Still not feeling great.

Hi all.

I'm 5 weeks out from having a PM implanted for bradycardia. The monitor recorded my HR in the 40s at night and 50s during the day. I also have neurocardiogenic syncope diagnosed after passing out during the head tilt test. Everybody told me how much better I would feel after having the PM fitted and how much energy I would have. Well, the energy level hasn't improved much, if any, and frankly, I'm having periods of rapid heartbeats now that I didn't have before. Also when I take a deep breath, my chest aches. Went to the doctor last week and he said everything was going as expected. Am I on track with the healing process and just being impatient or what? Would appreciate you input as I'm still new at this.


5 Comments

possible pericarditis

by Sharecropper - 2013-08-07 04:08:41

Cathy,

The pain I spoke of about painful deep breaths is intermittent and doesn't last but for a few short minutes so I don't know if that would qualify as pericarditis or not. Again, if I'm not doing much better by end of the week, I'll be on the phone to the Dr. office to get some instructions.

Can't thank you enough for your concern and information.

Sharecropper

Thanks for the response

by Sharecropper - 2013-08-07 04:08:46

Hi Jenny,

Thanks for your response to my post. I'm sorry, but I left out some information earlier. I have a dual chamber Medtronic device that is set on 60/130, take no medications, moderately active 60 yr. old female.

At the last Dr. visit, he told me my PM was doing everything it was supposed to be doing and he would see me again in 6 months. I did ask a lot of questions about things I knew to ask about, but didn't know about the rate response you spoke of. I'll phone in to check on that if I don't feel better soon. The Dr. also told me to increase the fluid intake and sodium by drinking water of course, and fruit juice for the sodium content. I'm trying to drink at least 3-4 liters of water per day so maybe that will help.

I guess I'm trying to get an idea of my new "normal" feeling and I'm just not there yet. Like this morning I'm on my cell phone and I get two "bumps" on my left side under the heart. It feels a little like a muscle twitching only harder and almost audible. Just a weird feeling and I don't know if I should be alarmed or not.

Another strange feeling happened while I was attempting
to walk around the block. I always walk 3 miles about 3 or 4 times a week. Three weeks after surgery I started my walk and about 3/4ths the way around or .4 mile, my heart started pounding and hurting. I stopped my walk, got some water and let my HR get down to 70 or so then tried to finish my walk at an even slower pace. I made it 1.8 miles and just didn't have the energy to complete the 3 miles. Needless to say, since the implanting of the PM came the day after the head tilt test and EP study, which was a surprise, and then the disappointment of not having the energy to do what I want to do, I'm just not a happy camper. It's probably as much psychological as physical now but I certainly will be glad when I get to that happy place!

Thanks again, Jenny for your reply.

Sharecropper

PS Meds can also have this effect

by jenny97 - 2013-08-07 09:08:22

I forgot to ask if you're on any new meds. They can have some exhausting side effects too.

so sorry

by jenny97 - 2013-08-07 09:08:29

you aren't feeling better as quickly as you hoped! There are many factors that could be playing into how you're feeling. First of all, surgery can take a while to recover from and everyone's recovery is different. That said, I would expect you would be at least starting to feel more energy by this point.

A second factor is the type of PM you have implanted and the settings. It looks like you have a medtronic PM of some sort. This is a PM that will help with the bradycardia but may or may not be entirely effective for the neurocardiogenic syncope. How effective it can be will be dependent on your settings. The way that most medtronic PMs deal with neurocardiogenic syncope is through the rate drop response. That is a setting where it senses a sudden fall in your heart rate and stimulates your heart to beat at a higher rate. My rate drop response is set to sense a drop of 30 beats in 30 seconds and kicks in at 95 beats per minute for two minutes. The idea behind this is that speeding up your heart rate will increase your blood pressure, hopefully keeping you conscious. Although I still have symptoms, I do not typically lose consciousness entirely, thanks to this setting.

Next time you talk with your doctor, you might ask if this setting is in place.

Now, I suspect it is, because you mention that you feel periods of rapid heartbeats that you didn't before. This very well might be the rate drop response. I often feel when mine kicks in. Given that I was losing consciousness a few times a week, I am pretty grateful now when I feel it and don't end up losing consciousness. But it took a while to get used to it.

That said, if you are feeling these episodes at times when you are not otherwise feeling symptomatic, they may be set to be too sensitive for you. You can talk to your doctor and he can adjust them to suit your symptoms and your lifestyle more appropriately.

Another factor that could influence your energy level is the range of rate that is set on your PM. You indicated that you had a rate in the 40s and 50s prior to the PM. What is it set at now? It's possible it is not set high enough to make a difference to your symptoms; your doctor can adjust that too. I think mine is set at 70 or 80 now for the lower rate, although I can't remember because we've adjusted it a lot (have had this PM since 2009 and a PM in general since 2001). At one point it was set at 90.

And finally, a few other factors that can influence energy level post PM (and with a diagnosis of neurocardiogenic syncope): blood pressure, hydration, weather, activity level, and other health issues.

You might check out your blood pressure and see if it is lower than normal. If so, talk to your doctor, of course. But also consider increasing your fluid and, if not otherwise contraindicated, your sodium intake. Mayo clinic told me I should be consuming 6-8 grams of sodium per day. They even suggested I mix it into my yogurt for breakfast - yuck!

Hydration can be difficult in the summer months, particularly if it's hot and humid, and dehydration and heat and humidity can certainly sap your strength.

Activity level - if you're used to being pretty active and then sit around recovering from health problems or surgery, you could just need to get back into a more active routine. When I was growing up and would complain of being tired, my dad would always tell me to go run around the block. He didn't make me do it and I didn't really believe it would help, but as an adult I've definitely learned that it can help in some circumstances. So, you might run this idea past your doctor as well.

Anyway, enough of my long-winded and possibly disjointed response. I hope that you get feeling better really soon and fully recover from the surgery and the condition that necessitated it in the first place.

Good luck!

Jenny

I hope you're feeling better

by jenny97 - 2013-08-27 09:08:48

and that it was a simple fix...

You know you're wired when...

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