Complications

I am new to this site and am looking for some advice. I am a 50 yr old female and I had a Medtronic Dual Lead Pacemaker installed about 3 weeks ago. Since that time, I have been having trouble with increased heart rate (above 100) when walking short distances and also major palpitations and irregular heartbeat. It is nothing new for me to experience the irregularities but not typically to this extent as medication was keeping it under control. The increased heart rate with activity is something new since the PM. My cardiologist tells me none of what I am experiencing is dangerous, the PM is doing it's job of keeping my heart rate from dropping too low and that my body needs time to adjust to the PM, which could take 2-4 months. We have tried increasing medication but that seems to make things worse but my before PM dosage is no longer working. I can't sleep due to the craziness going on inside my chest. I need some relief and don't know what to do. Has anyone ever experienced this? Even though the doc has said it's not dangerous it is still creating a lot of anxiety, which is probably making things worse. Help!

9 Comments

Sick Sinus/Tachy-Brady Syndrome

by kwhite62 - 2012-10-27 01:10:56

Thanks for your response.
I take meds for Tachy-Brady Syndrome and had the PM put in for Sick Sinus Syndrome.
I have had my check up (went 2 weeks early due to all the issues I was having) but the doc made no adjustments to the Rate Response....he said everything was working as it should and that I was having no serious or life threatening issues. He wants to treat the irregularities with medication and right now I am experimenting with the dosage to see what will work...if it will work. I would prefer not to take meds but it seems necessary in order to control the racing heart beat I was having.
I guess I just don't understand why all this has reared it's ugly head after the PM was installed. It was supposed to make me feel better, not worse.

I also agree

by TalkinCardio - 2012-10-27 04:10:52

with Frank and TraceyE. Dont settle with the way you are feeling. It took at least 4 adjustments to my settings before I felt comfortable again. The rep from Boston Scientific spent a lot of time with me to get it settings right for me.
Good luck, Cathy

Another question....

by kwhite62 - 2012-10-27 08:10:05

Thank you all for responding. The information is helpful. I do have another question....I understand the relation between heart rate and the rate response adjustment. But what about the irregularities I am experiencing? Especially when it's time for bed and I lay down. That's not the only time it happens but I guess it's more noticeable because I'm still. Would the rate response adjustment have any affect on this?

rate response

by Tracey_E - 2012-10-27 09:10:00

Ditto everything Frank said, with special emphasis on the rate response and medtronic technician parts. The pm can be working fine, it can be perfectly safe... that does not mean the settings are right for you and don’t need tweaked. RR has a number of sensitivity settings. It can take a few tries to find the right balance between not going up when you need it to and not shooting up every time you sneeze.

Effects of pacemaker

by ElectricFrank - 2012-10-27 12:10:21

Have you had your first checkup yet? You are likely experiencing the effects of an option called Rate Response which responds to your body movement using it to increase HR during exercise. RR can be turned on or off depending on your need. It can also be adjusted to better match it's action to your body. The pacemaker comes from the factory with default settings that are only intended to be safe for most users.

There are 2 sets of common conditions that require a pacemaker. One is called Sick Sinus Syndrome and has to do with the hearts natural pacemaker being unable to pace your heart at an appropriate rate. This is where RR is useful as it provides this function.

The second problem is one of the electrical blocks such as AV Block or the poorly named Heart Block. In this case the hearts natural pacemaker paces the upper (atrial) chamber normally, but a defective nerve bundle fails to conduct the information to the lower (ventricle) chambers. The result is usually a very low HR that doesn't respond to exercise. This requires that the pacemaker sense the beat of the upper chamber and use it to pace the lower chamber. There is no need for RR with this problem and it actually interferes with good rhythm.

There is a growing tendency for cardiologists to ignore the distinction, and just try to convince the patient that they just need to put up with the discomfort. Saves office time. One suggestion is to ask for a copy of the Pre and Post Interrogation report at each office visit. This has the effect of letting the clinic know that someone is watching who may understand. Another is to ask to have the Medtronic rep do a programming session with you.They are generally very competent.

It's best if you can avoid the meds if possible. Most have side effects that are unpleasant.

frank

Hmmm, I'm thinking

by ElectricFrank - 2012-10-28 01:10:33

As long as you are lying still the RR shouldn't affect the rhythm of your heart. However, some arrythmia's become worse during times of low HR. With a longer interval between beats there is the opportunity for errant stimulus to sneak in. You might try sitting very still in a chair to see if the problem shows.. If it is associated with a low HR they can set the lower limit to a higher rate.While its nice to have a resting rate down around 55-60, there's go problem with going up as high as 70 if it helps.

Another source of irregular beats is pressure on the vegus nerve which serves a number of areas of the body including the heart and stomach. Sitting leaned slightly forward can often create an attack of bradycardia from pressure of the stomach or intestines on the vegas nerve. You can also put pressure on the nerve while lying down due to the weight of the abdominal contents. I like to call it the Las Vegas nerve it's such a gamble.

And finally there are irregular beats called PVC's. These are experienced as a skipped beat followed by a heavy "thumper". They can occur individually or in runs. They are the most benign, yet the scariest of the things the heart can hit us with. They also can occur when laying down and are made worse by anxiety.

hope some of this helps,
frank

That may be it....

by kwhite62 - 2012-10-28 07:10:32

The PVC's you describe sound like what I experience. The skip then the thump that feels like my heart may beat right on out of my chest! The doctor has told me it is not dangerous but goodness, when it gets going it's really scary!
I am not taking a beta blocker....I take an anti-arrhythmic drug called Sotalol. I am taking a very low dosage right now. Post PM I started having all these problems so the doc increased the meds twice...up to 120mg twice a day. I couldn't tolerate it and things seemed to get worse. The doc gave me permission to adjust the dosage and see what would give me relief but not cause too many side effects. So I have gradually dropped the dose down to 40mg twice a day which is what I was originally taking. The elevated heart rate seems to have calmed down...at least I don't feel the palpitations with it. And, the PVC's as you called them have lessened a great deal, too. I actually got some sleep last night!
So do you guys have some medical experience or are you fellow pacemaker owners who have educated themselves? Just curious because your comments have all been very helpful. And it's always encouraging to hear the experiences of others and to hear the word "harmless" even though the doctor has told me that several times!
Thanks again for all the help!! I'm hoping things continue to improve over the next few days and weeks.

bedtime

by Tracey_E - 2012-10-28 09:10:18

Random thought, are you on a beta blocker in the morning? It can wear off by evening. I take mine as soon as I get up so it's full strength when I workout, but by evening I get some racing as it wears off. I talked to my dr about it, the days it's a problem I take an extra half dose. Usually I'm just hanging out at home so it's an annoyance and I deal rather than take more.

ditto Frank's comments about PVC's. Harmless but oh so uncomfortable and frustrating.

school of hard knocks

by Tracey_E - 2012-11-04 08:11:11

Frank is an engineer, I'm a computer geek. Neither of us has any medical training. I was born with a rare condition. I learned early that most drs have never seen what I have so I'd better be informed. I have great drs who are good about explaining things to me when something new comes up.

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