Prominent heart beats

Hi.  Does anyone take medication to quiten down a prominent heartbeat. I got my 4th pacemaker implant last october and felt not too bad until a few weeks ago. Now I'm having periods of my heart thumping hard and not sure if device is capable of doing this or it's a heart issue.  Hospital technician reduced the sensitivity and reaction but it's still happening.  GP is carrying out a 24hr BP monitor as my diastolic pressure was going quite high. I didn't know if having a 100% pacing device would prevent medication from working as I don't need my heart slowed down only quieter. Sorry if this sounds confusing. Thank you. 


14 Comments

Strong heart beats

by Gemita - 2021-02-05 02:43:45

Lizzie, hello,

I am sorry you are having "thumps".  I experience this a lot with ectopic beats and other arrhythmias.  It might have been useful for your GP to request an event monitor too so they could take a look at your heart rhythm also and maybe they will need to do this to get to the bottom of your difficulties.

Low dose beta blockade can help calm things down, or in some individuals may worsen ectopics, if this is ectopics but you need to know what the problem is first and the likely cause.  Only monitoring can give them this information.  It sounds as though you may well have a pacemaker setting problem too if they have already tried adjusting sensitivity.  I would go back to them for further advice.

Having a pacemaker will not stop any medication from working but any medication may need to be adjusted until they find the right level for you.  If they prescribed say a low dose beta blocker (like say Bisoprolol which I take) or a calcium channel blocker (like Diltiazem or Verapamil) to help reduce your symptoms, this would reduce BP and heart rate as well, but your pacemaker would kick in to prevent your heart rate from falling below the pacemaker minimum set rate so you would remain safe.

I see you have quite a history with similar symptoms. I note you have had an AV Node ablation. You could ask whether your lead is set unipolar or bipolar.  You could also ask your cardiologist/EP to check for ectopic PVCs.  Please go over your earlier post "Palpitation after implant" dated 21 July 2013 and response from CardiacTechnician in particular which provides excellent information Lizzie.  The other thing I would recommend is, if it is ectopics, to try to get your minimum heart rate raised.  Mine is set at 70 bpm day and night and at a higher heart rate my ectopics are very well controlled.  It was a falling heart rate, particularly at night which used to trigger my PVCs.  Good luck

Strong heart beats

by lizzie - 2021-02-05 07:14:45

Thank you for your speedy response. My technician had a look last week and there didn't seem to be any sign of eptopic beats. Just the normal rise from 70bpm up to between 80-90 bpm with very little effort. My last device was set at 70bpm and low reaction. This one is more technical and reacts differently she says.I'll get back to her and ask more questions. 

UPDATE  24hr monitor being fitted 2pm today.  

 

Strong heart beats

by Gemita - 2021-02-05 09:04:10

Lizzie, thank you for the update.  24 hr monitor sounds a good idea (?BP monitor or ?Event monitor).  Hope they find the problem in the 24 hr period, otherwise you might have to ask for longer term monitoring.  

Actually, my technicians confirmed that my pacemaker is set up to reject all ectopic beats, since it is set to record only stuff like Atrial Fibrillation, Flutter, Tachycardia, NSVT.  I suspect true ectopic burden is often unknown for many of us and prolonged ectopics can really cause symptoms.  Please let us know what is found.  

Also, I presume your thyroid is under good control and that your thyroxine levels have been checked recently?

Ectopic beats and pacemakers

by AgentX86 - 2021-02-05 14:12:18

It makes sense that your device tech didn't see PVC but it doesn't mean that they aren't there.  PVCs are so common that they're not tracked unless there are long strings of them, where "long" is a settings number.  It doesn't pay to track these because they take up recording space and any information is of little value.  

Often ectopics, even when they're very frequent, alternate with normal beats or may occur every third or fourth beat (or normal beat every third...).  This means that there aren't long strings of them because there are normal beats interspersed with them. 

Any infromation wouldn't be all that useful because PVCs are almost always benign, unless they do come if very long strings and account for something like 30% of the beats.

When I had these (bigeminy - every other) my PM couldn't detect them because the minimum detectable PVC string was five.  My "string" was never more than one but it came every other beat.  I happened to catch it and sent a remote transmission to my EP.  The PM tech saw it an immediately told me that it was PVC, not to worry.

Strong heart beats

by lizzie - 2021-02-05 14:50:20

Hi. It's an event monitor thats has been fitted at ECG department.  My BP monitor is due to be fitted on 18th Feb at local health centre.  My heart palpitations have been a bit troublesome today so we'll see what turns up. I do take thyroxine for underactive thyroid and had a blood test autumn last year which was satisfactory  but I may phone GP on Monday and request a repeat. My hospital technician did say they do BP monitoring too but not sure if I should just be patient and leave it till my surgery do it on 18th??? Thanks all for all advice so far. 

The choice is yours ...

by Gemita - 2021-02-05 15:05:08

Lizzie, it might be helpful to keep the monitoring all under one roof so to speak for ease of reporting, since hospital would need to contact GP for the results of BP monitor, but only my opinion.  

You may not wish to cancel and rebook your BP monitoring arranged for the 18th?  Is your hospital close by or is it more convenient to have BP monitoring arranged by your GP/local health centre?  Maybe they could send a copy of the report to your ECG department 

Pacemaker or something else?

by Gotrhythm - 2021-02-05 15:22:27

The first symptom I went to the doctor for (long before I got a pacemaker) was feeling my heart beating "really hard" for no reason. I felt it in my neck, not in my chest. All the heart tests where negative. Nobody even looked for arrythmias.

Many years later when I got a pacemaker, the first symptom of pacemaker mediated tachycardia, wasn't fast heartrate as you might expect, but feeling really hard heartbeats with distended veins in my neck. Sometimes the beat would be so hard, I'd involontarily go "oof!" as if I had taken a blow to the chest.  My blood pressure was all over the place.

The chances are your pacemaker is not to blame. It's not broken or doing anything wrong. The pacemaker is just doing what it is programmed to do. 

What is possible is that your heart is not responding well to the pacemaker's settings i.e. the pacemaker's programming isn't ideal for you. It's important that you learn to make this distinction since, in my experience it's not a distinction that pacemaker techs automatically make. They only check to see if the pacemaker is "working." And it always is. Pacemakers are marvels of reliability. The techs will tell you your pacemaker is "working fine."

Actually changing the pacemaker's settings is the EP's job. The EP is who you need to ask if the problem could possibly be that your heart isn't responding well to your pacemaker's settings.

Hope this helps and you can get to the bottom of what's going on soon.

Strong heart beats

by lizzie - 2021-02-05 15:32:14

I wasn't sure how to proceed with BP monitor but may suggest that when I speak to GP on Monday. My thought was the same as yours about keeping everything under one setting. My hospital is nearby but the PT (one I'd never seen before) said it may take 2wks to get result of today's test. He didn't seem much interested in my problem - unlike my usual PT. Definitely going to phone GP on Monday to request repeat blood tests. Thyroid for sure. GP did say at last call she was considering blood tests but not sure if she wanted the BP test done first.  My PT did say my PM model worked on movement and vibration and not breathing. Thanks again. You have been very helpful and patient with my endless questions. Also my GP would have no hesitation in providing results to ECG department as she is very proactive with her patients requirements.  

Gotrythem

by lizzie - 2021-02-05 15:38:00

Sorry can you tell me who you mean by EP please.    Thank you

EP = Electrophysiologist

by Gemita - 2021-02-05 16:42:34

An electrophysiologist, also known as a cardiac electrophysiologist or cardiac EP, is a cardiologist who focuses on testing for and treating problems involving irregular heart rhythms, also known as arrhythmias.   They will carry out complex ablations and implant electronic devices.

My cardiologist works as both a consultant cardiologist and a consultant electrophysiologist, but some cardiologists decide to specialise in the field of electrophysiology.

Lizie

by Gotrhythm - 2021-02-05 18:19:24

Ask whenever you need to. Everyone here is still learning--even those who have been around for years.

What Gemita says is right. All EPs are cardiologists who specialize in heart rhythm disorders. But not all cardiologists are EPs. 

The thing is that although many cardiologists insert pacemakers, they don't all have the training to manage rhythm issues, or know how to program your pacemaker when just the regular settings aren't working for you.

I just wanted you to understand that when they tell you "your pacemaker is working fine," it's true. Nevertheless, your heart could still be having a problem with your pacemaker.

Your homework assignment is to figure out which kind of cardiologist you are seeing.

EP

by lizzie - 2021-02-05 18:41:59

Thank you. I have never seen a cardiologist since 2013 tbh. I only deal thru my Pacemaker Technician so very much doubt if we have such a professional EP in our local area. 

Gotryrhym

by lizzie - 2021-02-05 19:00:30

As I said above I never see a cardiologist.  Not since post op visit 2013.  And in this pandemic I doubt I will be very high on the list. Thank you for your advice. 

EP/Technician

by Gemita - 2021-02-05 19:21:17

Don't be concerned Lizzie.  Many pacemaker technicians in the U.K. are highly trained and qualified and many members here only see their technicians for check ups and only get referred back to their EP if they have heart rhythm disturbances that need treating by say an ablation or medication.  I am under my EP because I still have difficult arrhythmias which need treating otherwise I would be seeing technician only.  

It is a very good sign you haven't needed to see a cardiologist or an EP.  Your pacemakers have been working well so far I would say.  Hopefully they will be able to help you with your present rhythm disturbances 

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