Breathless - Update II

hi all,

I persisted with the PM Clinic in so far as telling them that although all the tests they had defaulted to came back clear (angio/CT/XRay) I still didn't feel 100%.

They finally conceded and 'tweaked' my settings. The technican raised the lower limit from 50 to 60. She was somewhat reluctant to do it saying that the settings were currently optimised for me and adjusting in this way might - stress might - bring on some other complications. No explanation was given as to just what complications might materialise.

My argument was that text books and tests might be indicating the settings are optimised but I STILL DIDN'T FEEL RIGHT!!!

Anyway heres the thing, the settings were adjusted Monday and I've had a much better week. Still not 100% but definitely an improvment.

However there is something that is bothering me and I hope someone on here can shed some light. I've told the doctors and techs that things are 'odd' and I'm definitely not anywhere close to pre=PM /pre-heart problem levels of health.

The issue is this; after the most gentle of exercise my heart rate DROPS. Even at rest, for no reason it will DROP. Can you see the conundrum. It doesn't go up as it should. My wife is a trained nurse and thankfully has witnessed / monitored this herself, had she not I might be thinking I was losing it a little by now.

It is prevented going below 60 now because of the adjustment, last week it was prevented going below 50, either way I still feel unwell. Just not to level I felt prior to the 'tweak'.

I've just been monitored for 24 hours at home so maybe this will highlight something.

Still on Bisop 2.5mg. 

Anyone have experience of thisf?

 


6 Comments

Heart rate dropping?

by Gotrhythm - 2020-05-29 13:19:42

I do not understand what you are trying to tell us about your "heart rate dropping."

You say "After the most gentle exercise my heart rate drops." It's normal for the heart to slow down when you stop exercising.

You say "even at rest, for no reason it will drop" but later you say "It is preventend from going below 60..." So if it doesn't go below 60 when it "drops", what does it do?

heart rate dropping

by paulh - 2020-05-29 13:45:10

You say "After the most gentle exercise my heart rate drops." It's normal for the heart to slow down when you stop exercising.
Agreed but not immediately i.e. within the space of 1-2 seconds

You say "even at rest, for no reason it will drop" but later you say "It is preventend from going below 60..." So if it doesn't go below 60 when it "drops", what does it do?
It doesn't go below 60 now because the techs have upped the lower rate on the PM. Prior to them doing this the lower rate was set at 50. Pre PM insertion it was dropping to below 35. (Sinus Bradycardia)

I had a call from the techs today after they studied the 24hr monitor readings. They obviously could see when the rate was dropping which also matched wih my diary entries of feeling unwell.

The PM techs are also sending the Holter Monitor readings to Medtronic for further discussion with a view to 'tweaking' the settings more. Apparently PMs have different 'modes' which my Cardiologist failed to inform me of, or perhaps doesn't even know about...

I had the PM fitted early February this year and haven't had one decent week since.

heart rate dropping

by Gemita - 2020-05-29 14:01:25

Hello Paul,

As a matter of fact I can relate to a sudden heart rate fall at any time, both on exertion, after exertion and even at rest as I try to sleep but in my case it is clearly related to my arrhythmias.  When I go into an irregular rhythm my heart rate may race, then crash, as well as my blood pressure.  I often feel (from manually taking my pulse) that my heart rate can suddenly race, then drop to low 40s bpm and stay there for some considerable time during an arrhythmia like Atrial Fibrilllation even though my minimum heart rate is set at 70 bpm.  I say to myself, “how can this be”?  My EP has tried to reassure me that this just cannot happen and it was due to frequent ectopic beats occurring during my several “in and out” arrhythmias. I am not convinced !  Unfortunately I have several arrhythmias and when one starts, I can usually look forward to a melody of them as well as sudden surges/crashes in both heart rate and blood pressure.  These sudden changes often lead to breathlessness, chest pain and instability (syncope and pre-syncope) although since my pacemaker implant, I only experience pre-syncope now.

I hope your 24 hour monitor gives them a few clues, but if not, press for longer term monitoring (at least 10 days).  If an arrhythmia is causing your problems, you and your doctors need to know about it so that it can be treated.  You are on a low dose beta blocker (Bisoprolol 2.5 mg) which should help without causing too many side effects.  All I can say Paul is that an arrhythmia is extremely common and it can play havoc with our heart rate and blood pressure unless it can be controlled.

Here's what I think

by Gotrhythm - 2020-05-29 14:43:09

Okay. I think what you're talking about is how the accellerometer is programmed.

I had something like this at first. In heart rehab, by the time the nurse recorded my pulse, my heart rate was down to 60. Needless to say, it was frustrating because no matter how hard I tried, the post-exercise records showed my heart rate hadn't altered at all. 

I never got any where near my target goals.

I didn't begin to know then what I know now about pacemakers.

I can't say about you, but in my case, it was all about the pacemaker's accellerometer and how rate response was programmed.

First of all I needed a base rate of 70. Within 5 minutes, I felt better.  I felt "like myself."

But even with the base rate increase, there was still the problem of being out of breath when I started walking. After a half a block of so, I'd be okay. But dancing was impossible..

What I needed was a a much faster rate of increase, and a slower decrease.

 

Dropped heart rate on exercise

by Selwyn - 2020-05-30 07:21:57

My guess is that you are experiencing second degree heart block when you exercise and then there is a delay with the PM picking this up, or another arrhythmia.

With second degree heart block you can get a gradual lengthing of the pulse intervals until there is a dropped beat, or you can get various degrees of dropped beats ( eg. 2:1, 3:1, 4:1), causing various degress of pulse slowing.

These sort of things can come and go.

I would suggest some further monitoring, or try to pick this up with an event monitor ( a Kardia may pick this up for you.) 

As Gemita says other arrhythmias, exercise induced, would cause similar loss of ventricular response (pulse). Exercise is notorious for inducing arrhythmias. ( after all medics do an exercise test with ECG monitoring for this reason, and have the defibrillator greased up at hand - just in case!) .

I don't know why you are taking a beta-blocker. This potentially may worsen the situation in heart block, or help the situation with other arrhythmias. I think I would want to have a clear explanation of benefits as you have a bradycardia and no signs of coronary disease on your angiogram.

Breathless - Update II

by paulh - 2020-05-30 08:57:33

Hi Selwyn

Can't remember if I'd mentioned in one of my previous posts but when I was stress tested on a treadmill the techs found an extra beat occured above 120 bpm. So I had two problems - the serious one of the Bradycardia (less than 35 bpm) and the newly discovered extra heartbeat I experienced when my heart was worked above a certain level.

The Bradycardia 'fix' was to have the PM fitted and the Consultants response to the additional beat was Bisop 2.5mg. I can honestly say I've had no detailed explanation for this. It is very rare for my heart rate to get so high as to experience the extra beat.

Can I also say that the heart rate drop is not limited to exercise. I could be sitting watching TV and it will occur.

The techs are getting back to me next week after they have heard from Medtronic. 

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