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Discussion

Pacemaker

Hey there. I am new to this site so any help with my problem will be appreciated. I have a resident at a LTC facility that about 2 months ago was placed on a pacemaker. Within in the last 2 months she has become increasingly confused, agitated, and very weak. The thing I dont really understand is that her pulse, at times, is about 100bpm. I cant see how this is normal or harmless. If someone could give me any suggestions or sites to find my answer I would greatly appreciated! Thanks!:confused:

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Her increased confusion probably has nothing to do with her heart or her pacemaker....i'd look into other possibilities.

Also, people get different types of pacemakers for different reasons. The most common is 'bradydysrhythmias',...meaning heart rates that are too slow (ie. various heart blocks, symptomatic sinus bradycardia, etc.). The way they usually 'work' (without going into too much detail) is that they'll function and/pr pace the heart if it's beating too slow.

The pacemaker can 'sense' a heart-rate and pace if necessary. So, if your patient's heart rate is 100, the pacer is probably just 'watching' it...and wont start to pace unless the rate gets too slow.

hope that helps a little...

  • Admin

I'd be interested in what kind of pacemaker she has in, and how it's programmed. DDD? Is it a dual-lead/dual-chamber? Most are these days, but there still may be some single-lead pacers placed, and they may not always be what a pt needs. I know of some pts who had single-chamber placed, and didn't do well, were tired all the time. They went back to their Cardiologist (or changed MDs, I can't remember), who upgraded their pacer to a dual-chamber.

Your pt might need a programming adjustment, too. What was the underlying rhythm? Is it pacing at all or is the 100 bpm her own rate? Perhaps a lead slipped out of position and isn't sensing correctly. This has happened. The pacemaker parameters and function are one of many possibilities to check on her. Her symptoms seem too coincidental to the recent placement for me not to be suspicious of malfunction. Just my two cents.

I agree with dianah, I'd recommend the pt's pacemaker be checkout to make sure it is still working like it should.

Yes, the pacemaker should br checked out. But also try to talk someone into doing a urine cult, and possibly a blood cult.

The sx you describe can also happen to LOL's with a UTI. Sometimes I am amazed at what a UTI will do to the elderly.

bob

I agree w/2ndcareer RN.

A UTI(or other infection) is probably a much more likey cause of this pt's symptoms than a messed up pacer.

When was the last time a slipped pacemaker lead caused confusion??? I'm wondering what symptoms people are basing their assumption that the pacer is malfunctioning??(other than coincidence)

The Heart Rate of 100bpm wouldnt worry me... of course this may be a clue the patient is refusing his dig/lopressor/amio, etc. Or if he IS taking his meds, a dosage adjustment may be in order...however i doubt it...100BPM isnt dangerous.

If his pacer WERE malfunctioning you'd more likey see rates that were too slow (failure to CAPTURE), or VERY fast rates w/subsequent black-outs(failure to SENSE, causing pacing on a T-wave and inducing VT or Torsades.... VT and Torsades at 100bpm is unlikey.) .

  • Author

Thank you all for our replys. The resident has already been checked and treated and rechecked for a uti. That was my first thought too. I will check more into her pacemaker. Thanks a lot!

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