Etopics

I`ve been diagnosed now with etopics which seen to come and go in runs . This appears to have been the problem that's been making me feel really rubbish some days and do not feel like exercise. For some reason they have not been reported by the Techs at my regular check ups.
I was suppose to have had bigeminy rythms some time ago but could never feel it when checking my pulse.
Now however I can feel regular missed beats when feeling bad.
My question is why do I have missed beats when surely the PM is set to deliver a regular ones?
Thank for any input........mg

7 Comments

Etopics

by BillH - 2016-02-06 03:02:40

Etopics are NOT missed beats.

A pulse comes early and the ventricles are not fully filled and thus the pulse when is weak.

Then without a pacemaker there is recovery time in the ventricles so that it can't fire when the next pulse comes from the atria. So you only get the etopic beat.

Then at the next natural beat the ventricle has had extra time to fill and thus the pulse is extra strong.

The V's are the beats of the ventricle and A's the atrial.
In a normally.

A X A X A X A X.
With an etopic.

A X AX A A X

The PM tries to replicate the natural action of the heart.

And when it detects a ventricle beat, even etopic it knows that it can't pulse the ventricle for a short period of time.



Me too

by Alma Annie - 2016-02-06 11:02:33

I often have ectopics, at one time 12 a minute. EP said nuisance but not to worry. Also often have missed beats and If I count around the 1 minute I can find many missed beats. This also seems to happen when I am having ectopics so I do understand what you mean. My pm is set for 50 a minute but when they miss it can be as low as 44. However when this happens the pm corrects it so no worries. This doesn't happen all the time though. I suppose my heart still has not completely recovered from its trauma 4 years ago. As for feeling 'rubbish' well I often feel like that anyway but I don't think it is a heart problem.
Maybe you should have another complete check up and tell of your concerns. I am sure the EP will allay your fears, but it is always good to be sure nothing is wrong.
Alma Annie

Adjustments

by BillH - 2016-02-07 03:02:47

As I said there are adjustment that determine how long and when the PM waits to see if the heart is having natural heart beats.

Also there are adjustments about the sensitivity level at which a heart beat is detected. If that is too low then noise might be faking out the PM.

And there is an adjustment of the level the voltage sent to pace the ventricle. If that is marginal then it might not allways cause the ventricle to beat although it is sending pacing pulses.

Heart skipping a beat w/ a PM...

by donr - 2016-02-07 03:02:51

...I don't think so!

ASSUMPTION: Your PM is functioning correctly.
If that assumption is true, there will be ZERO missing beats. That's just the way a PM works. It monitors EVERY beat of your heart & if one is going to be late (Missing is infinitely late), it adds a beat where it should be, based upon its stored data.

A PM only measures elapsed time & compares the elapsed time it measures against what is in its storage as a criteria. F'rinstance: It measures elapsed time from an atrial contraction to the following expected ventricular contraction (Doesn't matter if the atrial contraction is caused by the PM doing its job). Supposing that the stored criteria for that elapsed time is 360 milliseconds (A millisecond is 1/1000 second); if there has been no ventricular contraction when the 360th millisecond is counted, the PM sends a pulse to the ventricles & makes them contract. The PM does that for EVERY beat, so you cannot miss one.

Now let's talk about ectopic beats (I call them PVC's, for Premature Ventricular Contractions). If you have ever seen one on an ECG trace, it does NOT even come close to how you feel it - IF YOU DO FEEL IT! I just had an ECG two weeks ago & the bottom strip (They call it the "Rhythm Strip) on the print out showed two instances of PVC's. It is interesting to examine them closely. What you see is:
1) The electrical squiggle for the Premature Ventricular Contraction looks obviously different from normal QRS squiggles for a ventricular contraction.
2) It obviously appears sooner than a normal ventricular contraction would.
3) Look for the little pimple of a blip (Called a P Wave) that occurs just before the normal ventricular contractions - it is NOT there for the premature one. (That's because the premature contraction is NOT triggered by the P Wave traveling down the heart to the V node - it is generated by some anomaly in the vicinity of the V node that triggers the action.
4) Look at the elapsed time between the two NORMAL Ventricular contractions that come before & after the premature one. It is exactly the same as the elapsed time between ANY two normal ventricular contractions flanking a normal one.
5) There is a BIG elapsed time between the premature contraction & the next normal one. THAT'S what you sense as a missing beat. Actually, the Premature contraction can be so abysmally wimpy that you do not sense that one at all - making you think there is a beat missing. But it is there & the PM counts it in two locations - in the HR of Beats per Minute & as a PVC.
6) suppose that you were taking your pulse at the wrist when the PVC occurs. Unless you are an experienced pulse taker, you will NOT feel the PVC. I know that from experience. When I first started having PVC's my wife was taking my pulse & felt NOTHING when I had a PVC. She got a HR of abut 36. A few minutes later, I was hooked up to the ER BP machine & it recorded a HR of 72 - I was in Bigeminy at a rate of 72 BPM, w/ half of them being PVC's.

As a sidebar - I did not sense either of the two PVC's I had while hooked up to the ECG machine.

A previous comment explained why the following normal beat feels so hard.

A RUN of PVC's: it is possible to have a run of successive PVC's. Since they do not have an atrial contraction preceding them, they can just occur in succession, each triggered by the spurious electrical activity near the AV Node. That would be very inefficient pumping by the ventricles, & be sensed as a very fast, but weak HR.

Hope I've helped.

Donr




EP

by Alma Annie - 2016-02-07 06:02:34

When I have queried missing beats with EP he told me that can happen and not to worry about it. I do have PM that is working well and I DO sometimes have missing beats. Not all the time but when it happens it is very definite, you can't miss it. It is as if my heart has hiccups and is struggling to beat, then it seems to correct itself, but it can take about a minute to do this, then its ok, then it might start up again. So Donr maybe I am just unusual, but it really does happen.
Alma Annie

Thanks

by mg - 2016-02-07 09:02:20

Thanks for the info.
I still cannot quite understand why if my PM is set to 70 and when feeling `good` I can count 70BPM. However when feeling `rubbish` I can sometimes only count 40/50. Where have the other beats gone that are programmed into the PM?
I could never feel the bigeminy and still could count the beats ok. The bigeminy made me feel `rubbish` but has disappeared and I`m told replaced with the etopic`s .
Regardless of what the experts says there is a definite relationship between my etopics and feeling `rubbish`. When I do not have them I`m fine and well active.
Thoughts please....mg

Thanks BillH

by mg - 2016-02-08 08:02:10

Interesting you mention voltage. Following a broken lead replacement 18months ago I ended up with pulsing in my stomach and after a long time and many visits finally got a setting that seemed a compromise by dropping the voltage. It is only since the `new` settings I`ve had these odd rhythms . Before the lead replacement I did not have a problem felt good and very active.
Thanks mg

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