Tachy brachy

I was on a beta blocker for many years.  For the past year I noticed a very slow heart rate.  My internist lowered the dosage of atenol.   Everything checked out fine in February.  For the past year my energy level had changed and I assumed it was because  of my age.  However, in March I woke in the morning and felt light headed so I took my blood pressure, my heart rate was so low and my blood pressure was all over the place.  My husband took me to emergency at the local hospital, and they immediately hooked me up to the heart monitor.  Long story short, I was admitted, they ran tests, and monitored my heart for a couple of days.  I was diagnosed with tachy/brachy, and seen by a electrophysiologist who ordered an event monitor for me to be hooked up to for three weeks.  They took me off the beta blocker and because of the quarantine I had an appointment with the electrophysiologist via the computer.  He said since I hadn't fainted or had other symptoms we would have another appt. in three months, and more than likely I would eventually need a pacemaker.  He didn't seem too concerned about my blood pressure readings which were very labile.  My concern at this time is how can they get a better control on my blood pressure since most medications for blood pressure usually slows your heart rate down.  Will they ever be able to normalize my blood pressure since I have this condition?  Hope this isn't too lengthy or confusing as I tried to condense the wording as there was a lot more that happened in between.  Also, does the insurance companies set up the criteria for allowing a patient to receive a pacemaker.  Is it necessary to faint before you are approved for one.  You could be driving a car or crack your head open from falling if they are waiting for you to faint.  Has anyone had similar experience with this?  I sure am looking for a little reassurance from someone who might have experienced a similar situation.

Thank you for taking the time to listen to me, I really would appreciate any feedback.






Blood pressure

by AgentX86 - 2020-05-11 19:57:18

Hi Geegee.  Welcome to the group but sorry to see you need to be here.  I know you don't want to be.

Anyway, the only non prescription ways I know to raise your blood pressure aren't recommended.  Of course, your husband helps at times, I'm sure. ;-)

You're right to be concerned about fainting. If anyone tells you that you need to lose consiousness  before you they're going to help you, fire them an go elsewhere. Immediately.  Insurance companies can be scum but I doubt any insurance company will go there against the advice of an EP.  As you note, syncope (fainting) can be deadly, to you or someone else. I don't think the insurance company is going to make the descision to open themselves to that liability.

The monitor was the right thing to do at this point.  Your EP needs to know more about your condition over time.  These things are almost always intermittent and it would be sheer luck for wierd things to happen while they had you hooked up to an EKG machine.  The Holter monitor will tell them how bad it gets during that time.  Be sure to push the button if you feel anything strange.

If you're willing to spend some money, you might want to look into a Kardia Mobile.  I believe they can be had from Amazon or AliveCore for $89 right now (the "six lead" model is something like $150).  This little device (about the size of a pack of gum) will give you an EKG anytime you want to look at it.  It can be used to email the EKG strip to your doctors, too.  It does need a smart phone to operate.  Highly recommended.

From what you've said so far, I think you're in good hands.  Your job is to learn as much as you can about your conditon.  Put together lists of questions to ask during your appointments.  Ask them.  Education is power.

Your husband's job is to back you up and listen during our appointments.  He may have to run interference for you, too (leave you to worry about your treatment and he can deal with the incompetent hospital administration - they're everywhere).  From experience, you'll miss things the doctors say during your appointments (and the staff will screw up, well, everything).  Right after, go somewhere a grab a cup of coffee and talk about what just happened.  Write dowm more questions for the next appointment.  Maybe you can answer them yourself during the mean time but you really have to be on top of your condition.  It's not all that difficult  and it makes a huge difference.  The more you know and can speak medicalese, the deeper your doctors will go into what's really happening and what your choices really are.  Again, education is power.


Blood pressure and tach brachy

by Geegee - 2020-05-11 23:31:53

Just want to thank you Agent x86.  Knowledge is empowering and I'm glad I found I joined this group.  

Blood pressure and tachy brady

by Gemita - 2020-05-12 06:41:20

Hello Geegee,

Your story is sadly too familiar and I too struggle with blood pressure and heart rate instability because of bradycardia, tachycardia and other arrhythmias.  I have had several syncope and many pre-syncope episodes over the years and they have been frightening and difficult to manage, especially if they occurred while I was out.  My EP suggested a pacemaker so that I could safely be given medication to control my arrhythmias and high heart rates when they occurred WITHOUT reducing my heart rate to dangerously low levels.  

If I am correct you seem to have high blood pressure which needs to be brought down and kept down and your concern is that your heart rate will fall too low as well with your strong medication?  A pacemaker is certainly a good solution which could be set to prevent your heart rate from falling below a minimum set level.  This should help prevent syncope, dizziness.

I have both low blood pressure and heart rate and although my pacemaker can be set to prevent my heart rate from falling, it sadly has no control over blood pressure and low blood pressure can be a major cause for syncope too.  I try to keep well hydrated which helps to bring up blood pressure and I always try to get up slowly from a sitting or lying position.  As I have low blood pressure I can safely take more salt to help improve blood pressure but of course with high blood pressure this would be dangerous.

My advice would be to keep pushing for a pacemaker BEFORE you experience a syncope event which could occur when you are out and cause danger to yourself and others.  Treating (normalising) your blood pressure with medication should be easier with a pacemaker in place to prevent your heart rate from falling to low levels.  My blood pressure/heart rate is very unstable too during periods of bradycardia, tachycardia and heart rhythm disturbances.  This can be helped with medication or other treatments, but certainly a pacemaker would be a good first step (according to my EP - electrophysiologist).  My symptoms have vastly improved since pacemaker implant in 2018.

I live in the UK and I had to get evidence of a syncope event (through long term monitoring) before I was offered a pacemaker.  I suppose they have to be sure that a pacemaker will indeed help with our symptoms since pacemaker implant comes with some risk.  You will have to be very persuasive Geegee and keep pushing.  I wish you lots of luck



by Geegee - 2020-05-12 12:22:46

Thanks for the info.  I always appreciate hearing any input concerning this problem since it is all so new to me.

Tachy Brady and Pacemaker Qualifications

by Marybird - 2020-05-12 19:16:27

Hi Geegee,

Your history sounds familiar to mine as well. Hopefully there will be a few answers to your questions in my relating my own experiences and sharing what I learned over the years as I dealt with issues similar to those you shared with us.

I have a long history of tachycardia ( SVT) and high blood pressure, and have taken a beta blocker ( metoprolol) for many years to control the tachycardia. For much of that time I also took diltiazem, a calcium channel blocker- with that combination it was a low dose of both drugs, and this was meant to help control the blood pressure as well as the tachycardia. For the most the med combination worked well, few issues with the tachy, heart rate or blood pressure.

But about three years ago, my heart rate started to fall, sometimes into the low 40's and high 30's. At first it was intermittent, would go back to normal appropriately with activity, and it was asymptomatic. Then it was a little more, but still not symptomatic, at least most of the time. My cardiologist discontinued the diltiazem. leaving me on a low dose of metoprolol, and he assured me my heart rate would "normalize". Well, for a couple months there was no change, the heart rate still fell as it had before, but then the tachycardia came back with a vengeance. The cardiologist ordered a ZIO monitor patch, and this verified the tachycardia as SVT ( later identified as atrial tachycardia by an EP I saw who reviewed these results)- occurring at about 20% of the total heartbeat "burden" so, a lot. The cardiologist tripled the amount of the metoprolol I took and this did a fairly decent job of controlling the tachycardia ( still some breakthrough), but then my heart rate began really dropping down, and the bradycardia became symptomatic. I went for about a year with this, with the bradycardia becoming worse and more symptomatic ( lightheadedness, exhaustion to the point where I couldn't do much other than sit on the sofa either sleeping or sliding into oblivion, having to pull over when I was driving as I thought I might pass out, and the worse thing to me, it seemed my mind was no longer working at times when I couldn't think to even finish a sentence, or complete a task).

I was finally referred to an EP, who called it as "sick sinus syndrome", and suggested for a first step changing the medication for a time to diltiazem to see if that corrected the bradycardia and hopefully controlled the tachycardia. Unfortunately it didn't do a very good job of either, I still had the bradycardia, and it didn't do as good a job as the metoprolol at controlling the tachycardia. The worst of both worlds!  The EP suggested that the "sick sinus syndrome"  in my case was most likely already an underlying issue for me, not caused directly by medication but perhaps exacerbated by it. He recommended that we control the tachycardia with medication ( needed to be increased) and a pacemaker to keep the heart rate from going too low. I also had the hypertension issues so needed medication for that as well, and the anti-tachycardia meds could and had been also used for hypertension control. I had a dual chamber pacemaker implanted in JUne 2019, and what a difference that has made! I feel so much better, it was a new lease on life for me. The metoprolol and diltiazem I take double as both tachycardia and blood pressure control, and I take losartan and chlorthalidone in addition for the blood pressure ( it's hard to control- family history).

You mentioned concerns with your blood pressure "being all over the place", so hard to get a valid reading, or with wildly differing readings? I don't know if this was your experience, but I know in my case, having a heart rate all over the place ( as I did when I went through all those tachycardias, irregular heart rates, bradycardia) made it very difficult to get a blood pressure reading at all sometimes ( I'd just get error messages). Or I'd get a high reading one time, a low reading when it was repeated, just didn't make any sense. Thing is, a systolic/diastolic blood pressure reading, whether it's manual or taken with an electronic monitor, depends on the appearance and disappearance of heart sounds or pulses to get those readings. So if your heart rate is irregular, or "whacky" ( as I described mine at those times), you may not get a reading or if you do it may be meaningless. If your heart rate is regular and strong, under control, you'll probably get a valid reading, and you can go from there to take care of your blood pressure.

With sick sinus syndrome ( of which tachy-brady is a form), one of the criteria for a pacemaker is documented symptomatic bradycardia. Passing out during a documented pause in heart rate, ( or an extremely low rate, which my sister did) is pretty good proof of a cause and effect relationship between the heart rate and passing out. But not everyone does this, I didn't either. So what your EP would be looking for would be documenting symptoms you're experiencing during your bradycardia, this is done using a cardiac monitor- such as an event monitor or perhaps one of the wearable monitors over time that records your EKGs, and you push a button when you feel symptoms. If the symptoms can be correlated with the bradycardia, establishing the cause, that's documentation for symptomatic bradycardia. I wore a ZIO patch for two weeks ( a year after the first one that documented the SVT) that showed the bradycardia, and I was able to document the symptoms I was having at those times, which established, as I understand it, the diagnosis.

Another criteria for pacemaker placement is "symptomatic bradycardia, heart block, etc etc" caused by medication necessary to control a condition and for which there is no substitute.

While there are medications for some conditions that may cause bradycardia in some people that can be discontinued or for which there are substitutes, medication to control tachycardia or cardiac arrhythmias have no substitutes. The medications used to control heart rate ( such as beta blockers, calcium channel blockers and digoxin), or heart rhythm ( antiarrhythmics such as amiodarone, propafenone, flecanaide, etc) work that way to control the heart rate or rhythm, there's no other medication to substitute. So a person who must take these drugs to control a runaway heart rate or rhythm has no other substitute, so these are necessary. If they lower the heart rate to the point where a pacemaker is needed, that's a justifiable reason for the pacemaker. Though they told me my sick sinus syndrome was most likely a creature of my own making, I still have to take the heart rate drugs metoprolol and diltiazem ( which for me work better together to control the tachycardia than either does by itself) even though they lower the heart rate big time, the pacemaker keeps the heart rate from going too low. Together it all does a good job to keep it all at equilibrium (most of the time, anyway).

The criteria for pacemakers I mentioned are just two of the 1A indications ( recommended) on the list determined by the American Heart Association, the American Academy of Cardiology, and the Heart Rhythm Society. The European Society of Cardiology has similar criteria. These recommendations have been "adopted" ( I'd guess you would call it) by Medicare in this country, and it looks as though other third party insurance carriers have accepted these criteria as indications for pacemakers, and would pay for them, providing the physician has documented that the patient meets these criteria.

Kind of long-winded, but I hope this helps some. I wish you luck with your journey through all of this, and an excellent outcome, whatever direction it may take.






Mary bird

by Geegee - 2020-05-12 20:14:24

Thank you so much for all the information.  It is really helpful.  Also, just knowing others have gone thru all this is very consoling.  I can't tell you how much I appreciate the fact you took time to explain to me in such a way that I can understand.

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