heart rate

A few thoughts

by Gemita - 2024-09-18 02:57:12

Smopace, there are a couple of reasons that I can think of why your father’s lower heart rate setting might go, or “feel” as though it is going, lower than the set “lower rate limit”, also called “base rate”.  They are Rate Hysteresis and Ectopic heart beats.   From your comments that “it doesn’t last long”, it would appear to be more likely that your father is dealing with intermittent premature atrial and/or premature ventricular contractions.

I note the heart rate fall does not appear to last long and this would fit in with a rhythm disturbance like a premature contraction and if they keep occurring intermittently for long periods, they may adversely affect cardiac output.  Depending on your father’s heart condition, frequent ectopic beats could perhaps lead to his worsening symptoms like congestion?  

All of your comments sound familiar to many of us with heart rhythm disturbances.  Our downloads may not pick up these seemingly benign ectopic beats.  For example, my pacemaker does not capture or store premature atrial contractions although premature ventricular contractions are recorded.  It depends what is set up in your pacemaker because your pacemaker will only record what your doctors have programmed it to record and store.  Perhaps that is why during a recent ER visit, nothing of significance was seen in the pacemaker data?  Perhaps it would be helpful to ask for external longer term Holter/Event monitoring to try to identify what is happening when your father experiences these symptoms?  It is not unusual to need additional monitoring even though we have a pacemaker.  A pacemaker is there to pace us rather than to monitor our rhythm disturbances.

So although this could be normal pacemaker behaviour, the patient will not benefit from intermittently feeling a slow, inefficient pulse.  What concerns me however is your statement that your father’s pacemaker seems to have issues (short V-V intervals).  Has this been fully investigated or settings adjustments made, to see whether he has any lead/connection issues or other difficulties?  

To sum up, I have personally found that frequent premature contractions can cause a slow, ineffective pulse, dependent on the force of the contraction.  Some members have even reported syncope, a symptom that is due to either inadequate stroke volume or decreased cardiac output caused by this disturbance.  To make matters worse, our pacemakers correctly sense the ectopic beat and inhibits pacing even though the effective output from an ectopic beat can be significantly less than from a normal heart beat.

I would be asking further questions if your father’s symptoms do not improve.

HR lower than basal rate

by Rch - 2024-09-18 03:13:21

Hi

The most precise way to check heart rate is radial pulse or Kardia/Apple watch etc which show the wave pattern and gives HR in real time. It might be perfectly normal to have HR below basal rate based on what was programmed for rate hysterisis which is usually about 10% or so. Then there are also ectopic beats that may not be counted on the pulse-ox or radial pulse. Since the ER doc didn't mention anything about low heart rates and that the pm was working fine, I wouldn't worry about it much. He may have reviewed the heart variability chart or the histograms to check the low heart rate burden and perhaps didn't see anything. As to the chest congestion, you mentioned your dad got better after some rest. How long was the rest? Couple of hours or days? If it's couple of hours, the ER doc may have addressed that. I am sure he had an Chest X ray, 12 lead EKG and some cardiac blood work in the ER before he was discharged. So, my suggestion to you would be to discuss with the Cardiologist to review the intorregation data with regard to impedance, sensing, capture etc. I hope you will get a satisfactory answer soon.

IPG rate

by piglet22 - 2024-09-18 05:59:19

The first thing is to make sure you are measuring heart rate as well as possible.

In a home situation without access to sophisticated equipment, you have several choices.

I'm defining HR as useful pumping cycles with "normal" output.

Radial pulse always works for me. You can pick up and count the rate and at the same time feel any arrhythmia. My primary interest is pauses caused by ectopics (PVCs).

An oximeter is useful, but isn't good if there are underlying weak contractions. I suspect this is down to some sort of averaging process going on to stabilise the reading. It will certainly indicate that something is wrong, but the figures may be inaccurate.

A BP monitor works well for HR and some (Omron M10-IT) detect arrhythmias quite well.

I've got used to the flutter sensation that always indicates a lower than normal rate.

In a relaxed situation, my HR never drops below the IPG value of 70 BPM ( used to be 60 BPM). There may be a 69 or a 68. That's good PM control. I'm not aware of anything like hysteresis being set.

Hysteresis of 10% below a set point would mean an allowable resting rate of between 63 and 70 BPM.

As PM IPG base rate is essentially a timed event, I can't see why hysteresis would be needed.

If any of the HR methods or sustained sensations like a flutter, or lightheadedness indicate a lower than normal rate, there's good reason to ask your pacing team to look at it.

Always remember, depending on who you talk to, that PM is fine means that the PM is functioning to specifications and settings, but not necessarily mean that you are.

How many times have I been told that PM is fine only to keel over because my useful HR is in the 40's.

Pleased to say that the episodes of sustained ectopics have either creased, or Bisoprolol is doing it's job.

Thank you

by smopace - 2024-09-18 13:17:23

My father got recovered after a few hour sleep in the emergency room after all kinds of checks, including chest xray, ultrasound, blood test. The blood test TROPONIN I went from 12 -> 17 -> 15. He himself felt better and the doctor said TROPONIN I is going down. So the emergency released him. 

As to the short v-v interval, his cardiologist has scheduled a lead revision procedure for him plus his battery has a little over one year left, so plan to do it altogether.