Heart rate

Almost 4 months since implant and on my 3 month checkup doctor noticed my resting heart rate was in the low 100's. I guess my watch and BP cuff were not reading my pulse correctly. My struggle is that I cannot seem to be very active cause I top out around 145-150 and the doctor said that's correct. I've called the office to see about other options but I'm shocked that my resting rate is so high since I was given a PM for 2nd degree heart block and a HR in the 40's. Have any of you had a similar experience? If so how was it treated? I guess my hope is that it can somehow non surgically be lowered so I can be more active. I'm also on 25mg of Metropolol extended release which I thought was also supposed to lower your HR. It's really confusing to get a PM for a low HR and then it be to high. Thank you for your input. 



by Persephone - 2020-11-29 12:06:49

Hi jgwin, perhaps you would consider requesting a holter monitor to record what's going on over the course of one day or more. It sounds like your EP is not fully explaining things to you....some additional data may be helpful for you to facilitate your conversation with your EP or to seek another doc who will be more communicative.

Heart rate

by EdH - 2020-11-29 13:02:46

Been there, done that.

After my implant while recovering in the hospital, I had the same experience when my pressure was too high. My Norvasc high blood RX was doubled and took two days to return to normal.

I also was given Metroplol and after Two days of monitoring, I was discharged from the hospital.

About a year later, the side effects of the Metropolol (light headed, somewhat unbalanced) became unbearable, so I reviewed the problem with my primary doctor, and we stopped the Metropolol. 

All is well for me now.

Your scenario sounds like mine, but the question is, the timing of the problem when you were in recovery.

I see you are on Metoprolol

by Gemita - 2020-11-29 13:04:22

So sorry to hear about your resting heart rate being so high.  That must be uncomfortable.  Have you worn a monitor and have they confirmed Atrial Tachycardia or another atrial tachyarrhythmia as the cause ?  Your beta blocker should help although you may need a higher dose to bring your heart rate down and to keep it down.

Yes, following pacemaker implant and for some 3+ months I experienced tachycardia at rest and it was extremely stubborn to resolve.  I had to increase my beta blocker (Bisoprolol) and surprisingly I was told to stop my anti arrhythmic med Flecainide which was thought to be partly responsible.  

Have they considered pacemaker mediated tachycardia, or perhaps you could ask. Have they tried adjusting your settings?

Doctors comments

by Jgwin - 2020-11-29 13:25:09

On my 3 month checkup I was told I was pushing it to hard. I'm 45, fairly active and feel like I hit a wall and then the PM just shuts off cause it can't pace that high. Dr. confirmed that. If I'm already resting at 100 then I don't have far to go. I thought the Metropolol was just for high BP, but my BP is only really high when I'm stressed, which is all the time at the Dr. I did show them the records on my phone that I take twice a day. It's actually pretty managed and a little to low on the beta blocker.if I'm relaxed it's 90s/60s.  Cardio just said to let him know if the resting HR was bothering me, which I have, but otherwise he said I'm doing well on it. If I'm put on a higher beta blocker, won't it make my BP even lower? I don't think I can handle that. In recovery I had what they said was programming issues immediately after surgery. HR was 140. It was pretty scary, they did start giving me Metropolol because my BP spiked because of all that was going on. I'm wondering if that's what really brought down my HR after all or as mentioned it's when my BP spikes. I've never been more stressed since this all. You guys are great thanks for the the input it helps. 

Metoprolol will control BP and heart rate

by Gemita - 2020-11-29 13:40:34

Yes that blood pressure (90/60) is a bit low and yes Metoprolol at higher doses will certainly bring it down further.

Have you worn an Event monitor which will give details of rhythm disturbances and heart rate?  My BP and heart rate spike with arrhythmias and I am afraid the more stressed you get, the more likely that your numbers will increase.  

Yes, they may be right about pushing too hard, especially as you are suffering from tachycardia.  Have they adjusted your upper heart rate limit upwards to allow you to exceed 145-150 bpm during exercise, although they may be worried about doing this with your current tachycardia symptoms.  In the very least I would recommend asking for an Event monitor to see what is happening, or you may need another med to help which would not drop your blood pressure too much.  There are a variety of meds they can try.  

But stay calm and don't push too hard.  This will get sorted.  It might be trial and error until they find the right treatment (or non treatment) for you.  I was ready to give up thinking I had made a big mistake getting a pacemaker, but it calmed down quickly once Flecainide was withdrawn.  

heart rate

by Tracey_E - 2020-11-29 14:22:10

Your rate is so much higher now because your sinus node is setting the pace. With heart block, the sinus node is working normally, going up and down based on oxygen levels in the blood. but the signal is not getting through to the venticles so they beat at random. With a normal heart, the sinus node tells the ventricles when to beat so the heart stays in sync. Once you are paced, the pacer is making sure the ventricles beat when the atria does, completing the broken circuit. So that's why your rate is so much higher now. Your sinus rate was always this high, you just didn't know it because the ventricles weren't staying in sync. It's the ventricular beat we feel as our pulse. 

Have you tried cutting out caffeine and alcohol? They can both raise our rate more than you may think. I was having one-two cups of coffee a day, cut it out and my resting rate dropped from around 100 to around 80. Worth a try. 

Meds are the main way to treat a fast beat. They can ablate if it doesn't respond to meds or stays dangerously fast. 100 is not dangerously fast. 

If your bp gets too low with the metoprolol, there are other options. 

My resting rate was high at first but settled down over the first 6 months to a year after being paced.

Thanks Tracey E

by Jgwin - 2020-11-29 15:22:37

That explanation really helped. I only have one dr. Pepper a day. I don't drink coffee, but I can't imagine a world where I can't have a drink or two on the weekend and don't really want to. I guess I'll cut out the one and I do mean one soda a day and see what happens. I do notice that if I calm down I seem to lower the rate. Problem is I have an extremely stressful job and my new fear of dying isn't helping. There I finally said it out loud but that's the truth. Cardio says that my heart is healthy, but the electronics are messed up and the PM should fix that. (His words exactly). The meds seem to really make me depressed though. Maybe a new one will help? I don't want to have an ablation. Other than cutting the coffee, is there anything else you did to get it to settle down? Mine seems to be speeding up. 


by Persephone - 2020-11-29 15:50:13

Hi jgwin .. I agree that anxiety and depression are unwelcome guests in our lives. I wholeheartedly support Tracey's recommendation to eliminate caffeine...one of the more positive things I'd done in the early months of covid was to pour all of my remaining coke zero down the sink. I don't miss it at all and I see that it was not adding value to my life.  Anyway, my typical HR was 90 bpm after pm adjustments 1.5 yrs ago. It was a bit scary and I felt what I would describe as chest pressure, but it settled down over time. I just now manually counted something in the neighborhood of 70 bpm (even on a holiday weekend where all the family members are extra needy).  Take good care and remember to put your health first. 

Mine's high too.

by Graham M - 2020-11-29 16:05:45

Hi Jgwin,

I've had my PM for 15 months for heart block (was stage 2, but now stage 3) and have noticed my HR going up and down.  If I'm very still and relaxed, it will go down to about 70, but as soon as I move, up it goes.  At my last PM check about a month ago, the EP told me that I was having the occasional episode of atrial flutter that lasts just a few seconds,and that my SA node was pacing at 103 bpm with my PM turned off.  I expressed my concern about this and she said it is not a problem until it gets up to 120.

I no longer smoke or drink alcohol, but do drink several cups of coffee a day.  I also take beta agonist bronchodilators for COPD, which may be the main cause of my high HR.  Perhaps I should ask for my medication to be reviewed, but at the moment I am happy to live with it because I feel good.


Best wishes


Good hydration is important

by Gemita - 2020-11-29 16:08:32

Really interesting to read Tracey_E's comments. So this seems to be sinus tachycardia and if so, I wonder how long you have had it and whether it has caused any problems, although I see your cardiologist says your heart is healthy which is a good news.  I presume you have had the usual checks (echocardiogram) to look for any enlargement of heart chambers and that arterial/ischaemic heart disease has been ruled out?  I wonder whether blood check for infection, thyroid, anaemia, electrolytes would be helpful?

Keeping well hydrated will help steady/bring up your blood pressure. Dehydration can cause higher heart rates and trigger my palpitations, but extra fluids always help. Avoid chocolate too because caffeine is in that!  I know you won't want to hear this but I would focus on rest, relaxation and calming activities to get that heart rate down naturally to avoid needing higher doses meds or potentially more invasive treatment.  It is worth a try first. I hope this resolves quickly.

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