Too much diltiazem - very low heart rate

I have this device I wear on my ring finger that tracks O2 and HR.  It can be set to vibrate on upper and lower HR ranges as well as lower O2 alert.   I have mine set at 88% for O2 and 50 lower and 130 upper for HR.   The device is very accurate when I've compared it against other devices that also perform those functions.  

At 4:49 AM Sunday night my HR dropped from 90 to 30 with data recorded on both sides showing the gradual decline and return to 90 (meaning it was not a data error) It did this again 4 more times in next 30 minutes when out of frustration, I decided to wake up and get an EKG.  

First thing I noticed was despite having CPAP on which keeps me at 95% consistently, I saw a steady decline of O2 into the mid 80s coinciding with the very low HR recordings.  

I then took an EKG which while I am extremely bad at reading these things had a strong resemblance to the tombstone EKG (not a good thing) so maybe this device saved me from edging into the end of all of my concerns and worries.

10 minutes later I am in NSR and other than the high rate all appears normal. 

Dr. Natale's assistant advises me to stop taking the evening dose of diltiazem and last night things were improved, only dips into the mid 40s. But way more of them (12) and through out the night.

Not to be dramatic but I think that my heart was beating so slowly and so weakly on Sunday AM that it was affecting my oxygen levels even with CPAP on that without the alarm and vibration, I might have been headed south for good.

The reason I say this is that many cyclists of my generation were taking EPO and getting very thick blood which required them to wake up in the middle of the night to exercise when their heart rate got too low or risk dying in their sleep (which many did).

An explanation - [youtu.be]

In summary, having some kind of device that alerts you heart and O2 levels might be of huge benefit. Personally, I'm willing to believe this device at the very least provided actionable information about my condition all the way to possibly saved my life.

I'm looking forward to life without these drugs - diltiazem, flecainide etc.

I was at my oncologist once while having steady PVCs and they hooked up an oximeter, as their usual routine, and it was reading 27. They kept me there for an hour until my PVCs passed and my regular hr was displayed on their oximeter. Were you having PVCs?

The tombstone ECG you mention refers to an ST-elevation myocardial infarction (STEMI), also known as a heart attack. STEMIs are not caused by low heart rates or low O2 levels; they're caused by blockages in cardiac arteries.

I think you're reading way too much into this and exaggerating the potential consequences. I would follow the NPs advice, and not wearing that monitor might not be a bad idea either. It's doing you more harm than good by creating unnecessary stress. You're not going to die in your sleep because of some dips into the 40s or even 30s.

first EG was a hot mess - MD said "sinus rhythm with premature atrial contractions"

Second one (10 minutes later) looked very normal and was NSR.

Photo here - [flic.kr]

I normally use the monitor to wake me up if cpap falls off or if not using a cpap to alert me to use it. Some nights I don't need it and avg 93-95 w/o.

In the confusion early sunday AM, I couldn't understand why it kept alerting while cpap was on and I kept taking deep breathes and exhales to stop the vibration. Only when I saw the data did I see the 30s hr and steady declining O2.

Something serious was going on and no way am I not sleeping with this device on - but after last night, I am changing lower HR limit from 50 to 40.

Ad an fyi and btw - I am unaffiliated with this device but it is the best thing I've purchased in last year.

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NotLyingAboutMyAfib
Ad an fyi and btw - I am unaffiliated with this device but it is the best thing I've purchased in last year.

Thanks NLAMA for your recommendation of the Wellvue O2 Ring. Mine is being shipped and I should get it by Thursday.

The reason I want it is because I get uncontrollable painful foot spasms where the toes and foot looks like the scene from The Exorcist— locked and twisted. My GP thinks it’s lack of O2. I get it especially during AF, flutter or PVCs. I also get spells when I walk of feeling like I am going to faint. I think this Bluetooth O2 oximeter will rule out hypoxia. I already am taking three times my usual magnesium to rule out leg spasms resulting from low mg.



Edited 1 time(s). Last edit at 10/05/2020 11:01PM by susan.d.

I originally bought the item after my 3yr old son (at that time) mocked me one morning and made apnea like sleeping sounds "here's daddy sleeping" - I was horrified and bewildered how wife got used to it over the year. Love is not only blind but DEAF.

Device proved to me in just a few nights that I needed a CPAP - after getting one device confirmed CPAP was beneficial.

Device later used to document nature of AF as vagal and I used it successfully to alert me to vagal dip and HR variations prior to an event to allow me to intervene and prevent AF events until the prime mover nature of my AF made me persistent.

I use it now to help gauge quality of sleep. But what happened sunday/monday is the best value so far.

[flic.kr] Does anyone know - are those random spikes ectopics? AUg 2019

[flic.kr] Blanking period sleep w/o cpap sep 2020

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NotLyingAboutMyAfib
[flic.kr] Does anyone know - are those random spikes ectopics? AUg 2019

[flic.kr] Blanking period sleep w/o cpap sep 2020

Are data averaged or beat to beat? If beat to beat, can you zoom in and look at say a 5 minute or 20 minute window, where you can see the individual beats?

The first ECG you posted was indeed a hot mess, but it was a hot mess of ectopics. Looks like a mix of PACs and a few PVCs. Nothing to worry about.

And just know that nothing going on here is going to cause you to die in your sleep.

This device only does every 4 seconds. I have a Polar model that does every sec but also requires a chest strap.

But even back in 2008 I had the same pattern so maybe my AF was long overdue. I am going to check an old computer and see if any of those are stored.


Cool Carey - I hope you're right but I won't get to argue the point if I was. LOL

I didn’t know it was only 4 seconds. I was hoping for live O2 readings. My cheap oximeter does a tad faster. My iWatch records hr around 4 seconds too.

I haven't been in NLAMA's situation, but I have noticed that Diltiazem can really lower my HR. I only use it for rate control during AFIB, it works, but I only take 30mg of the short-acting formulation at a time, because my HR went down under 50 taking 45mg.

Multaq also lowers ones hr
That’s why I cannot be on a BB while on multaq to calm my PVCs. I have to wait until after my blanking to try to rid my PVCs like my index.

Nlama,

Have you ever consider the possibility that your wellvue is wrong? Mine was, It’s a cheap Chinese device that relies on outdated software. Sleep apnea was one of the causes my dad had afib and ultimately a stroke, so I’ve always been careful about my sleeping o2 levels. There are plenty of devices out there to monitor your O2, and many months ago I tested the welllvue along with my wife and we both experienced inaccuracies over a month of usage in terms of sleeping heart rate and o2 readings, we both had apple watches and kardia (fda approved) and months of data to compare it to. I can say with certainty that wellvue isn’t at all a device you can rely on. Slight movements and placement of the device will affect the readings. My advice is to get another o2 device and possibly the new Apple Watch to compare the heart rate and o2 readings.

On a side note, I solved my sleep apnea by taping my mouth shut for about 6 months and my brain just relearned to keep the mouth closed and now I always sleep with my mouth closed and still monitor my o2 levels every 3 days or so and never see any drops below 92.

JohnnyS- I wished you posted last week! They have a refund policy but I believe I will be paying a lot in shipping both ways. I regret now not getting it from amazon so I could cancel it. I just bought it the other day directly from wellvue and it’s being shipped. I have the iWatch and Kardia for hr but they can’t detect O2. What Bluetooth O2 monitor do you recommend?

My device seems to be accurate when I test it against Polar products, and other O2 devices. The only exception is that the Wellue ring doesn't work when I ride the bike because my hands on the bars bend my fingers to have no contact with the ring. I'll do some double checking today but I never had any doubt about the device or accuracy. I can run 4 devices at the same time to see.

AFAIK all electronic devices are cheap Chinese made, my only complaints about Wellue is that the silcon surround tends to catch on the sheets while sleeping and that it has 4 second intervals for recording vs per second.

Susan - relax - see if the device helps you then worry about returning.

Some results - I'll update

Polar HRM and O2 ring on HR - agree within 2 beats at 100 bpm (101 and 99)

O2 Ring and fingertip O2 sensor - agree within 1% or same - varies

Polar and fingertip sensor - cheap sensor off by 40-50% (maybe because afib isn't read well??) I'll test on wife later.

To Johnny's credit some Amazon reviews mention accuracy in 1 star reviews. And the 5 star reviews seem peppered. I also see some comments that Wellue deletes the ad when they get too many bad reviews and start fresh with a new ad.
This is probably SOP with most products.

In my view - even if the device was inaccurate but consistent in its inaccuracy (always reporting 2-3% under or over) I can live with that for the ease of use and features it has.

To date, the device has helped me many times and in many ways.

Excellent honorable company. I emailed them and if I refuse the O2 device package I will get a full refund. I get a generous discount at Apple and am investigating possibly getting the new iWatch with o2 down the line. I had my spasms again in which my toes locked up during PVCs. It’s a coincidence I had a pulmonologist appointment yesterday and he was not a fan of the device (only because it’s not medical quality) and is sending over a medical o2 holter. So JohnnyS post was of interest. That should help in my decision. I also have a very good oximeter for spot checks

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johnnyS

On a side note, I solved my sleep apnea by taping my mouth shut for about 6 months and my brain just relearned to keep the mouth closed and now I always sleep with my mouth closed and still monitor my o2 levels every 3 days or so and never see any drops below 92.

As you can see in the graph I posted here, even though I've been taping for years, I have to continue or else I get apnea.

[www.afibbers.org]

Susan - as long as you find something that works for you.

Does apple alert you with vibration on both O2 and HR ? (lets your partner sleep)

For me this is the main feature of the ring. Even if wrong - for instance, reads too low, I can sandbag the alert levels. But so far I see no need to do that. My device appears to be accurate and continues to hold a good charge.

NLAMA/I don’t know about the new iWatch, but mine I set 50 HR as my minimum alert and >100 for my maximum. It will vibrate after 30 minutes of low, high or AF. At any given time I can take a look at my hr app on the watch. It will show approximately every 10 minutes or so spikes what my hr has been. Today I was outside watering and dragging the hose. My watch showed my hr went from the low 60s to 104. If I keep the app open on my watch, it will refresh with my latest hr every 10 seconds. Right now it is 71, one minute ago it was 70 as an example. A friend works at Apple and added me to his friends and family list so I get his generous discount once I decide to upgrade. I just happy with my older model. I would need more bells and whistles to spend the $. Aren’t they developing a glucose sensor (smell?)

[www.wareable.com]



Edited 4 time(s). Last edit at 10/05/2020 11:00PM by susan.d.

George,

My issue wasn’t only the apnea which was moderate, but also the sleeping position so I recorded myself with a camera for an entire week and this made me realize that the body shifts and you end up all twisted especially if you had a late night meal and you’re not tired or can’t fall asleep. So I changed my habits, no carbs, sugar or dairy and don’t eat after 4pm, sleeping on side only with elevated head straight and going to bed only when extremely tired, otherwise if you can’t fall asleep laying there your body tends to reposition often and your position of spine, chest and neck constricts the airways and makes the O2 drop. I still do a video recording once in awhile and I’m amazed that my body barely moves other than going to bathroom once at night. So basically I sleep in the same position either left or right side and it has worked for almost two years.

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johnnyS
My issue wasn’t only the apnea which was moderate, but also the sleeping position so I recorded myself with a camera for an entire week and this made me realize that the body shifts and you end up all twisted especially if you had a late night meal and you’re not tired or can’t fall asleep. So I changed my habits, no carbs, sugar or dairy and don’t eat after 4pm, sleeping on side only with elevated head straight and going to bed only when extremely tired, otherwise if you can’t fall asleep laying there your body tends to reposition often and your position of spine, chest and neck constricts the airways and makes the O2 drop. I still do a video recording once in awhile and I’m amazed that my body barely moves other than going to bathroom once at night. So basically I sleep in the same position either left or right side and it has worked for almost two years.

Thanks!

I'm sure sleeping position is an issue for me. I am never tired, always have tons of energy, and I've never been able to sleep on my side. I usually start on my stomach and end on my back. I also try sleeping with elevated head, but that is face up. With mouth tape on, this gives a reasonable night's sleep per my Oura ring and the uninterpreted data (heart rate, heart rate variability, breath rate, temperature). If everything isn't perfect, I don't get to sleep. I don't eat processed food, sugar or dairy. I do eat leaves and unprocessed veggies. I don't eat after 6pm. I don't mind wearing the tape and get good sleep with it. I do prioritize sleep and am unwilling to forego sleep & stay up a number of days (which is what it would take) till I'm really tired enough to sleep in any position.

Johnny, I sleep about like you except trade sides every 2-3 hours or after nature calls. Sleep is complicated because 4 yr old son comes in most every night by 4 or 5. Last night 11:58. We only have a full size bed. So it's elbow to elbow for everyone and he kicks like mule, so sleep quality suffers.

My # 1a requirement for sleep is a cool room 68 or lower but I no longer tolerate below 32 like I did when I was young. 40s and 50s are fine though. #1b requirement is a fan blowing the stale air away from my face. A breeze of some sort is a necessity. Without it I feel like I am suffocating.

Good cotton sheets, down pillows and blankets of different weights and densities and a very firm bed are all #2. I am a pretty picky sleeper.