New pacemaker

I recently had a pacemaker put in on August 23, 2023. I have felt that my pulse is too high now. Most of the time it is in the 90s.  I have had high blood pressure for a long time but the pulse part was never an issue for me. Until I took my blood pressure on August 16th and discovered that it was in the 40s. I was advised to go to the ER which I did not want to do so I went to an urgent care instead and my EKG was abnormal so they sent me over to the ER.  They did a angiogram to make sure that my arteries were not clogged and then they did put in a pacemaker for bradycardia. I am in the process of trying to get into a new doctor because I felt the doctor that was assigned to me in the hospital was stretched too thin. He had PAs to do his rounds at four different hospitals. He worked out of seven different hospitals, and then another PA to take his office appointments, and I wanted a relationship with an actual doctor that I could talk to you each time, so I'm in the process of trying to get into this new doctor. I'm concerned about my high pulse rate I feel it needs to be adjusted. Has anybody else had this issue where they put it in and your pulse rate stays too high normally my pulse rate would be in the 70s or sometimes low 80s but yesterday and some other days it's like in the 90s. My pacemaker is set to kick in anything below 60 and up to 130.  I never thought I would have to have a pacemaker and I'm not at peace with it. I don't know if its my anxiety with it that is causing it to be so high or if it's just set too high but I was just curious if anybody else has had this happen because I haven't been able to remedy it yet. 

10 Comments

pacing

by Tracey_E - 2023-09-22 17:03:41

I'm glad you found us. It's normal not to be ok or happy about it! I found that understanding how it works helped me accept it. I may not like it, but if I understand I can deal. 

Do you have heart block? If yes, then it's common for your rate to go up considerably. It will likely settle down over the next weeks or months.

With heart block the atria works normally but the signal wasn't getting through to the ventricles. So it was beating and beating and beating, and the ventricles were beating when they were in the mood because they weren't talking to the atria. Now, every time the atria beats, the pacer gives the ventricles a fraction of a second to get with the program. If it doesn't, then it sends a tiny signal that mimics what the heart should have done on its own. The heart responds with a ventricular beat, which is what we feel as our pulse.

The pacer is a gas pedal, not a brake. It can't stop it if the heart goes faster on its own. It'll just sit back and watch. If heart block is what you have, then it would make sense that your rate is higher because now all of those atrial beats are ventricular beats also. The pacer is completing the broken circuit.

A  normal rate is 60-100, so 90 is not considered abnormally high. 

It's common to see a PA and for EP's to cover multiple hospitals. My previous EP had fabulous PA, she spent more time with me overall and worked hand in hand with him. She was quick to get him if she needed him. My current EP has a terrific NP. I see both of them but she's the one I reach out to with questions because she answers emails promptly. This is the way medicine is these days. Don't write off an excellent PA or NP just because they don't have MD at the end of their name. They have extensive training in their field. But if you are not comfortable with your current care, don't be shy about shopping around and find one who is a better fit. 

Fast pulse

by StephanieRae - 2023-09-22 17:26:52

Thank you Tracey for responding so promptly and in depth! Yes I did have an atrial block. I am uncomfortable with this faster pace and was hoping it could be adjusted because my blood pressure escalates too. So you think it will adjust down by itself? I wonder if my anxiety about it causes it to be higher.

The Cardiologist and PA's I had in the hospital were nice but not super responsive. They would often ask the doctor questions and he would not get back to them until much later which is what makes me think that he is a little over stretched.  Also after the initial placement of the pacemaker, it was discovered the next day that one of the lines had come detached so the next day he had to go back in and attach it. I asked before the procedure if it would be a good idea to have antibiotics administered since they were re-opening me back up and he explained that it's not always a good idea to have too many antibiotics because then your body becomes resistant to them and this I know, but still, I was curious and a little concerned about it.  Then before they took me in he got halfway down the hall and turned around and called back for the nurse to get a certain anabiotic for me stat and she couldn't get it right away, so he said to start me immediately on something else and then, as soon as that one came in to put me on it, which I thought it was nice that he was considering me but did I give him that idea and should he have already known that?  Then, after my postop visit, I had called into the PA in the office twice and did not get a call back then at the end of the week I did get the authorization for the new cardiologist and as soon as I canceled my appointment there. She immediately called me back and asked if I had any questions.  So for those reasons I just feel that they are a little overstretched or some thing it didn't make me feel confident with them. Thank you so much for listening to me and commenting! I really appreciate it! 

s/p pacemaker for heart block

by Rch - 2023-09-22 18:17:20

I agree with Tracy's opinion!!! The pm kicks in to fill in the heart blocks. May be those ventricular kicks give you the uncomfortable feeling! To ease your mind however, you could request the PA to do a surface 12 lead ECG and see the rhythm! In my opinion also, PAs are more accessible and helpful than physician providers! 

Fast pace

by StephanieRae - 2023-09-22 18:33:11

Thank you Rch! I obviously have a lot to learn here. I have nothing against PA's. I used to go to one all the time in my general practitioner's office and I loved him for me and my kids. I also have high blood pressure so the faster pace seems to be elevating that as well. I am hoping to get some resolve when I get in to see the new cardiologist. I really appreciate being able to ask questions here though! 

Antibiotics

by PacedNRunning - 2023-09-22 21:17:09

Antibiotics are standard for any surgical procedure. It's a one time dose within 30 mins of surgery. Perhaps he thought you meant long term antibitotics for after the procedure. You should only need the one time dose.  I think all practices are stretched thin.  They can't always call you back or answer your questions right away.I  usually give my doctor at least 48 hours to return my messages or calls.   Also, never heart of atrial block, I think you mean AV block? Block from the lower chambers. There is sinus block but that is uncommon to pace and that comes from the atria.

Maybe look up reviews about this cardiologist.  Maybe you caught them at a busy time.

Fast pace

by StephanieRae - 2023-09-22 21:26:26

I think you are right pacedinrunnijg about the kind of block I have - I think I have the wording wrong. It is the lower left chamber that was not taking the charge from the upper chamber and sending it over to the other side. As far as the antibiotics no. Because they did do it for the initial implant of the pacemaker. But the day after when the lead came detached and he had to reopen my wound - there were no IV antibiotics given until I mentioned it to him. Thank you for your input! 

higher rate

by Tracey_E - 2023-09-22 22:01:38

If you have av block, the higher resting rate is all you. This is what your heart was trying to do all along but the block prevented it. It can feel racy at first but it doesn't take long to feel normal again, and it may slow down some. 

Higher rate

by StephanieRae - 2023-09-22 22:09:39

Tracey, actually my pulse has been consistently in the 70 and 80s. I have high blood pressure so I monitor it regularly. I missed a few days but on 8/11 it was 78. I recently had to put my dog of 13 years to sleep and was grieving him pretty badly. I don't know if this has to do with it or not but when I took my bp on 8/16 my pulse was in the 40's. And again on 8/17 in the 40's. That's when I called the nurse line at my doctors office and they advised me to go to the ER. What I am feeling now does not feel normal- it feels uncomfortable like a panic attack sort of. I hope this is not the new normal. 

Fast pulse ( tachycardia)

by Selwyn - 2023-09-23 07:38:13

If your pacemaker is set properly, then your fast heart rate can be due to other things. Be aware, a fast heart rate will elevate your blood pressure .

Anxiety is certainly one common cause for a fast heart rate.

Caffeine ( as in tea, coffee, cola drinks etc.) will increase your heart rate

Alcohol and other drugs can increase you heart rate ( eg. nicotine, ginseng, bitter orange etc).

Some common medications may increase your heart rate ( eg. cough and cold remedies, some antibiotics, some antidepressants, etc.)

An overactive thyroid may increase your heart rate.

Your fast heart rate may benefit from a medical opinion.

It is always best to consider some lateral thinking. ( https://www.debono.com). With this in mine, do consider that your life has likely to have been saved by your pacemaker, and that you are in fact better off than those without a pacemaker ( Given the fact that sudden, cardiac deaths are an everyday reality). Wonderful that you actually know that your coronary arteries are in good shape. Many happy years ahead...

 

Fast Pulse

by StephanieRae - 2023-09-24 18:52:58

Thank you Selwyn - I am trying to get into my new cardiologist but have to wait until the end of next month.

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I am 100% pacemaker dependant and have been all my life. I try not to think about how a little metal box keeps me alive - it would drive me crazy. So I lead a very active life.