EKG Interference?

I was in the hospital Monday night for a throat infection which was bleeding. My BP was high so they put me on the monitors. My HR was at 132 for two straight hours in ER. They put me on a portable ECG monitor to do a cat-scan thinking I may have bleeding in stomach from taking plavix and aspirin. My pulse dropped immediately to 70 on the portable as soon as the other machine was disconnected. They hooked it back up and both the portable and the wall machine jumped to 132. During cat-scan, rate was normal with portable. They brought me back to ER and as experiment hooked me up again to ECG machine and pulse jumped up to 132.

I think the wall monitor (the thing that looks like a small TV and shows BP, Oxygen, a few ECG waves, and HR). My pacemaker guy says that it is impossible to get electrical feedback from those machines. He says the machine was picking up afterbeats (or something like that) and doubling the actual heart rate. The people in ER said my PM was pacing entire time at 132. They think machine was sending out electrical impulses and messing with my PM.

Pacemaker guy next day said pacemaker was fine after interrogation. He said this happens more often then people realize. However, I had to get an IV which stopped up, had a failed and painful attempt to get another IV, and then finally they got a new IV in. They gave me medicines to lower BP and pulse in IV...which if everything was actually normal is not good. I mean do you really want to lower a heart rate that is already being paced? Isn't that dangerous?

My basic questions: What really happened? Who is right? How can I stop this from happening again? I even have the ECG print out and it says I was in Vent. Tachycardia. Very stressful.

9 Comments

What Happened

by SMITTY - 2009-12-31 03:12:32



Hello Thompson,

I have a few comments, but no answers for you.

I think have it nailed that the monitor caused the increased heart rate since it happened three times. While I've been on those things a number of times I never had one to diddle with my pacemaker. I do know that some, if not all, transmit the data you read in the room to another lactation, usually the nurses station. Wince that is a microwave transmission, it may be a stretch, but it is possible that radio transmission was causing the interference.

I see you got the standard answer from a pacemaker tech when they don't know what in the hell is going on either, that being "your pacemaker is working fine." If that sounds cynical, I am cynical about the way some of those people try to lay BS on us because they think we know no more about a pacemaker than they do. That may be true, but why can't they just admit they don't know either. That part about the "machine picking up after beats" sounds like double talk to me. To me a conscientious technician wood have been on the phone to a manufacturer asking for help.

I certainly agree with you and Inga about not giving you meds to lower your heart rate that is being paced at 132 BPM. Meds are not going to affect that pacemaker. Why they could have given you what would have been a lethal dose when you were moved, or disconnected from the monitor.

Finally, and I'll stop my ranting. I hope you can have a heart to heart discussion with your doctor about this. I would expect that if it has happened to you, someone else has made that trip. Or if possible, change doctors.

Good luck

Smitty

Hm....

by golden_snitch - 2009-12-31 04:12:04

Hi there!

No, it's not dangerous to give medications that lower the heart rate and blood pressure when you are already being paced. Since the pacer has a minimum rate programmed, your heart rate can't drop below this minimum rate, no matter which medications you get.

I don't know what happened. My first guess would have been that the monitor interpreted the pacer spikes as beats and then added the QRS-complexes and so the actual heart rate was doubled. What's important, I would say, is: did you actually feel the tachycardia? Did someone take your pulse manually several times?

Don't trust the diagnosis on the printout of the ECG: it's a diagnosis made by the computer program and it's often incorrect. For example when I'm paced in the atrium and ventricle, the holter usually interprets this as ventricular tachycardia just because the QRS-complex looks different. Might be the same in your case.

Best wishes & happy new year!
Inga

Reason

by bigbronc - 2009-12-31 04:12:56

Most likey the monitor was counting the pacer spike as a T wave thus doubling your heart rate. Depending on the monitor used, the leads they choose on the monitor to view and most especially where the nurses place the pads, sometimes they get in a hurry and just throw them on throwing off the axis.

The question was...

by golden_snitch - 2009-12-31 07:12:04

Quote: "I mean do you really want to lower a heart rate that is already being paced? Isn't that dangerous?"

That was the question, and this question can be answered with a NO because the pacer will kick in when the rate drops too low. Giving meds for the wrong thing is, of course, not good. However, many drugs that lower the BP - and that seemed to have been high - can also lower the heart rate. So, maybe it was good to lower the BP.

Best wishes
Inga

Welcome to the Wonderful World of Medicine

by Kathy.m.wenger@gmail.com - 2009-12-31 07:12:35

I can feel your pain.
Hey Inga, how do you know that it is not dangerous to give those meds to lower heart rate, are you a Dr.? Common sense says giving meds for the wrong thing is NOT good.
Back to Thompson: I am sorry you had such a bad experience, wading through the Pacemaker world is a stressful thing at times. Hang in there, I can't give "expert" advice but can just feel your pain!
Kat

Typical

by ElectricFrank - 2009-12-31 11:12:45

The comments above about the rate doubling problem is likely the cause of the high rate. It isn't always exactly double so the 70,132 rates would make sense.

Now the real issue. Whatever happened to the old time honored method of feeling the wrist pulse and timing it? Any time I get a questionable HR that's what I do.

As for the meds they always present a risk and shouldn't be given when the data isn't understandable. Some of the cardiac meds don't just "lower HR". They also affect the timing of the QRS-complex, and even affect the way the heart responds to the pacemaker.

All in all it sounds like you had a rather incompetent hospital team. Scary.

frank

P.S.

by PaulT - 2009-12-31 12:12:16

Happy New Year Everyone. This is a great website...

Me, again with thanks and questions.

by PaulT - 2010-01-02 01:01:27

I agree with all of your comments...and really appreciate the feedback. I keep wondering if I should make a formal complaint as I know I asked at least 5 (and closer to 10) if there was someone available who deals with pacemakers. They never did. The next day, the pacemaker guy said they have someone available 24 hours a day and could have been reached. I get so frustrated with getting totally different answers from the professionals.

Plus, I am not a physician and had no idea that this was a false reading and that all the results should have been ignored. Obviously, all the people in the ER had my same lack of knowledge. This is another area of complaint. Now that I read your comments I think the guy told me is that it was probably reading my spikes and QRS (whatever that is). Unfortunately, and I hate to admit this as I think I am a fairly bright person, but when medical people start talking, I just start going into a daze. I was also frustrated when he started talking and saying that the ER people were not interpreting things correctly and then I tend to stop listening. Any ideas?

I had my PM inserted 3 years ago and had thought I had adjusted to this. Had read about it online and had never seen that this type of thing could happen. I agree with those of you who said that it could have very negative consequences, i.e. getting medicine unnecessarily. Being in the ER, not feeling good, and then getting bizarre readings is not my ideal time to determine the best way to be an advocate for myself.

I need a book to learn more. Just last week I said I wondered if they have one called "ECG for Dummies." On top of it all, I realize that I do not know nearly enough about my pacemaker.

To make it my worse, the day before we had just left the hospital and my father-in-law had suffered a mild heart attack. His 2nd. He had stents inserted this summer and 3 years ago, plus had a by-pass. They said his HR dropped to 31 and 28 BPM at different points while in the hospital this last weekend. Since he had the stents inserted they said he could not get a pacemaker right now. I was not there when the doctor talked to him, but we do not know if he must wait a certain period of time or what. Any ideas? They also think he should get tested for sleep apnea.

By the way, I did help take my father-in-law to the hospital the night he started his heart attack. Guess what? The ECG machine did not work!!! They had to get another machine...and this hospital is reputed to be the best cardiac center in our state. Geez, I always thought minutes mattered.

Again, thanks for your feedback.

Whoops, two last questions. Is there a really good layman's book on pacemakers and heart disease? Second, I have been reading about so many different types of pacemakers...I just assumed mine helped when my pulse was below a certain rate. They said mine paces up to 130. Why? I have no idea why he kept telling me this, but again, I was too frustrated. Back to prozac I guess (just a joke).

maybe an answer

by Dr P - 2010-01-19 02:01:51

I am a pacemaker physician.

I need to know:

what is the company and model of your pacemaker? you can get this from your ID card


there might be a perfectly understandable reason for this pacemaker behavior if your pacemaker has a "minute ventilation" sensor.

not all pacemakers have these, and not all pacemakers with these sensors are programmed to use them.

a good layman's book?

go find the books written by Tom Kennedy.

I dont have the references right now, but I am sure that amazon or borders has them.

search

tom kennedy and pacemaker

tom kennedy and defibrillator

You know you're wired when...

Your pacemaker receives radio frequencies.

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