Unusual Heart Rates

I thought I would share my current issue with you. My CRT-D fitted in September is set at 55bpm and this is mostly my actual pace when I check with my home monitor. However the last couple of weeks I have been having spells of higher rates of 85 to 102 which usually occur when, but not exclusive to, moving about. My BP also increases. At the higher heart rates, I get chest flutters and feel unwell and I have to lie down. I usually then go back to 55. As advised by my GP I have increased the bisoprolol from 5.0 to 7.5mg. I have had blood tests, stool tests, chest X-ray and 24hr ECG monitor. The day before the ECG I suffered lots of irregular rhythms but on the day I felt fine and the doctor said all was normal. I seem to get these high heart rates more since the response rates were turned on end of October, is this a coincidence I ask myself. An ablation has been discussed but I haven't heard anything yet. This evening we had a food delivery and whilst helping put away the groceries my heart rate went to 100 with palpitations.

I have a pacing clinic check up 14/12 and I have a list of questions but do you have thoughts from your experiences on what I should be asking? I think I need to see the cardiologist but expect it will be the technician again. Thank you all.

3 Comments

I believe you recently saw your cardiologist?

by Gemita - 2023-12-09 18:44:02

Graham, 

I am aware you have a holiday in Thailand coming up, so please ask about taking a monitor with you to keep in touch with your clinic and make sure you have got all the paperwork prepared in case of any emergency.  I expect you are getting excited.

As to questions to ask, perhaps something like the following, unless these are already on your list:-

Could you please confirm whether any arrhythmias are being seen, like Atrial Flutter or Atrial Fibrillation or non sustained Ventricular Tachycardia?  If so, could you please confirm the % time I am out of normal sinus rhythm and in an arrhythmia like say Atrial Fibrillation?

If the time spent in Atrial Fibrillation or any other arrhythmia is high, will I need a change of medication or an ablation?  

Could you please confirm what is causing my higher intermittent heart rates and blood pressure.  Could this be due to Rate Response?

Could you please confirm whether there were any signs of high atrial or ventricular heart rate episodes or other "events" which required anti tachycardia pacing therapies or other therapies to treat them?

Does Rate Response setting need to be better optimised for me?  If so, would it be possible to work on a treadmill with a technician present to adjust my settings?  Explain you feel the Rate Response setting may be triggering your higher heart rates.

Do I need a review of my meds before I travel to Thailand?

Do I need my ventricular lead switched on at some stage to ensure that my ventricles are synchronised, otherwise what is the point of having a CRT device?

You could ask for the % time you are paced in the Right Atrium and the % time in the Right Ventricle and perhaps ask whether they could give you a summary of your most important Settings or copy of your visit report?

If you have made diary notes of any difficult periods of symptoms, like dizzy spells, shortness of breath, near faints, weakness, low or high heart rates, irregular rhythms (palpitations) or the need to lie down, then during pacemaker check, give the technician the time and date when these symptoms occurred.  They may then be able to find a stored ECG to confirm the rhythm disturbance present causing the symptom(s).  

Do you want to share with us the questions you have put together Graham.  I wouldn't go with too many questions, only the important ones in case of time constraints.  It would be helpful knowing what you intend asking?  

Thanks for your reply

by Graham Harry - 2023-12-09 18:54:06

Your list of questions is very helpful. I will print out a list for my visit this week. As for Thailand, we are rearranging the holiday for later next year as I couldn't travel in my present state. I spend most days lying in bed resting. I am happy to share my questions.

Sorry to hear this Graham

by Gemita - 2023-12-09 19:05:17

although it is more important that you remain safe at all times and that your condition is stabilised.  Looking at those heart rates, they don't look particularly high but if your heart is not functioning well, or the heart rhythm is "irregular" like AF, I know how much this can affect our strength and blood flow.

Take good care Graham.  You will make that trip to Thailand when you are ready.  I will say goodnight.  Rest well

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