New to pacemaker & heart rate still below 40

Other questions

by Gotrhythm - 2018-10-25 15:06:00

Did the PR stay at 36-40 of did it return to 60-70? For how long did the PR remain 36-40?

If it was for a second or two, chances are that the pulse-oxymeter reading is being thrown off by occasional arrythmias like PACs or PVCs.

PACs and PVCs are "real" heartbeats, and so your pacemaker will count them as a beat your heart initiated on its own. But because they're contractions that happen a little bit too soon, they are inefficient heartbeats and might not send a pulse all the way to your finger that is strong enough for the pulse/ox to read. Make sense?

PVCs are very common (even for people who don't have pacemakers) and generally harmless. I find when I'm having a lot of them, the pulse/ox reading will be low for a second or two, and I start feeling pretty funky but I have learned there is no cause for alarm. Even though my heart isn't behaving very well, my pacemaker is indeed "working fine." In a minute or two my pulse/ox will read a steady 70 BPM with 02 of 98%.

If your pulse rate has gone to 36-40 and stayed there, at the very least I would want to have a medical professional manually take my pulse and document the results. Sometimes- rarely but it does happen--the pacemaker is "working fine" but the heart is not responding well to being paced. That needs to be evaluated by a professional.

Thanks, Robin1 & Gotrhythm

by PTara - 2018-10-26 00:50:40

The Cardiology with Electrophysiology specialist did the implant. I didn't eat or drink much or in large quantity at a time. My pulse when I woke up this morning (Day 2 after the operation) was 40 and 60 after I had breakfast around 9:30pm.

Yesterday, I also did the manual measurement pressing my fingers on my wrist for full 1 minute when I got 40 BPM. Taking loads of medecines

For coronary artery disease:  Aspirin, Apolets/Plavix, Ezetrol,

Antibiotic after pacemaker implant: Cephalexin 

Prevent irritating stomach: Controloc

I guess these two are for the latest sick sinus syndrome: Isosorbide, Vastarel 

Liquid Magnesium ... not sure for what

Medtronic BPM setting was at 60-120. Not sure if there are any questions about setting I should ask the doctor in the next follow-up? 

Some similarities

by Rick1945 - 2018-10-26 06:57:33

Hi 

Well I'm also 73 and had a stent put in on October 11 and then a PM on the 17th. I am finding on occasions [not always] that my pulse rate decreases while walking and sometimes below the set limit of 50 on my PM. 

However this rate is recorded through a Garmin smart watch and I don't know how accurate that is.  My family Dr suggests it may be inaccurate due to PVCs or PVAs.  I don't feel any different when the PR appears to drop.

[My original diagnosis came as a result of a very dizzy spell and very low blood pressure].

I think it is important to "rely upon the experts".  Next Thursday I am having my PM checked prior to an appointment with the cardio guy.  Hopefully he will shed some light on the situation.

I think you and I, and many others, are very fortunate that this technology and treatment exists and that we have access to it. 

Still unstable

by PTara - 2018-10-26 13:59:48

Thanks, Rick1945. Wish you al the best in your next follow-up. Mine is next week. Today is the 3rd day after the implant and pulse rates are up and down from 38 to 75. At least there were moments within a set range although still feel tired like before PM insertion. I guess our body is adjusting. Will give it more time until the next follow-up.

Best wishes

Pulse rate?

by Rick1945 - 2018-10-28 00:00:23

How are you measuring your pulse rate PTara?  

Using my smart [?] watch my heart rate around the house etc is good/normal/appropriate .....

But it is also my "new normal" to start a walk with a PR of around 100 and, after about 400-500m, see it decline steadily into the 80s, 70s, 60s and 50s - while feeling fine.

It is diffcult to manually check my pulse when I stop because my PR then returns to the 70s and beyond.  

I'm buggered if I know what is going on and am keen to find out.  I did have one stent inserted 3 weeks ago but no other signficant blockages were found - although there is a lot of plaque build-up throughout the coronary arteries.

Patience is needed..... 

Smart Watch Pulse Problems

by KonaLawrence - 2018-10-29 02:31:00

Oh my, I've had these kind of problems myself.  I'm a very active 70-year old.  I've have "weakness" and had a "low" pulse rate when running, swimming, bicycling, rowing, even walking.  I had 8 Pacemaker Interrogations & tuneups in my first 9 months.  But all of that had to do with high heart rates during heavy exercise.  All of my low rate problems turned out to be incorrect readings.  I've used many different devices to track my heart rate.  Here's what I found...

Smart Watches are often inaccurate, yes even the very expensive ones.  It especially happens during exercise, even walking.  Chest straps are very inaccurate because they get confused by the electric signals from the pacemaker.  Wrist-based pulse watches are very susceptible to sweat, hair and motion (and tightness of the strap).  Finger-based oximeters have the same problems.  Also, as others have said, PACs and PVCs can give you an incorrect reading.  The only way to be sure is to take your pulse manually at your wrist or throat, then take it again, then again, and again.  After three or four times you will get a reliable reading.  It's best to count for a full 60 seconds, but you can count your pulse for 15 seconds and multiple by 4.  Either way, it's often possible to get "funny" numbers, even manually.    Your pacemaker will NOT allow your pulse to remain below the minimum rate for more than a couple of seconds.  I used to get low readings myself from time to time, from various devices.  I've learned to always check manually as that's the "gold standard".  Good Luck.

Aren’t pacemaker dealing with PVC too?

by PTara - 2018-10-30 01:07:15

I couldn’t stand breathing difficulty and tiredness so I went to see the doctor yesterday earlier than what they had scheduled. Medtronic staff was there. She put Medtronic sensor on my chest over the pacemaker and has confirmed that the machine is working fine. All are solid and out of the box settings are the way to go for now. No need to make any customized setting whatsoever. 

The doctor said the reason for shortness of breath and tiredness was from PVC condition. My heart hasn’t been fully beating and it beats again prematurely causing an interruption to the blood flow and resulting in exhaustion. 

She then further explained that that because of PVC, any household electronic blood pressure/heart rate measurement (mine is Omron) or smartwatch will not be able to capture all of the beats, hence the low count. For example, beat 1 is too soft, Omron isn’t able to detect it and it does beats so the pacemaker is not required to work. Beat 2 came millisecond after beat 1 (which is premature) then again pacemaker is not required to work as the heart is beating naturally. Suppose that beat 2 is weak again so it can not be measured in pulse rate. If Beat 3 hasn’t come up after 1 second (since pacemaker interval was set at 60-120/min), pacemaker will then be activated. So in fact, there are 3 pulses (beat 1 and 2 naturally and 3 by pacemaker) but household machine will only be able to measure 1 (the last beat by the pacemaker). The doctor suggested to use fingers manually measure, pay really close attention will give more accurate result. 

No matter what figure/measurement it is, the underlying problem is I still feel tired. In therory, I guess a pacemaker would fix my sick sinus syndrome by making sure that my heart is beating but couldn’t it help me to manage premature beating as well?