From too slow to too fast

Just had my six week PM checkup with my cardiologist and I am not a happy camper. Have you all had the experience with your cardiologist that he really does not know what the PM can and cannot do?. I was having a slow heartrate and pauses which is why I got the pacemaker.. All he seems to know is that now my HR won't go below 50 because PM will kick in. I asked about my palpitations at night and he says it could be because I am in and out of afib. I thought it might be that my pulse was in the 80s whereas before PM it was always in the low 50s. Asked about sleep mode. He knew nothing about that. I asked about this "spacey" feeling I have been having when I go outside shopping. He is doubling my atenolol because maybe my HR is too high. Now this from a doctor who has treated my heart problems for years and has a sterling reputation. He admitted he is not knowledgeable about the various programs.available on the PM.
Why should my heart rate be too fast now when two months ago it was too slow. Two things having nothing to do with each other?? All of a sudden the HR increases after PM installation. Sorry to sound frantic but I am. Anyone else have this increase after implantation and what was the cause. Thank you for any relief you can give me,

7 Comments

odd

by Tracey_E - 2013-01-21 08:01:50

It's odd that he is so clueless about pm's! I get that a regular cardiologist is not an electrician and doesn't know as much an an ep and often doesn't do the programming himself, but it seems he should know a little more than what he showed today.

Did you get the pm because of av block? If that's the case, it makes sense your rate would go up. With av block, the atria is beating normally but the ventricles aren't keeping up so the pulse is too slow. Once paced, the ventricles beat every time the atria does so the rate goes up.

Or, if you have rate response on it could be too sensitive and take your rate up unnecessarily, but that would happen with activity not while sleeping.

Is he guessing you are in and out of afib or did he see it on the pm printout? Because if it's just a guess, I would not increase the atenolol just yet. How is your bp? Atenolol can lower your bp and cause that floaty feeling.

Should this be post or comment

by magenniskeith - 2013-01-21 09:01:35

I was hoping to hear from one of the regulars like you TraceyE. My holter monitor showed HR of 30s along with pauses while sleeping. Also when exercising my HR would not increase so I tired easily. I had Mitral valve replacement, tricuspid annuloplasty repair and maze procedure done seven years ago. Afib was eliminated for some time but was back. another reason for PM I imagine. Have never heard the term av block given as a diagnosis.
My EKG that they did today showed in and out of afib. Out when he listened to heart so it is not always there. My blood pressure is good. What you said about rate response rang a bell. I had it put on two weeks after implant. Maybe it is too sensitive and is raising rate unnecessarily. Doctor was going to show medtronic person my EKG tomorrow to see if she could determine if there is a specific setting that could help. I am to raise atenolol to .50 and come back to see him Feb. 1. Maybe the EP wii have suggetions before then. In meantime I will monitor pulse and BP and see how I feel. I had so firmly established in my mind that the six week period of recovery would end in a joyous raising of my arm above head and a leap of joy. Silly me. Thanks.

healing

by Tracey_E - 2013-01-21 10:01:31

Sadly, the healing doesn't always work that way! But on the bright side, you CAN raise your arm and swing it wildly, go for it, it will feel good! You'll get there. It's more common to be a gradual process to heal and get the settings right, less common to get it right first try, darnit.

Does not sound like you have av block. If you are pacing a lot atrial then you are using rate response and it's VERY common to take a few tries to get the sensitivity just right, find that balance between going up when you need it but not skyrocketing when you sneeze.

Hoping the EP can be more helpful! One thing you dont want is both the cardio and ep messing with your settings, just one or the other. My St Judes rep goes to both, so whoever I see, he's in on it and makes sure everyone is on the same page.

And comment is what you want. You could start a new post but then you'd have replies in two different places

sensitivity to rr

by magenniskeith - 2013-01-22 01:01:09

I guess I don't have to worry about my cardiologist trying to advise the tech after his admission that he doesn't know about the various options but thanks for the warning.. I am encouraged so by what you said about a few tries being needed. Maybe something as benign as my ever present cough from post nasal drip could be activating the rate response if it is at too high a strength or voltage or whatever the correct term would be. I will call doctor tomorrow afternoon and hopefully he will have some suggestions from the tech. Are the techs always EPs or is that a classification above and should I ask what they are or does it matter? You are going to have your fingers kepy busy with me.

Hope for improvement

by magenniskeith - 2013-01-22 07:01:42

Tracey, I didn't have to wait until the end of the day. At 8:30 the nurse called for me to come in and see the tech. Obviously my cardiologist heard me yesterday. He showed the tech my EKG and had questions. They lowered response rate and added a sleep mode.He admitted he did not know that feature. I evidently have in addition to bradychardia, atrial tachycardia the rate of which is enough to confuse the pacemaker and react in an incorrect manner. My HR was sometimes 190 and increasing the atenolol should help that. So I had my cardiologist, the nurse and a medtronic tech there and we all discussed and agreed. A great visit as opposed to yesterday.I previously had an appointment set with the cardiologist for Feb. 1 to see if doubling atenolol was a help, and the Feb.26 for the tech again. If this isn't a success, the tech said she would try turning off response rate. A much happier camper today. We really are the only ones that really know our own body and personality.

techs

by Tracey_E - 2013-01-22 09:01:09

An ep is an electrophysiologist, a cardiologist that specializes in electrical problems. Some offices train nurses to check the pm's or have a technician that only checks pm's. Some drs use manufacturers representatives and a rep is usually present during surgery. Most ep's do it themselves rather than rely on a tech or nurse.

My rep works for St Judes, not either doctor. He's in my dr's office one day a month and he's been there for each of my surgeries. He's not a dr, his background is actually engineering and he knows the pm inside and out.

Cardiologists rarely reprogram themselves, they either rely on reps or techs. My rep and cardio talk but for the most part the rep is making the decisions, or at least the recommendations and the cardio just agrees. You'll run into problems if your cardiologist doesn't know much about it and he uses someone trained only to do checks. There are exceptions, but for the most part all they're trained to do is run the reports and spot irregularities. Fine tuning is often beyond their skills. So, if you don't have a fabulous rep or extraordinary cardio, depend on your ep.

My fingers are tough, have at it :o)

whew!

by Tracey_E - 2013-01-22 11:01:38

I am so happy for you!! I was a little worried but it sounds like your dr is one of the good ones who's not afraid to go looking for help when he doesn't know the answers. Yay!! Medtronics reps are generally really good, nice to know he went straight to an expert. Fingers crossed the setting tweaks and med changes help you feel better.

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