Heart rate remaining high after walk will not drop below exactly 100bpm

First thing that comes to mind is settings, second is Magnet response

by crustyg - 2020-12-15 10:39:37

It's quite common to find Magnet Response delivers a fixed pacing rate of 100BPM.  Not particularly easily activated but I can see how I could do it with my smartphone in my shirt breast pocket and the lovely magnet in the back of the 'phone case that allows it to attach to the convenient stand/holder in my car.

So assuming that your lower rate limit hasn't been *set* to 100BPM, my guess would be magnet response.  If your HR is exactly 100BPM, day and night, hour after hour?

I'm lucky, I have my local EP-centre techs on speed dial, I know a lot of their names and they would probably let me come in at short notice to see if there's something fundamentally wrong (easier to be nice to me and get rid of the old fool than be difficult). I'd start with a remote transmission from the box under my bed, mind you.

BTW, please would you check/edit your posting to see if there are lots of blank lines at the bottom?

It's moved to a constant 120bpm

by quikjraw - 2020-12-15 11:49:24

Thanks Crustyg 

I've been trying to ring the cardiology department for the last hour but can't get through so I'm going to ring the Dr 

Am I overreacting?  Its still not gone below 100 but after several times of checking it went to exactly 120 bpm and has stayed at that now.

It's really strange and feels uncomfortable

Stay calm

by Gemita - 2020-12-15 12:31:30

John,

No you are not overreacting.  You know what you feel and it doesn't feel right.  Have you spoken to your doctor?

My EP/cardiologist would probably tell me to take a low dose additional beta blocker to try to calm things down, otherwise to visit A&E if I was at all concerned.  But please do not panic, that will just push it up further. 

I don't know how you are checking your pulse, but you know that home monitors can be out by far.  Feel your neck pulse to check whether the rhythm feels regular or irregular, whether it slows, then speeds, or whether it is just steady but fast.  Anything over 100 bpm is tachycardia, but my doctors are not too concerned when it is in the 100-120 bpm range, but of course you should really go by "how you feel" and if you feel at any time that something is not quite right, then get medical help.  Better to be safe than sorry.

Is your fast heart rate consistently at 100-120+ bpm?  Does it ever drop lower when at rest?  If it is running high most of the time and steadily at a rate of around 100+ bpm I would ask your Cardiologist or pacemaker clinic if this could be pacemaker mediated?  If so, I would press for some checks and adjustments.  Keep up the pressure if you are in any way concerned.  Better to get this sorted before Christmas and while it is actually happening so they will have the evidence.  Good luck John

so frustrating

by quikjraw - 2020-12-15 13:04:16

Hi Gemita

I am calming down a bit now, I think I am more annoyed that it is not possible for a whole afternoon to get in touch with the hospital who fitted the pacemaker, how can that be right?

I have rang them again now and the phone simply dies now after several rings.

Its still racing but I have seen a Dr and they confirm it is racing at over 100 but they do not know why, my blood pressure is normal and they said they could hear no murmours.

They are going to try and contact Stoke Cardiology unit but I do not hold out any hope of it being sorted today so I expect I will be up all night with yet another feature of the pacemaker that is not needed.

Gemita you mention pacemaker mediated tachycardia, how would I know the difference between that and say a setting issue on the pacemaker due to a magnetic field issue like Crustyg mentioned?

In addition if it is a pacemaker beat that is causing it to stay that high will betablockers make any difference?

How would you know?

by Gemita - 2020-12-15 13:19:02

If you are not in the range of a magnetic field or anything that could be causing this and you still get tachy symptoms for no particular reason, then you have your answer John.  My gut feeling though is that this is still your heart getting used to pacing, trying to adjust to what is set up.  You are still also healing.  Also you may be getting an arrhythmia causing this, which is why if it is prolonged and worrying you, I would not hesitate to seek help.  Go to A&E at your pacing hospital or back to your pacing clinic and ask to be seen.

Yes a low dose beta blocker will make a difference John even if this is pacemaker mediated.  I am surprised your GP didn't suggest it, although they don't like touching patients under the cardiologist without the cardiologist's approval.

Are you still tachy at rest?  Yes please stay calm.  100+ bpm is only just out of the normal heart rate range (60-100 bpm), so providing you feel okay (no major chest pain, breathlessness, sudden weakness, dizziness) you should be able to "safely" cope with this heart rate until you are seen

Calming influence

by quikjraw - 2020-12-15 14:04:20

It such a calming influence to be able to discuss things on here so thanks for that Gemita and Crustyg.

Its still above 100 yes and no other symptoms other than the sensation of it happening in my chest and a very slight headache.

I will try the hospital that fitted the pacemaker again tomorrow. 

It is so annoying as i also developed Superficial thrombophlebitis last week which is almost certainly associated with my stay in hospital in some way so to have another issue a week later is starting to get frustrating for me and my family.

kind regards

Superficial thrombophlebitis

by Gemita - 2020-12-15 14:23:46

Yes John, let your Cardiologist know about the above development too.  Tachycardia can also be due to many conditions as we well know, so he may want to do a few blood checks for infection, inflammation, blood clotting.  You will be okay.  Keep well hydrated, and try to get a good night's rest.  I will leave you in peace now!!

Crusty's guess

by AgentX86 - 2020-12-15 14:43:23

Since it's exactly 100bpm, I'd guess that Crusty is on the right path, though I don't think it's the magnet thing.  That should reset when the magnet is withdrawn.  Whether or not it's a magnetic thing, my bet is on the settings.

Pretty sure it's not magnet

by crustyg - 2020-12-15 15:51:18

Thanks for the update Quikjraw.  If it's changed to 120BPM then I think we can be certain this isn't a magnet response.  It's actually quite difficult to activate magnet response and keep it activated for hours on end.  A change of HR rules this out.

More likely, I suspect, is some form of re-entrant arrhythmia with a 2:1 block limiting your ventricular response.  In your shoes my next action would be to initiate a patient initiated data transmission (ironically for *me* I have to contact the EP-techs to get it authorised!) and then camp by the telephone to get an urgent appt.  Failing that, I'd take myself to the ED where they will run an ECG and then you'll know.

Urgent, as in sometime over the next couple of days.  Don't take no for an answer.

Best wishes.

Agree not a magnet

by quikjraw - 2020-12-15 16:07:34

Thanks Crustyg,

The Dr did not ring back as I expected so will do just that and push for an upload. Its been 5 weeks since my implant and still not even a mention of a follow up appointment.

I downloaded the correct app within a few days of the implant and it is still awaiting approval from the hopsital or they could have had downloads by now.

Thanks again I will try and update once I know more.

Persistence

by Persephone - 2020-12-15 16:59:55

Hi quickjraw - I hope you are feeling better.  I know this sounds really simplistic, but maybe try some deep breathing:  count of 4 through the nose, hold for a count of 5 (or as long as is comfortable) and out slowly through pursed lips for a count of 6.  

It's great that your blood pressure is normal.  As Gemita pointed out, you may want to ask your doc - when you actually do see them - for a low dose beta blocker so you know you have a mild solution to help get you through troubled times. I have a beta blocker but rarely take it; somehow just knowing it's there helps, though.

My PM clinic was not responsive for follow up initially either; they seemed to be going through some changes or whatever; I learned that I needed to contact them to schedule follow ups.

Take good care.

sleeping on it!

by quikjraw - 2020-12-16 04:23:07

As is often the case sleeping on something can make things better.

I have woken this morning and it is back to normal, my heart rate dropped back to a solid 60 in the night again (not my preferred lower level but that's another discussion).

I am still going to try to contact the hospital to talk it through and at least get a date for the first follow up.

I must admit I really thought I was going to be stuck at above 100 until I actual had some intervention as I have never experienced that before but turns out I was wrong.

Thanks for all you support

John

Get that download examined

by crustyg - 2020-12-16 08:56:03

Hi John: Great to hear that you're feeling better and that your HR is down to normal.

I suspect that this makes my remote diagnosis more likely: with *luck* your PM will have logged this in the arrhythmia log - but there's no guarantee as they are only set to record certain events if thresholds/rates etc. are exceeded.  Not remotely as good at capturing odd events as an implanted reveal device - different design objectives.

Your EP team need to know about this sooner rather than later, so keep pushing for a remote transmission and emphasise how long the episode took (and date/start-time).

Best wishes.