throat constricts, irreg. hb's with exertion

I am a 59 year old female, 7 days post-op for a dual chamber totally dependent PM. I am having serious throat constriction, light chest pain, and very irregular heartbeats whenever I exert myself. I went to the cardiologist that inserted it 2 days post-op with this. I kept telling him my pulse would be eractic on my oximeter going from 50 bpm to 150 to 120, etc. He told me that wasn't possible as the lowest setting was 80 bpm. I put the oximeter on my finger and showed him. He listened to my heart while it was doing that and told me I was having PVC's where the atrial was beating 2 to one of the ventricle. he put me back on Diltiazem that I had been on before the PM for a-fib. He told me to go home and rest, rest, rest. 've done that for days and was doing a little better, but now it has started again. Is this going to last forever? Is there something I can do to make these PVC's go away? I tho't the PM would be the answer, but now I'm afraid to even walk across the room. This just isn't what I bargained for. I used to be so active, but that has just stopped! I realize I have to give it time, but does time take away the PVC's? appreciate any advice.
MOJO

4 Comments

thanks, Ing

by Mojo - 2013-06-20 04:06:16

Thanks for your comments and advice. Yes, I had an AV-node ablation after PM insertion. I will try to be patient. I guess I need to get used to the new norm, living with a PM. Wouldn't the "episodes" be recorded and read when I go in for a reading next week at my normal follow-up app't? And I've read some on Rate Response - is this something that should be addressed then also, or doesn't that apply in my case?
Again, thanks for your wisdom.

PVCs

by golden_snitch - 2013-06-20 04:06:25

Hi!

If you have Afib, did you undergo an AV-node ablation together with the pacemaker implant? I guess so, because you also said that you are pacemaker dependent now. If you had the ablation, your pacemaker is most likely operating in a modus where it simply ignores what your atria are doing, and only paces your ventricles. At least that is the modus one choses for patients with permanent Afib who undergo AV-node ablation. In that case, your doctor's explanation of PVCs where the atria beat 2:1 of the ventricles, does not work. The eratic heart rate can only be caused by PVCs = premature ventricular contractions, nothing to do with the atria. Maybe what he wanted to say was that every second ventricular beat is a PVC?

Your heart might still be a bit irritated from the ablation and the pacemaker implant; it has never been paced artificially before. Therefore, I'd say that the PVCs might just be a reaction to those interventions, and that it could very well be that your heart soon calms down and the PVCs become less.

I'd probably take a drug for now that reduces the PVCs, and then wait a while, maybe a few weeks, and then try to get off of it and see what your heart does. And what I'd also do is to get those PVCs documented with a holter monitor. I don't think it's enough that your doctor just listened to your heart without ordering an ECG.

Best wishes
Inga

Hi

by Casper - 2013-06-20 05:06:30

Hi Mojo,

I found your questions interesting, I'm glad Snitch "Inga", shared her wisdom.

She is definitely one of the residents experts her. Thanks Inga also.

Casper

Rate response

by golden_snitch - 2013-06-21 02:06:35

Thanks, Casper!

Mojo, if you are in permanent Afib, and therefore have your pacemaker programmed in VVI(R) mode, so sensing and pacing the ventricles only, then rate response will be an issue for you. You have no properly functioning sinus node that dictates the rhythm, and responds to exercising or just moving around, so the pacemaker needs to do that job. The "R" at the end of the mode, e.g. VVIR, indicates if the rate response is already switched on or not; if there is no "R", then it's switched off.

Not sure that the PVC episodes are recorded, but I guess all pacemaker at least give you a count of how many PVCs you have had. My pacemaker shows a percentage (PVCs out of normal heart beats) and a number. It also records episodes when I had several PVCs in a row (salvos).

Good luck for your follow-up!

Inga

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