Shortness of Breath

PM fitted in April 2013 with some complications (including intermittent AF). Thought I was getting over everything, but get breathless with exercise. Recently I was taken to A&E because of SOB, PM was working 100% (60bmp, unusual for me) and they changed my PM setting from DDI to DDD. I felt better (85bpm) and was discharged. Now a week later and I still have the same SOB with exercise (eg a Shower or a flight of stairs). I have moved my PM checkup forward to next week so I can discuss with my doctor.

Questions?: What is the difference between DDI and DDD? Can SOB be PM related or more AF related? Should I discuss an Ablation? Anything else to question them about?

I have got to admit that I am really fed with all of this. My Dad who 75 also has a pacemaker, and is fitter and more able than me (47)! Any suggestions really appreciated.

13 Comments

Afib

by ebfox - 2014-01-17 01:01:12

I have to respectfully disagree with the earlier comment on Afib. If you are in afib, you are likely going to be exercise intolerant and short of breath. (ask me how I know)

That said, some of the comments about a potential blockage offer a possible cause; you need a heart cath to determine if that is the case. The enzyme test you had won't show if you have 90% blockage- you will find out after your heart attack. Do you have any chest pain? The magic words to get a heart cath are "I have chest pain, my left arm hurts and I am short of breath..."

Anyway, good luck on all this, I know it is frustrating.

E. B.

Swapping Cardiologists in the UK

by IAN MC - 2014-01-17 01:01:47

Hi Tiger just an observation on your comment re the difficulty of getting a different consultant here in the UK.

My GP seems to be all-powerful in getting whichever consultant-referral he recommends ( and what I persuade him to do ! ) . After pushing from myself, I have now seen 3 different cardiologists. But if you have the means to go private, go for it ; as long as you don't end up with the same guy , with the only difference being loads of bedside manner at an extra cost !

Best of luck

Ian

safasf

by boxxed - 2014-01-17 07:01:27

Everyone's experience with AF is difference. Some are symptomatic, some don't even notice. Some are only symptomatic to the actual fibrillation of the atrium, and some are only symptomatic to the RVR from the AF.

Best bet would be to keep log of days/times you are particularly short of breath, and compare notes with your doctor. PMs have wonderful logs and recorded diagnostics, especially when it comes to AF. There may be a correlation. If not you know it's not the AF and the doctor can investigate other causes.

Cardiac Enzymes test

by BigThinTiger - 2014-01-17 09:01:09

No Cecil, but I did have a cardiac enzymes test which was normal (after a second test), so I was told I had not suffered a heart attack. Is that the same thing? I'll ask anyway next week. (Learning fast). Ian

SOB

by manaman - 2014-01-17 09:01:29

Have you had a hear cath done to check for blockages?
Same symptoms I had (3 different times) each time stented and immediate results for the better!
Cecil

SOB

by manaman - 2014-01-17 10:01:29

Enzyme test WILL NOT reveal blockages!
In fact neither will ANY test including stress,EKG etc at a constant % and NONE will tell the percentage of a blockage! The ONLY REAL test is a heart cath!
My example of first heart cath back on 12/27/2009 went like this:
Taken to local ER via ambulance and had the following test done: (stayed in ER for 12 hours)
1. chest x-ray 2. enzyme test (three times) 3. EKG
ALL test were negative!!???
ER doctor was going to send me home with indigestion!!
Asked him to contact my cardio dr at DUKE and after doing so was transported to DUKE after 6 more hours of waiting (and tons of nitro for chest pains and left arm discomfort)
Arrived at DUKE and a heart cath was done immediately which revealed two blockages (in the same artery) one a 95% blockage and the other an 85% blockage. Two drug emmiting stents placed and I IMMEDIATELY felt better.
Reason for me going to local ER was I could not walk a flight ok stairs or even walk 60 yards pushing a wheelbarrow to my garden.
DO THE CATH (if you can) It's fool proof and will also show any developing minor blockages!!
Cecil

From my Medtronics manual

by KAG - 2014-01-17 11:01:15

In DDI mode, sensed atrial events are not tracked. When an atrial event is sensed, atrial pacing is inhibited, but a SAV interval is not started (see Figure 51). Instead, ventricular pacing is delivered at the current pacing rate (for example, at the Lower Rate)...

DDD is an atrial tracking pacing mode. Atrial tracking means that when the device senses an intrinsic atrial event, it schedules a ventricular paced event in response (see Figure 50).

I'd ask for a copy of your PM interrogation report and see what your upper tracking rate is set to. Sometimes if the upper rate is set to low you'll get SOB when exerting more.

I don't have any experience with AF so not sure on that but I'm sure others will chime in.

Keep asking questions. Sometimes it can take a while to get things adjusted for you, but if your SOB is due to your settings they can easily make tweaks.

Kathy

Your atrial fibrillation

by Selwyn - 2014-01-17 12:01:04

At the age of 47 years, your atrial fibrillation (AF) is not likely to cause shortness of breath (SOB) when it kicks off- the ventricular response rate is usually around 120 beats per minute, not too fast for a fit, young guy like you. Other arrhythmias may be more disturbing! I trust you can be sure you only have AF?
Do make sure your pacemaker has the rate response setting switched on, this will ensure your heart rate rises with exercise ( if it does not do this then you will experience shortness of breath with exercise). The setting is then DDDR. KAGS advice re. threshold rate settings needing to be adjusted to a rate suitable for a fit, young guy like yourself, is highly relevant.
The Automatic Mode Switching ( AMS) report of your PM check can tell you how much, and for how long, you are having AF: this is a useful little counter to juggle against medication dosage, if needed.
Ablation is not without complications, and needs to be considered in the light of your AMS readout, amongst other things.
Let us know the outcome or if we can help further,
My advice is to go to see the specialist with knowledge, though keep most to yourself on simmer, and only let the occasional choice bubble out.

Wow

by BigThinTiger - 2014-01-17 12:01:25

Thanks

Kathy - Thanks, it sort of makes sense. I have a copy of the Initial Interrogation Report for my PM before they switched it from DDI to DDD. Its really hard interpreting it, and I cant find an Upper Tracking Rate. I'll take it to my Cardi.

AngrySparrow - Love your style and thanks for the advice, especially about suggesting things to Drs. I've been trying to do 5000 steps a day (most times fail!), but sex - are you trying to kill me :) Its a bit difficult to swap Consultants in the UK, and I'm more than likely to see one of his Juniors anyway. I might consider going private for a second opinion if no further tests, help or explanations are forthcoming.

Is your Sinus node OK?

by KAG - 2014-01-18 11:01:13

If your sinus node is working OK then Rate Response shouldn't be turned On. Your heart's sinus node will provide the rate increase when you exert more. So for example, I have total AV node block, sinus node works OK and my mode is DDD. Having RR On in this case can cause conflicts between the PM and sinus node.

If your sinus node has problems then Rate Response comes into play and takes over the sinus node functions when they're faulty or not working. In this case your mode would be DDDR. There are many additional settings when RR is turned On to adjust how quickly and how much your PM responds to increased activity.

On my interrogation report the upper rate is listed as "Upper Track". Mine is set to 160 bpm. They increased it to fix my SOB problem.

From all the posts you can see that there could be many different reasons for being SOB. That's what's great about this site, so many varied experiences to draw from. I'd start with the simplest, to me your PM settings and go from there.

Keep after it and hopefully you'll be feeling much better soon.

Kathy

upper tracked vs upper sensed

by Stillrunning - 2014-01-19 01:01:49

Whats the difference in upper tracked rate and upper sensed, last visited they insisted on changing the tracked down from 160 to 150 because they said I was pacing too much in Ventricular

asfasf

by boxxed - 2014-01-22 08:01:58

Just an FYI: Your atrium dictates your natural heart rate.

Let's assume you have a good Sinus Node (good atrium) and NO conduction. As in, your ventricles do not hear your atrium beat, and it will hardly beat on it's own without a pacemaker.

Upper Track is how fast the Pacemaker go to match (track) your atrium 1:1. So say that your atrium is going 100 beats per minute. The pacemaker will match by pacing a ventricular rate of 100 to match 1:1.

There is a danger to that. What if you have afib? Afib can cause the atrial rate to exceed 400 beats per minute. We would never want the pacemaker to match Afib 1:1 and try and pace (track) to 400bpm.

That's where Upper Tracking Rate comes in. It's the limit in which the pacemaker will track what the atrium is doing.

Upper Sensor Rate relates to your Rate Response. Some people have bad sinus nodes. They could be in a chair or in a marathon and their heart can't go faster and slower appropriately. That's where Rate Response comes in. It's a sensor that tells when you're moving (or how deeply you're breathing) and increases how much it's pacing beyond the Lower Rate.

Upper Sensor Rate, like Upper Tracking Rate, is another safety check. What if you're on a very, very bumpy road? Older generations of rate response reacted very badly (and aggressively) to a gravely road, and we wouldn't want the sensor saying "let's beat @ 400bpm based off how erractically this guy is moving". That's where USR comes in.

Consultant Results mmmm

by BigThinTiger - 2014-01-23 12:01:51

Ok - Seen the consultant (one of his team actually).

The explanation is as follows.... Bad news: I have gone into full heart block and the PM needed changing from DDI to DDD to compensate for this. Its pacing at 100%.... Good news: No AF has been seen for the last 14 days.

The theory is, the Sotalol I was taking for the AF is responsible for the heart block, so I have been advised to reduce this over a 2 week period and return to the clinic in 2 months time to see if the heart block is still there.

As for the ongoing lethargy and SOB, this was attributed to some peoples bodies not liking being paced so much. (mmmmm). I guess I have to get used to it and do more exercise?

In the meantime full blood tests have been taken and an ultrasound (under stress) has been ordered.

Any comments gratefully received.

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