Pacemakers and Heart Rate Changes in Elderly Patients

Cardiac pacemaker and heartbeat?

Dear Doctor:
I would like to inquire about the issues related to my father's pacemaker and heart rate.
He is 73 years old and had a pacemaker implanted 8 years ago after a cardiologist deemed it necessary following a cardiac catheterization.
He has been returning for check-ups every three months.
Two years ago, he suffered a cerebrovascular accident (CVA) and is currently classified as having moderate physical and mental disabilities, continuing rehabilitation to this day.

In the past two weeks, his heart rate has been exceeding the previously set rate of 60 beats per minute, rising to between 90 and 112 beats per minute.
After his recent follow-up appointment, the physician conducted a 24-hour Holter monitor and an office ECG, both of which were deemed normal.
The doctor stated that an average heart rate of 72 from the Holter monitor is normal and that the office ECG was also normal.
Therefore, the doctor believes that the pacemaker is pacing rapidly rather than indicating an excessively fast heart rate, possibly due to the rehabilitation activities, which we found difficult to understand.
In the nursing home, heart rate measurements are taken outside of rehabilitation sessions, and it has been noted that he experiences shortness of breath due to the elevated heart rate, prompting nurses to suggest administering oxygen when necessary.
The nurses do not strongly believe that there is a direct correlation between rehabilitation and the increased heart rate.
Could there be other pathological factors causing the elevated heart rate while the ECG remains normal? As a family member, what else can we do? I am a pharmacist and look forward to your response.
Thank you very much.

Xiao Mei, 40~49 year old female. Ask Date: 2009/12/03

Dr. Bu Shiyun reply Cardiology

Many factors can affect the condition after pacemaker implantation.
Typically, if the pacemaker is set to 60 beats per minute, it means that when the heart rate is too slow, the pacemaker can stimulate the heart to beat at 60 beats per minute.
However, heart rates exceeding 60 beats per minute are usually due to the patient's intrinsic heart rate (although in some cases, if the rate-responsive mode is activated, the device may adjust the heart rate).
Therefore, an increased heart rate may refer to the patient's own heart rate, and it is important to consider other issues related to cardiac or pulmonary conditions, which may not be directly related to the pacemaker.

Reply Date: 2009/12/03

More Info

Understanding the complexities of heart rate changes, especially in elderly patients with implanted pacemakers, is crucial for both caregivers and healthcare providers. Your father's situation, involving a history of cardiovascular issues and recent rehabilitation efforts, presents a multifaceted challenge.

Firstly, it's important to recognize that heart rate variability is common in elderly patients, particularly those with underlying health conditions. The heart rate can fluctuate due to various factors, including physical activity, emotional stress, medications, and even the presence of underlying medical conditions. In your father's case, the increase in heart rate to 90-112 beats per minute (bpm) during rehabilitation could be attributed to several factors:
1. Physical Activity: Rehabilitation exercises can naturally elevate heart rate as the body requires more oxygen and nutrients during physical exertion. This is a normal physiological response, especially if the exercises are more intense than what he is accustomed to.

2. Pacemaker Function: Pacemakers are designed to maintain a minimum heart rate, but they can also respond to the body's needs. If the pacemaker is programmed to allow for a higher heart rate during activity, this could explain the observed increase. The fact that the 24-hour Holter monitor showed an average heart rate of 72 bpm, which is within normal limits, suggests that the pacemaker is functioning correctly.

3. Anxiety or Stress: Emotional factors can also lead to an increased heart rate. If your father is experiencing anxiety related to his health or rehabilitation, this could contribute to the elevated heart rate.

4. Medications: Certain medications can influence heart rate. If there have been any changes in his medication regimen, this could also be a contributing factor.

5. Underlying Conditions: Conditions such as anemia, hyperthyroidism, or infections can lead to an increased heart rate. It is essential to rule out these possibilities, especially if the heart rate remains elevated outside of rehabilitation sessions.

Given that the electrocardiograms (ECGs) have returned normal results, it is reassuring that there are no immediate concerns regarding arrhythmias or other acute cardiac issues. However, if the elevated heart rate persists or is accompanied by symptoms such as shortness of breath, chest pain, or dizziness, further evaluation may be warranted.

As a family member and a pharmacist, there are several steps you can take to support your father:
1. Monitor Symptoms: Keep a detailed record of his heart rate, symptoms, and activities. This information can be invaluable for healthcare providers in assessing his condition.

2. Communicate with Healthcare Providers: Regularly discuss any concerns with his healthcare team. If you notice persistent changes in his heart rate or new symptoms, don't hesitate to reach out for further evaluation.

3. Encourage a Healthy Lifestyle: Support your father in maintaining a balanced diet, staying hydrated, and engaging in appropriate physical activity as recommended by his rehabilitation team.

4. Manage Stress: Help him find ways to relax and reduce anxiety, whether through mindfulness practices, gentle exercises, or engaging in enjoyable activities.

5. Educate Yourself: Understanding the function of the pacemaker and the implications of heart rate changes can empower you to advocate for your father's health effectively.

In conclusion, while fluctuations in heart rate can be concerning, they are often a normal part of the body's response to various stimuli, especially in elderly patients with complex medical histories. Continuous monitoring, open communication with healthcare providers, and supportive care can help manage these changes effectively.

Similar Q&A

Understanding Pacemaker Surgery for Heart Rhythm Issues in Seniors

My mother is 72 years old, taking medication for hypertension, and her blood pressure is well controlled. She experiences shortness of breath while walking, and her heart rate ranges from 45 to 55 beats per minute, with no other discomfort. An electrocardiogram (ECG) and echocard...

Dr. Huang Guosheng reply Cardiology
Hello: A pacemaker can improve symptoms caused by a fast or paused heartbeat, such as dizziness and fainting. The placement of a pacemaker is generally quite safe, with only a few cases of complications such as damage to the heart vessels, pneumothorax, or wound infection. The in...

Understanding Pacemaker Options for Elderly Patients with Heart Issues

Hello, Doctor! My father is 82 years old and recently underwent a 24-hour Holter monitor test, which showed that his heart rate sometimes spikes to 200 beats per minute and drops to as low as 50 beats per minute. The doctor has recommended a pacemaker. My father has had three str...

Dr. He Dongjin reply Cardiology
Hello, the installation of a pacemaker is intended to meet the body's needs. I haven't seen the electrocardiogram, but if a cardiologist recommends it, there must be a necessity for the procedure. It is a minor surgery that anyone can undergo. Based on your description ...

Managing Blood Pressure and Arrhythmia in Elderly Patients

Hello Doctor: A few days ago, my mother (76 years old) was diagnosed with arrhythmia through a 24-hour Holter monitor. The attending physician mentioned that it is not severe enough to require a pacemaker at this time. My mother's blood pressure is maintained around 140/70 m...

Dr. He Dongjin reply Cardiology
Hello, these two medications should not cause a decrease in heart rate due to lowered blood pressure. If you are experiencing discomfort, it may be related to the drop in blood pressure, but it's hard to say for sure. Perhaps you could try temporarily stopping NORVASC to see...

Understanding Pacemakers: Managing Heart Rhythm and Exercise Concerns

Hello, Doctor. I had a pacemaker implanted in early July this year due to complete atrioventricular block. I would like to ask: 1. Because I enjoy cycling and hiking, after getting the pacemaker, I feel chest tightness and a heavy heartbeat when my heart rate reaches 130-150 beat...

Dr. Huang Yinghe reply Cardiology
Hello: 1. The function of a pacemaker is to prevent bradycardia. After the device is implanted, you can still exercise normally. The pacemaker has an activity feature that increases the heart rate during physical activity, which may cause palpitations and chest discomfort. If you...