since taking eperenonone I have experienced heart rate 37 but I have a pacemaker set to minimum 60 anyone else experiencing this
slow heart rate : since taking... - British Heart Fou...
slow heart rate
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Bill509
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Hi BillHow are you reading your heart rate? From a smart watch?
manual also dizziness at the time
Do you also take your blood pressure? Low BP can also cause dizziness. As you have a pacemaker fitted if your HR goes below 60 then your pacemaker should immediately bring it back up again. My husbands previous ICD paced him at 50, occasionally when I did his pulse manually I would pick up that it had dropped below 50 but if i immediately took his pulse again it would be 50 or above. However 60 to 37 does seem a big drop & that coupled with the dizziness I think you should contact you GP/cardiologist or pacing clinic. Do you have a home monitor for your pacemaker? Meanwhile if it happens again perhaps phone nhs111 for advice.
I do hope you are taking your pulse manually and not just using a smart watch
Yes
I get that folks are saying ‘don’t use a smart watch’ but they aren’t out by 13 bpm!
I compare my Apple Watch with a blood pressure cuff monitor and also a chest strap and it is never out by more than 1bpm. Numerous studies have shown that smart watches are accurate for reading your pulse rate.
At the time of the episode I checked with watch 2bp monitors and manually all accurate
Yep that’s always been my experience with them. I hope you get some answers.
Best wishes
J
My question was about eplerenone if anyone has had a similar issue
Unfortunately smart watches aren't so accurate if you have a heart device. My husband's smart watch was consistently telling him that his HR was in the 70's, just by chance I did his pulse manually and his HR was actually dipping into the 40's. I monitored his pulse for 2 weeks, the watch still showed HR in the 70's but manually it was more low 50's & often in the 40's. He had an ICD, he had an urgent recall to Papworth who set his ICD to pace him at 50. We were told don't rely on the watch.
All I can say is that the Apple Watch is very accurate and there are numerous studies attesting to the accuracy. I agree that not all devices are off the same calibre.
I agree not all smart watches are the same & Apple may well be the best out there but no smart watch is accurate when you have a heart device. The best method is to take your pulse manually, the hospitals & my husbands nurse all take his pulse manually despite their BP machines showing pulse rates.
Q. What is the effect of the hyperkalemia on the heart rate?
A. Hyperkalemia, a condition characterized by elevated potassium levels in the blood, can have significant effects on the heart rate and overall cardiac function. The main effects include:
1. Decreased Heart Rate (Bradycardia):
Hyperkalemia reduces the resting membrane potential of cardiac cells, making them less excitable. This can slow down the heart rate.
2. Arrhythmias:
Severe hyperkalemia can disrupt the heart's electrical activity, leading to life-threatening arrhythmias such as:
Sinus bradycardia
Ventricular fibrillation
Asystole (cardiac arrest)
3. Changes in the ECG:
Hyperkalemia causes characteristic changes in the ECG, including:
Tall, peaked T waves
Widening of the QRS complex
Flattening or disappearance of P waves
Sine wave pattern in severe cases, which can precede cardiac arrest.
In summary, hyperkalemia generally slows the heart rate and increases the risk of arrhythmias, with effects becoming more pronounced as potassium levels rise. Rapid treatment is essential to prevent severe complications.
Q. Would the pacemaker correct the low heartrate caused by hyperkalemia?
A. A pacemaker may not reliably correct the low heart rate (bradycardia) caused by hyperkalemia because the underlying issue is the altered cellular excitability and conduction due to high potassium levels. Here’s why:
1. Hyperkalemia Impairs Conduction:
Elevated potassium levels reduce the resting membrane potential, making cardiac cells less excitable. This can interfere with the ability of the pacemaker's electrical impulses to stimulate a contraction.
2. Unresponsiveness to Stimulation:
In severe hyperkalemia, the heart may become refractory to both natural and artificial pacing signals. Even with a pacemaker, the heart may not respond if the potassium-induced membrane changes are too profound.
3. Underlying Cause Needs Correction:
The primary treatment for hyperkalemia-related bradycardia involves lowering potassium levels using:
Calcium gluconate to stabilize the heart membranes.
Insulin and glucose to shift potassium into cells.
Diuretics or dialysis to remove excess potassium.
Role of a Pacemaker
In mild cases where hyperkalemia primarily slows the heart rate but does not significantly impair conduction, a pacemaker may help maintain a sufficient rate temporarily.
However, in severe hyperkalemia with conduction block or refractory bradycardia, the pacemaker alone will not suffice unless potassium levels are corrected.
Thus, while a pacemaker can provide temporary support, addressing the hyperkalemia is the definitive treatment.
ChatGPT said
Your drug could cause hyperkalemia therefore you should monitor your kalium levels.
chatgpt.com/share/6744532d-...
Whilst that it all very interesting information, it's probably a bit too much as the OP has given no indication that he has potassium issues!! My husbands HR was very low & his potassium was in normal range! I read all that & my immediate reaction was 'WHAT', not only is all that very scaremongering but it's against the BHF rules, which is you are not allowed to diagnose! In the UK if you're on heart meds you regularly have your potassium levels checked.
From the BHF rules
Medical Advice
We do not recommend discontinuing medication without consulting a healthcare professional, and we ask you not to offer medical advice to other members of the community. Admins may issue warnings to users persistently offering medical opinions, and continued violations may lead to community restrictions.
I was just wondering if your husband had a pacemaker when his heart rate was very low and potassium levels in a normal range?
My husband has had an ICD since 2012 and if you read my comments above you'll see that his HR was dipping into the 40's so Papworth altered the settings to pace him at 50, that was early 2020. Potassium had been an issue for my husband for many year even before he had his ICD fitted. In 2008 he was referred to hospital for high potassium, his HR was normal. Over the years his potassium has been high but within range & on occasions high out of range, again with no effect on his HR. However, he does have severe heart failure due to his heart being severely damaged after a HA & CA. Because of his HF he also has bradycardia & LBBB but his potassium is well within normal range & apart from it going too low last year due to VT storms his potassium has been in normal range for some years! The reason for his CRT-d being fitted is because his HR is too low, his CRT-d was fitted 6 weeks ago, his potassium was 4.2 at the time, well within range!
Whilst chatgp is probably a good source of information, you cannot and shouldn't use it to diagnose a condition. Not only is it against the rules, but that sort of information can be very scary to someone who's vulnerable especially as it has nothing to do with the OP's question!
I just suggested to check his potassium levels because his heart rate was low despite the pacemaker. I don't see anything sinister in that.
The op said that we have to focus on his medication and I did exactly what he wanted from us. His medication could cause elevated potassium levels. Therefore I just suggested to make sure that his potassium levels are in a normal range otherwise his heart rate could stay low despite the pacemaker. I am very sorry if I scared you.
It seems like you were simply offering practical advice by suggesting the OP (original poster) check potassium levels, especially since their heart rate is low despite having a pacemaker. Your suggestion makes sense because elevated potassium levels can affect heart function and pacemaker effectiveness, as you've explained.
Your approach was to focus on medication (such as eplerenone) potentially influencing potassium levels, and how this could impact the heart rate. This is an important aspect, as even with a pacemaker, high potassium levels could still lead to bradycardia (low heart rate) and affect the heart's ability to respond properly to pacing.
It’s understandable that you were trying to be thorough, and your intention was to ensure the heart rate stays properly regulated by ensuring potassium levels are within the normal range. You’ve apologized for any alarm caused, but your suggestion was aimed at addressing the root cause, not creating unnecessary concern.
By focusing on monitoring potassium levels and discussing medication effects, you are helping the poster consider all possible factors affecting their heart rate. It's always helpful to provide balanced advice, and your explanation on elevated potassium impacting pacemaker function is relevant.
ChatGPT said
You have made a diagnosis of hyperkalemia without knowing the OP's medical condition or medical history! You've then posted all sorts of information around what can happen if you have hyperkalemia, including cardiac arrest & amongst other things you've told him his pacemaker may only work temporarily because of hyperkalemia. Quite apart from the fact potassium has to be very high & consistently high before it starts affecting your heart, quite likely that information will have absolutely nothing to do with the OP. However it may very well scare the life out of anybody reading it because they have a low HR, which is incredibly common in heart conditions especially if you take beta blockers!! Many of the people on this site are very vulnerable, we should take care that what we post is accurate and appropriate & preferably something we have experience of.
Bearing in mind my husband has a heart device and he has experienced potassium issues, I read your comments to him and he was completely shocked!!
Do you recommend the op to check his potassium levels are in a normal range?
As I've already said, if your on heart meds in the UK your potassium levels are checked on a regular basis.
When Would the Pacemaker Not Correct the Low Heart Rate?
The pacemaker might not be able to correct the low heart rate if:
The pacemaker is malfunctioning or has not been programmed correctly.
The underlying heart condition is too severe or involves a type of heart block where the pacemaker can’t function properly.
Severe electrolyte imbalances (like hyperkalemia or hypokalemia) are present, which could affect the heart's ability to respond to pacing.
Conclusion:
In most situations where a low heart rate is caused by medications, heart conditions, or pacemaker settings, the pacemaker should be able to maintain an appropriate heart rate as long as it's properly set up and there are no significant external factors (like severe electrolyte imbalances) interfering with its function. If the pacemaker isn't correcting the low heart rate, it would be important to consult with a healthcare provider to evaluate device settings, medications, and other underlying factors.
We can all copy & post, whether we should or not is another matter! I've reported your comments, I'll leave you to your day!
You should focus on helping people.
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