Uses of Pulse Oximeter in Rhythm Monitoring

[Jerry_NJ]

Most (all?) of you have seen the small clip-on-the-finger over a finger nail used in doctor offices to measure the Oxygen Saturation level in your blood (target 95% or better I believe).  These doctors don't have a pulse display on their units or simply prefer the manual method to measure pulse rate, which both the nurse and doctor do, the doctor of course also listens to my heart with a stethoscope.

It is difficult for me to feel my pulse (a blessing in many respects) and I have for years used a stethoscope to count my pulses, heart rate.  The only indication I have of the blood oxygen saturation is if I am dizzy or breathless more than what I recall as normal.  I have thought that it would be helpful to be able to measure the O2 level at those times and even to run a DIY sleep test (this in general would require a recording meter).

When I saw this type instrument with a combined HR and O2 plus a pulse intensity readout for under $25 delivered I ordered one.

Here's what I learned for my profile and what I have concluded about a number of aspects of my AFib condition on my physical being.  I compared/checked the device HR by counting my HR while using the clip on, good agreement.  I checked my wife who does not have any diagnosed heart conditions and found reaso6 nable readings and a smoother more uniform heart intensity readout than I got for myself with AFib.. as expected.  I take the intensity differences between her and me indicative, not quantitative even though it is provided via a 6 bar readout scale.  

I found my O2 consistently obove 95% even when I was feeling O2 starved, like when standing up quickly.  I also found my HR reasonable and in the 70s when resting and typically around 100 when in light physical activity.  

Now for sleeping, or really maximum rested times.  

I did not get a recording meter for $25, but as I wake up often during the night it is easy for me to clip the device on with minimum physical effort when I wake up.  Some interesting findings (to me) - I am on a normal release Metoprolol (BB) and Calcium CB which is taken at about 10:30 PM, so by 1:30 AM I am still in the fully medicated area of the BB concentration (half life of 4 hours assumed).  

Early in the morning (around 2 AM) I found my fully relaxed in bed HR as low as upper 50s and O2 levels as low as 90%.  Later in the morning (around 5 or 6 AM) I found my HR around 70, suggesting the BB had lost a considerable % of its strength (now in its 2nd half live, about 75% metabolized) and the O2 levels over 95%.  This seems reasonable and in fact during the day my seated and fully resting HR runs in the 70s to 80s.    The lower O2 level of 90%, which is the threshold of trouble as I understand, at 2 AM is a minor concern to me.  This many not be a trouble indicator under the condition of being under BB and CCB near full strength and just in/out of sleep resting state.  I continue to check and see if my results are consistent/repeated.

In any case I find having this testing device affordable and quick way to check my HR, and also get the O2 saturation  -  the value of the heart intensity readout is not clear, but does give me some concern... guess it is the variations I hear with the stethoscope.

[DeltaDawn23]

Jerry -- if you indeed have sleep apnea, it could be contributing to your ongoing afib.  My ep thinks my afib was caused by my (undiagnosed) sleep apnea over a number of years.  

I have used the cpap for 10 years and after a period of adjustment, it is not too bad.  I would prefer not to need it, but it is tolerable and I can't imagine trying to get along without it.  I was exhausted all the time without knowing why before I got the machine.  They do have a Nasal Aire II cannula type device that makes it possible to use with out having a mask sitting on your face, something I could not tolerate.

I just purchased a pulse oximeter and have notice when waking my oxygen is low, then slowly comes up.  I am due for a pulmonary consultation and perhaps another sleep study, so will inquire then whether this is an issue I need be concerned with.

I am in the process of switching from Norpace (been off of it for 3 days) to Rhythmol (start tomorrow).  I have been using my Atenolol and Xanax and have had just a few flutters after the first day, when I had some irregular beats.  Makes me wonder if the Atenolol alone might control it.  I see my ep in 2 weeks for an ekg and a visit to determine how I'm feeling.  I hope the Rythmol works, altho reading the precautions is the stuff of nightmares:P  I will be interested to see how it all shakes out.

Take care and keep us posted on how the sleep study goes.  Cpap is not all that bad if it comes to that and you may well feel a lot better stamina-wise.  Good luck.

[Jerry_NJ]

I had chest X-rays and when with them to a Pulmonary Specialist. He said no lung problems were indicated from the X-ray images.  But visible inspection of my throat (wind pipe) and the Oximeter record he prescribed a Sleep Study.  That will take place tomorrow night at my local hospital.

I sent a friend (fishing buddy of the past who is about 10 years younger than me) my story about the upcoming sleep study. He wrote back that he has been using a CPAP for about 4 years, and LOVES IT.  He said it showed him how good he can feel when he gets a good night's sleep.  I still hope to avoid, the Pulmonologist said some of the minor constriction in my throat could be due to being overweight, the standards says I am obese at 250 and 6'5"  I find that term obese an overstatement of my case, I weighted about 230 when I was still a runner. But, I'd rather try to lose 25 pounds than have to deal with a CPAP.   So, some good news:  Lungs look okay (in spite of my history as a past smoker) and the purchase of the Oximeter put me on the path of getting this health problem examined.  Yes, and my new doctors have all accepted me as a Medicare patient - thus my personal out-of-pocket cost will be no more than 20% of the reduced Medicare rate schedule.  I do have a secondary insurance plan but my health is so "good" I have not even paid the deductible in recent years. My secondary pays nothing until I pay the deductible as is normal.

I am not sure how much this tracks "Heart Rhythm" but as the subject says, I purchased the Oximeter to help me adjust my beta blocker (now Antenolol) that is use the heart rate reading, which I have.  I am now up to the full prescribed beta blocker dose of 25 mg every 12 hours.  I think I have adjusted to Antenolol sufficiently for that level to not "too much" dizziness when I stand.  I will report here too on the results of the Sleep Study.

[Jerry_NJ]

The US Health Care system is still working great.  Look at the progress in under 10 days.

Monday March 25, Annual Physical Exam.  I mention to my doctor my continuing congestion problem and my sense of suffocation sometimes when I awake form sleep.  Told him I have my own Oximeter and have observed oxygen saturation levels below 90% for brief periods.

Wednesday/Thursday March 27/28 I wear a recording Oximeter with results reported to my primary care doctor Thursday or Friday.  The equipment was delivered and picked up form my home by the COPD service company.

Monday April 1, I get a telephone call form the COPD company suggestion delivery of oxygen, I said "hold on" I haven't yet discussed with my doctor.l

Tuesday April 2,  my doctor agrees supplementary oxygen is not yet confirmed as needed, refers me to a Pulmonary specialist.  Gives me a copy of the report that shows I logged over 8 minutes in the 85/86% saturation level.  I telephone the Pulmonary Specialist for an appointment, one was set for Thursday morning, April 4, and I was sent to hospital for chest X-rays which were completed within minutes of my arrival.

Bad news, is it appears I may have COPD or Apnea problems.  I may undergo a full Sleep Study, that has not yet been determined.

The value of the Oximeter I purchased has proven to be high, I would not have asked for a recording oximeter at home test if I hadn't observed the low reading when waking during my sleeping period.

[Jerry_NJ]

I would be surprised if a O2 o 96% would cause any symptoms, or "feeling bad".  I just checked mine an it reads 97%, I don't recall ever seening 100% and a 99% is very rare for me.  

As for feeling bad when walking, I can no longer walk up a hill without stopping... I think it is more a question of my legs feeling very tired/stiff, not of being breathless.  I attribute all of this to my AFib and my beta blocker med.  

This being a weekend and Easter as well today, I have nothing back from my doctor on my overnight O2% recording.  I will ask for a copy of the data to look at myself and will have a few questions if he says all looks okay.

One question is about the 02% going down to 90% or lower, even if just for brief periods... or asked another  way, is it normal when one is asleep for the O2% to drop as the need for oxygen is much reduced when in t sleeping state.

My wife said this morning that she awoke an noticed I was breathing very softly, then more normally.  She said she put a hand on my side to feel for breathing as the sound was too low even for her excellent hearing.  

I man need ot go in for a "sleep study" if there are any questions from the Recording Oximeter test.

[helyanna]

I hope that you will get help and be well.

I have had a couple of times nasal congestion when suddenly woken. I have postnasal drip, and my eye pain is continuying.

Recently I have found oxygen readings slightly lower than during AF. When I was walking outside during AF, my ox.% went often to99 or 100. Now it often goes to 96 during walking and I don't feel well during walking.

I have the result of a spirometria test done on March 4. There I see that MEF50 is too low, 47% before and 56 after Ventoline inhalation. The result is similar to that from a few years ago, when they said to me that I have some obstruction in my smaller bronchioles. No cause is known for this. I don't smoke. Could there be some connection with the obstruction and AF? Could AF have damaged my lungs and therefore I don't feel well during walking? I have not yet had a doctor's consultation about the spirometria result. It has to be noted that I had a long-lasting respiratory infection in January-February of this year.

[Jerry_NJ]

Prescribed Oximeter over night run made last night 11:30 PM to 7:30 AM this morning. The unit is a compact finger unit (just the Modem) with a flexible 6' or so cable connecting it to a small (about size of a medium human hand) recording and display unit.  It displays heart rate and oxygen % in real time.  The finger unit was secured by me with supplied "No stick" medical tape. I put tape around the cable and around the "clamp on" Modem.

While my concern expressed to my PM Doctor was sleep apnea, the test service is about COPD, which is the test that was run, I now understand.  I suppose if I stopped breathing for brief periods that too would show a  sudden drops in % oxygen.  I will ask my doctor about that.

An immediate concern to me was that I observed a O2 reading in the low 90% many times during my awake times. These did pass with the reading returning to 97% or more for most of the time.  I could not associate the lower readings with any sense of suffocation, our difficulty breathing.  As always I struggled with nasal congestion.

This experience is yet another experience I have with the wonderful USA medical system that I fear we will lose as the new governmental takeover of our healthcare rolls out. Here's this example of the VIP medical service we get in the USA, even those of us on Medicare with its lower payment schedule:

Monday my annual physical - doctor prescribes over night oximeter record
Wednesday equipment delivered into my hands
Thursday I have the unit packaged for a pick up by the testing company
The COPD service will read out my unit today and report today to my primary care doctor... all done in one "work week".

I believe my symptom and the prescription of testing for COPD is considered time critical, patient is at some risk of sudden complications, even death. This thinking (mine) may be what puts this test service on a "fast track", still, from what I read on this Community and in the general news this type of expedited service is not provided in many or (all?) the countries in which the government manages the delivery of health services.  I believe the USA is on a path to diminished health care, a deep sadness to me for my children and all our citizens.