonder if my pm lower rate needs to be set to a lower value?

Just for reference I have a Biotronik Evia DR-T installed for syncope which occurred after excercise.

Thanks,
-Les

8 Comments

Thanks

by ltcoop - 2013-03-06 05:03:43

Thanks for all of your comments and ideas, I think you guys are great. I'm on a waiting list to get an event monitor in about 8 days, not sure why everything takes so long I guess that is adding to my frustration. I'll need to check on the PMT protection feature to see if it is turned on as Snitch has suggested. Do I want this to be on or off ?

Say Tracey when you get your SVT's how long does it last and how frequent do they occur, I could be having the same thing. I don't drink coffee, just an soda on occasion I don't recall having one the days it happend, but something to think about.

Could be anxiety related, I'm not ruling anything out at this point. As Don mentioned since I'm dealing with computers eveyday, I'm used to researching software issues where when there's a problem I usually have the tools to figure out and get it resolved, but in the case of the pace maker/heart I have to rely on other people to help me to figure out what the problem may be.

I think I'll get a printout of all of my pacemaker settings, here I go again acting like the software guy again...

Aside from the pacemaker club I wonder what are other types of support/counseling groups or individuals that I could contact locally, I'm in the Sacramento, CA area.

Thanks,
-Les

Don't think it's the pacer...

by golden_snitch - 2013-03-06 07:03:47

Hi Les,

with that little pacing, the lower setting at 50bpm, and all rate response sensors off, I'd not suspect that the pacemaker is causing these sudden heart rate spikes. A skipped heart beat, usually a premature ventricular or atrial contraction (PVC/PAC), sometimes triggers arrhythmias. I used to have that a lot with atrial tachycardias: They never started on their own, it was always a PVC that triggered them. So, maybe there is an atrial rhythm that sometimes kicks in, triggered by a skipped beat, and that makes your heart rate speed up. There's also the possiblity of short, pacemaker mediated tachycardias (PMTs), but those typically go along with ventricular pacing which you don't have. Nevertheless, you can ask the cardio about it, and ask him, if the PMT-protection feature of your pacer is switched on. If it's an atrial (ectopic) rhythm causing these episodes, you could try for instance betablockers to suppress it. However, I'd never take any drugs for such short and infrequently happening episodes of benign arrhythmias. To document these episodes you could ask your cardio for an event recorder. It's a bit like a holter monitor, but you can keep it for around 30 days, and you only activate it when you have an episode. It does not even need to be attached to your chest as some are the size of a credit card, with electrodes on the back, and you press it on to your bare chest when you have an episode.

Hope this helps a bit.

Inga

pacing

by Tracey_E - 2013-03-06 08:03:02

If your heart is doing it on its own, the pm won't record it because it's not pacing.

I get SVT, supraventricular tachycardia, which basically means the atria sometimes takes off racing. It's annoying but harmless.

caffeine

by Tracey_E - 2013-03-06 08:03:31

Random thought, had you been drinking coffee or another stimulant when it happened? I am super sensitive to caffeine, a cup of regular coffee would make my heart do that.

What's wrong w/ getting data???

by donr - 2013-03-06 08:03:37

That leads to understanding - after a few thousand questions. But, hey, who doesn't start into a journey in a strange land w/o questions. There's nothing wrong w/ being a software guy - just remove the pocket protector from your shirt & have at it. (Back in my early engineering days, there was no such thing as software. Geeks were recognizable because they wore a slide rule hanging from the belt. I know - "What's a slide rule?" The Eniac still ruled the digital world from The Army's Ballistic Research Labs & IBM was just starting to put out the first rudimentary business applications. Alan Turing was still alive.)

BTW: understanding leads to reduced stress/anxiety. They are the elephant in the corner; they can affect anyone & overlay whatever ill you suffer, amplifying & exacerbating whatever symptoms you may have from the physical problem.

One wee bit of advice - follow Occam's Razor - the simplest explanation is probably the correct one.

Don

A few Questions

by donr - 2013-03-06 10:03:47

Les: Welcome to a VERY strange new world - at least for you.

I read your profile & see that you are a jock - I assume that you do a LOT of running & have a naturally low HR because of all the exercise. a super-fit guy who had ZERO problems before your heart's electrical control system went south.

You also are a software engineer, so think very logically & precisely & analyze things closely when faced w/ a systemic problem of some sort. (Remember GE's MSD FORTRAN? Probably not - you'd have to be retired to go that far back. I was the engineer that used to find bugs in the program all the time & drive the 1964 version of you berserk. Those were the days of punched card inputs & massive tape storage systems.

Anyway, I digress from hearts to computers, but they have a lot in common. EXCEPT that computers have no emotions; no sub-conscious; no ability to really reason.

There are two descriptive terms that need definition - "Normal," & "Common." In my lexicon, NORMAL means that nearly everyone experiences the effect, while COMMON merely means that some significant number of them, albeit sometimes small, experiences the effect. In my analysis, you are experiencing a common effect, not a normal one. There are tens of millions of PM hosts out there, but your kind of experience affects relatively few of them, but it is a common thread among those who have problems.

A couple questions for you:

1) You say that your HR is normally about 50 while you are at rest. To me, rest means essentially asleep, or reclining on a couch watching meaningless TV w/ your brain in neutral. You are using the 50 as your HR while sitting at the computer, apparently working. USUALLY, your HR while doing anything is higher than the lower limit set for your PM. So, I ask, "How do you know your HR is at 50 while sitting at the computer? Do you check it out frequently?"

2) You say your HR suddenly shoots up to 80. Again, a "How do you know? Do you check it immediately, or is that a guess?"

You further stated that you essentially made your self a bed rest patient shortly after getting the PM implanted to avoid feeling the effect of your HR shooting up.

You sound like you are super-sensitive to your HR. Most people haven't the foggiest clue that their HR goes to any number short of the 120's (put in your own number here - but some number you sense when exerting yourself significantly. For a couch potato, it will differ from what a jock senses.)

One issue that is extremely common among new PM hosts is a sudden awareness of every little anomaly in heart beat AFTER they get the PM. Aware of things that were there all along pre PM - they just suddenly become more aware of them occurring now.

Let's talk briefly about HR's. If you watched your HR on an ER monitor for 5 min or so, you would be amazed at how frequently it changes - like literally w/ every beat. That's because every beat is an individually timed thing & the monitor determines rate by the length of time between individual beats. A small time variation from beat to beat will compute out at a change in HR that frequently.

Your PM works the same way - it functions on the time it EXPECTS your heart to use for each beat & if ANY individual beat does NOT show up on time, it fills in. If the next beat shows up on time, it does NOTHING. You said that you were being atrium paced about 19% of the time. That means about 1/5 of your beats are not showing up on schedule. Those beats are distributed randomly throughout your HR & are paced INDIVIDUALLY, not as a group or a sequence.

You ask what could be causing this to happen.

Consider a psychological effect. There is one to every physical effect we have. I read a certain anxiety into your posts/comments. That comes from the depths of your sub-conscious mind, and it comes so fast it is unbelievable & you DO NOT even realize it happens. Say your sub conscious senses something happening different in your heart - it can trigger a shot of adrenalin faster than a jackrabbit on a date! Before your conscious mind even knows it happened. In these issues, the conscious mind wears lead diver's boots! The sub conscious is wearing the lightest running shoes you can imagine. That is what keeps humans alive in the face of danger. The adrenalin makes your HR go UP, even if only for a minute or so. Finally your conscious mind takes command & you settle back down.

It is an unfortunate fact that the anxiety issues can perfectly mimic the effects of an electrical control problem of the heart. You talk about having to sit for a short while to bring your breathing back under control. This can be either a physical or a psychological (Read that as anxiety) problem.

That happens commonly to new PM hosts. What you may be seeing in the PM techs is their attitude toward patients that categorizes them as imagining things/anxiety issues. They want to force us into their generic settings & discount your problems as anxiety related. they may well be, but the Cardio community will NEVER discuss this w/ you outright. It is something they hold close to the chest & sneeringly think it or talk about it after you leave.

Stop & do some personal mental debugging, throwing into the list of possible causes a psychological explanation. You will have to do it - they never will.

Don

i'm having the same problem!

by Andy2907 - 2013-03-14 06:03:41

Hi, i'm 16 years old and I've had my pm for 4 months (i had a congenital third block) and i've been having a similar problem in wich I can feel my heartbeat suddenly go up when i'm relaxed. I feel like I can't breathe properly and get really tired... I've been feeling this for about a month and really frequently... I've gone to the hospital 3 times now and the dr said everything was fine, but if it's fine then why do I feel that way? It's really freaking me out...
What did your dr said? Could you find what was wrong..? Any advices? Thanks (:
BTW: sorry if my English is not really good, i'm from Costa Rica and Spanish is my first language, not English :S

response to same problem

by ltcoop - 2013-03-14 08:03:27

Hi,

I sent you a private message

-Les

You know you're wired when...

Your device acts like a police scanner.

Member Quotes

A properly implanted and adjusted pacemaker will not even be noticeable after you get over the surgery.