Heart Beat in rhythm of three

[gregjohnsondsm]

For about two weeks my heart rhythm has changed to a series of three beats, then pause, then three beats, then pause.... I was wondering if others have seen this issue? My dr. has taken me off Metropolol since last Thursday. I tested positive for Covid on Thursday also. Probably had it for at least 1 week. Now I have a mini monitor that is sending out warnings everytime my HR goes to low. Seeing rates in the high 30's to 40's. Excercise gets it back to 60's.
Anyway, I'm hoping that getting off the Beta blocker helps, or recovering from Covid helps. But I thought the three beats was interesting and curious if there is a known reason for this.

 

[Wiles Darkwinter]

maybe

Ventricular quadrigeminy as a manifestation of concealed bigeminy - PubMed

Long rhythm strips were analyzed from five patients with frequent ventricular extrasystoles. The predominant pattern was quadrigeminal; i.e., three sinus beats between extrasystoles. However, about 20% of the interectopic intervals contained numbers of sinus beats (S) greater than three...

pubmed.ncbi.nlm.nih.gov

OR

Premature Ventricular Contraction - StatPearls - NCBI Bookshelf

 

[Superman]

I had that briefly the other day. My wife heard it. I said, “Well, at least it’s regular?” Lasted maybe a minute or not even.

 

[gregjohnsondsm]

Well, the almost cardiologist (Nurse practitioner) decided that I might be progressing towards total heart block. The recommendation is to proceed with a pacemaker as soon as possible. I know that this forum is not probably the place for discussion of pacemakers and options, I respect the well thought out discussions and cannot find a similar site for arrhythmias. So..
Anyone have any opinions on pacemakers / brands / where to have the surgery done? I had my AVR at Northwestern in Chicago but they can't get me in until late in march.

 

[pellicle]

Well, the almost cardiologist (*Nurse practitioner) decided that I might be progressing towards total heart block.

I assume some more diagnosis is planned before that on the diagnosis of a *nurse??

 

[Wiles Darkwinter]

I assume some more diagnosis is planned before that on the diagnosis of a *nurse??

Yeah. Nurse practitioners are very experienced and competent clinicians, but this should be coming from a cardiologist.

 

[Wiles Darkwinter]

If anyone is interested, I did some googling and it appears that Nurse Practitioners in some countries have almost the same authority to diagnose and prescribe medications as doctors, and in some cases they have the same authority. They also specialise e.g. cardiac nurse practitioner etc.
It takes 4+ years of extra study on top of your usual 3-4 year nursing degree many of them hold a doctorate in their field.
So I might humbly withdraw my last comment, until further notice haha

This isn’t a scholarly article but gives the main points:

4 Steps to Becoming a Cardiac Nurse Practitioner | Incredible Health

Cardiac nurse practitioners (CNPs) are part of a team of medical professionals who safeguard heart health. They help care for patients with acute and chronic heart diseases.

www.incrediblehealth.com

 

[pellicle]

t takes 4+ years of extra study on top of your usual 3-4 year nursing degree many of them hold a doctorate in their field.

I'm not sure you should be so concerned, booking you in for surgery is quite a different matter to prescribing drugs.

I would doubt that fitting a pacemaker is something they would do, at most it would be referral to an electro cardiologist and or direct to a surgeon (for their evaluation).

From this page:

​

How To Become A Cardiac Electrophysiologist?​

To become a cardiac EP, one must follow a career path similar to that of a cardiologist, with additional training. This specialty combines surgical interventions with modern technologies and classic patient treatment.​

Some people may enter this specialty with an engineering degree, as it involves an understanding of electrical circuits.​

• Complete a pre-med Bachelor’s degree.
  • Gain useful experience in a medical setting.
  • Keep a high Grade Point Average (GPA).
  • Pass the Medical College Admission Test (MCAT).
  • Complete the 4-year medical school program, including a 3-step United States Medical Licensing Examination (USMLE).
  • Сomplete the 3-year residency in internal medicine.
  • Join a cardiology fellowship.

Obtain the certification from the American Board of Internal Medicine in cardiovascular disease that covers:​

• Heart attack;
  • Valve diseases;
  • Arrhythmias;

Then you must complete 2-additional years in a fellowship in cardiac electrophysiology. It is also possible to train as an electrophysiology technician and assist cardiologists/electrophysiologists with invasive procedures, such as:​

• Programmed electrical stimulation;
  • Electro-anatomical 3D mapping;
  • Catheter ablation;
  • Device implantation for cardiac rhythm management;

and has substantially coherent references to back up those assertions

I suspect the above wording was quite 'loose'.

 

[Wiles Darkwinter]

Yes they obviously don’t fit pacemakers

I was more highlighting my ignorance in that nurse practitioners aren’t “just nurses”.

 

[Lynn]

Gregjohnsonds, ended up with a pacemaker as a complication of my valve replacement surgery. My AV node was damaged resulting in complete heart block. (The upper chambers don’t communicate with the lower ventricles at all) My pacemaker was implanted by a cardiac surgeon, with a couple of pacemaker techs present to make sure the device was working and that it was set according to the surgeons orders. It was done with a local, so I was awake to hear the back and forth.

I am in Canada, so I can’t comment on US system, but here pacemaker surgery takes place at hospitals that have a cardiac surgery program. It isn’t a big deal surgery wise for the patient, (at least not compared to the valve replacement) but it is a very technical procedure. The device and the leads that go into the heart must be properly placed.

For me, with complete heart block there is no choice but the pacemaker. Sounds scary, and it was at first but it works very well. For me, because I have a good natural rhythm in the atria or top chambers of the hear, the bottom chambers are simply paced to that.

Your nurse practitioner may be very seasoned, however in Canada a pacemaker would be something ordered by a cardiologist. Post surgery pacemaker maintenance Is also a consideration. Pacemakers need monitoring and periodic adjustment. I am able to have my pacemaker checks done more locally at the same hospital where I see my regular cardiologist vs the surgical Center. My advice would be find a pacemaker tech you feel comfortable with and keep on their good side lol. Mine is a wiz with the settings and has gotten me in promptly when I have needed something.

Good luck with this. Let us know how it goes.

 

[pellicle]

I was more highlighting my ignorance in that nurse practitioners aren’t “just nurses”.

ahh ... well we're all ignorant about something, what counts is you actually went off and looked into it, then posted back here about that.

top points IMO

 

[Dana]

 

[Dana]

For about two weeks my heart rhythm has changed to a series of three beats, then pause, then three beats, then pause.... I was wondering if others have seen this issue? My dr. has taken me off Metropolol since last Thursday. I tested positive for Covid on Thursday also. Probably had it for at least 1 week. Now I have a mini monitor that is sending out warnings everytime my HR goes to low. Seeing rates in the high 30's to 40's. Excercise gets it back to 60's.
Anyway, I'm hoping that getting off the Beta blocker helps, or recovering from Covid helps. But I thought the three beats was interesting and curious if there is a known reason for this.

Curious if there was any follow-up on this? Above joke notwithstanding, before I got my pacemaker, I had every third beat missing. It's a 2nd degree AV block called 3-2 Wenckebach block, due to, not really a block but, poor conduction between the SA node and the AV node which, for me, was due to radiation treatments 35 years prior that scarred the nerves called the bundle of His that do the conduction but it can happen for other reasons even in young people. (I was 60). Then it progressed to every other beat missing (2-1 block). The solution was for my EP to implant a pacemaker that senses the P waves in the SA node and pulses the ventricle (QRS complex) for you so it works in spite of complete (3rd degree) block which is what eventually happens. You can read more about 2nd degree AV block here. It definitely needs fixing because progression to third degree block can be life-threatening if you don't have an escape rhythm. This is when the heart basically beats itself. (Any cell in the heart can become a pacemaker and start the beating without the electrical pathway from the AV node.) But escape rhythms if you are lucky enough to have one are slow like 30 bpm. If you don't have one then your heart doesn't beat, that's why the pacemaker implant is an easy decision.

 

[Dana]

Sorry about that post, couldn't figure out how to delete it... I just now saw what I had missed previously. The follow-up on Jan 23!

 

[erricojj]

Today, I had a pacemaker installed to correct a heart block degree 2 type 2.

Background:

Had SAVR for bicuspid aortic valve July 2022. 70 yo as of the SAVR. Overall have had a good recovery, completed 36 sessions of cardio rehab, and have gotten back to the gym 3x per week plus additional exercising.

Since I live 1/2 the year in Florida, I decided to establish a 2nd cardiologist there. At our first appointment in February, I mentioned to him that my Omron BP monitor reported irregular heartbeats during the measurement cycle. This was not every measurement, but almost everyday, usually in the AM. The cardio decided to put a 24 hr Holter on me "just to be safe". 2 days later, I recd a call from him that they picked up pauses of up to 2.5 sec 8 times. My pulse was occasionally dropping into the 30s. I didn't really have the classic symptoms they list for heart block, but I might have been getting close...sometimes feeling a little lightheaded.

The cardio referred me to his colleague, an electrophysiologist. He believes there's a good chance that my AV node was damaged during the SAVR as the surgery site is very close.

In all, I feel lucky to have caught this before it degraded to degree 3, or before I experienced passing out while driving. If the Omron monitor, which I bought in October, had not indicated the irregular pattern, I would still be unaware.

Wanted to share that heart block can sneak up on you and we SAVR patients are likely to be at greater risk.