100% paced and fainting

Hi all,
I had mys pacemaker put in 15 months ago and they completely ablated my AV and Sinus nodes (lots of reasons). Generally I feel better than I did before (at least now I can get out of bed and actually have blood pressure). :-)
My question is about the pacing. I have responsive pacemaker that does adjust to different demands placed on my heart, and my cardiologist has made multiple adjustments to get me the best rates, etc.
However, I am finding that I can't stand up after sitting for a while, or stand for very long (especially while cooking), as I have a tendancy to faint.
Any ideas why this may be happening, or what could be done about it?
Thanks.

2 Comments

NCS/VVS

by jenny97 - 2012-01-19 09:01:52

First, I hope you've spoken with your doctor about this. Hopefully (s)he will be able to work to minimize this kind of problem and, at the very least, rule out any life threatening conditions.

Second, if you've been sick and spent a lot of time lying in bed or just resting, you may need to take it slower as you rebuild your strength and your tolerance to vertical activity.

That said, this sounds like it could possibly be neurocardiogenic syncope/vasovagal syncope, which results from a sudden and/or large drop in blood pressure. This is generally NOT considered a life threatening condition, because when your blood pressure falls, you lose consciousness and, in a supine position, your bp increases to a life sustaining level.

Unfortunately, most pacemakers do not help directly with the bp. They can only work on the pulse which, it's hoped, will help with the bp issues. The Biotronik Evia, which is the only PM FDA approved for this condition, works a little more directly on the mechanisms that cause the drop. I don't fully understand the mechanism though, so I won't try to explain it.

Other PMs that are sometimes used to treat this condition include a rate drop response setting that senses when your heart rate drops by more than some number of beats in a pre-defined amount of time. Mine is set to sense if I lose 30 bpm in 30 seconds. Then it kicks in at a preset (higher) rate to try to get the bp back up. Mine kicks in at 95 bpm for 2 minutes. The theory is that this will increase the bp sufficiently for my body to take over and maintain the normal bp.

In any event, you can have a decent pulse and still experience sudden drops in bp, leading to loss of consciousness.

Most people I know of who suffer from this debilitating but NON-life threatening condition, are treated with an increase in sodium (Mayo told me 4-6 grams of sodium a day to start), increased fluids, exercise (particularly lower body - like recumbent biking or rowing), and medications (such as midodrine or florinef). We are also told to get up very slowly after sitting and never to sit for longer than an hour without taking a few seconds to stand up.

One thing that's been helpful for me is to identify my specific triggers. If you haven't already identified patterns, you might try keeping a record of your symptoms. Then coming up with a plan that will both keep you safe and help you build up your tolerance for those activities might be helpful. For me, standing and cooking is a trigger, too, so I always drag a chair into the kitchen and sit while cooking or in between cooking tasks if I feel faint.

All that said, it's a pain to manage this condition. I went 5 years with no fainting spells and then (despite running 4-5 miles a day and still having a PM) suddenly began having numerous fainting and near-fainting spells. I haven't re-stabilized entirely yet, but I hope things will normalize for me soon. And I definitely hope the same for you.

Good luck!

Thanks for the feedback

by collyer3 - 2012-01-20 04:01:10

Hi jenny97,
Thanks for the feedback.
I have spoken to my cardiologist about this a couple of times, but still trying to get to the bottom of things. I do have a Biotronic Evia implanted, as it is rate-responsive, and it was hoped it would help with this issue.
You have given me some good ideas before I speak to my cardiologist in 2 weeks.
It's also nice to know I am not the only one.
Thanks again.

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