Advice needed please

Hello this is Yolanda, I had my PM put in on 3/6/13 (Boston Scientific dual chamber model K063). My setting were initially 60 low and 145 high and then my sensitivity was adjusted twice between 3/13 and 3/27 in which my sensitivity was turned up so i could begin exercising some to lose the 45 pounds i put on prior to PM. When i went in to see my Dr to get medical clearance to return to work as I am a R.N., he made more adjustments which included increasing my high to 160 because from 3/27 to 4/18 my HR was 145 more then 10% of the time he said (was doing alot of walking and feeling better than ive fely in a long time), he also adjusted some of my sensing features. I returned to work that night and felt horrible, overwhelmed and just plain crappy, my HR was constantly 160 and i could feel it rising in my throat. The next night same thing very little walking and that feeling was in my throat and when i checked sure enough i was 160 again. This is more the sensing adjustments than the rate i believe. What sensing feature should be re adjusted? any suggestions? need help so i can get back to feeling better so I can properly take care of my patients. One more important thing, I keep getting this hard flicking beat it started a couple days after surgery and has increased from once every few days to a couple times a day, (i could be sleeping or sitting) and last for 1-2 minutes, it is very startling and I have never had this prior to PM, Please help

1 Comments

pacing

by Tracey_E - 2013-04-22 02:04:02

I'm sorry you're not back to full speed yet! It's great that you've been out walking, it's a big step in the right direction.

Why did you get the pm? Wondering if you are pacing atrial or ventricle. Keeping the upper limit higher than what your atria does on its own is usually ventricular pacing for av block, you need the ventricles to pace as fast as the atria.

Rate response, the sensing, is for when the atria doesn't go up on its own when it should. If your atria is going faster than your upper limit, it doesn't sound like it needs any help. They often leave RR on whether we need it or not because theoretically it just won't kick in, but it can interfere with what the heart is trying to do on its own.

I don't use RR so I don't know much about the details of the settings, but something I've found helpful is to get on the treadmill in the office while they have the pm computer hooked up so they can watch exactly what happens. Saves a lot of time trying it out and coming back!

I would question the 10% part, that's almost 2 1/2 hours a day. Were you walking hard enough to keep your hr up that high that much? If you were, that's great, just wondering if some of the high rates isn't walking. You can also ask what times of day you were going that fast. I have fast episodes every check. If it happens between 7 and 8 am, we know I was at the gym and caused it so we don't pay any attention. If it's at 3 am, it's something else.

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