Could there be a setting problem?

Hi,
I had PM inplant in 2010. Specifically I was chronically tired and a halter monitor showed that my pulse rate went down to 39 during the night. Sometimes.
So it was decided that a PM would help, It was set at 60bpm, Every 6 months I had to go in and have it read. It showed that sometimes, for only a few seconds at a time, my heart would race. But I don't remember feeling any of this however. Starting in early 2012 or thereabouts,I was getting pretty breathless doing almost nothing. My PM was adjusted to 70bpm. Still feeling ill. No energy, tired. Then chest pressure so bad, I went to the E.R. I was told an angiogram would have to be performed and it seems I was having a mild heart attack and my LAD artery was stented, I was put on Plavix/Aspirin. And have to take that for a year. Which is pretty bad, because I'm already on Coumadin due to a stroke 13 years ago. Consequently, I start bleeding at the slightest touch. I have bruises everywhere, But I digress.
Still not feeling well and unable to walk more than 25 paces before having to stop, my Cardiologist had me do a treadmill test. I laughed at him and said well this should take all of 15 seconds. And I was right. I was wired up to about a dozen or more leads. But 10 seconds into walking my heart zig-zagged in huge mountains and valleys that they had to stop the test. Dr. said he thought I was a good candidate for ablation. So a date was set up. And a catheter inserted, But of course my heart would not cooperate while I'm laying still. He tried to get my heart to race, even using drugs, but it would not cooperate. After 3-4 hours of this, he gave up and said he'd have to use drugs. So I was put on Sotalol. This was last March 2013. Ever since, I have felt much worse. I went back to him. He reduced by half my prescription of Toprol. And told me to come back in two weeks. He was then on vacation for a month. But I started up the Toprol again after 2 weeks per his instruction....BUT I stopped (on my own) taking the Sotalol. I am just as bad as I ever was. I cannot walk 25 paces without stopping. I just cant get my breath. My heart pounds in my chest BUT my BP is normal and no matter how I feel like my heart is pounding, my pulse just NEVER goes over 70bpm.
My active lifestyle has come to a screaming halt. I can barely walk to the bedroom. When I'm sitting, sleeping, laying down, watching TV, on the computer etc I feel great. But walking, cleaning, ironing, cooking?? Forget it. I just want to know what's going on. And doing nothing is sure to bring its own complications. Anyone have any suggestions?? Is it a faulty PM?? Could it be??


9 Comments

AyJay

by jeanlancour - 2013-08-07 11:08:13

I have nothing to say except I can see why you would be at the end of your rope. I would be feeling helpless at this point..but I would be pushing every dr I came in contact with to do something. If they couldn't come up with an answer send me to someone else, maybe a fresh look by another dr. Please know good thoughts will be coming your way. Don't give up. Jean

AyJay

by Bevof NC - 2013-08-07 11:08:18

Maybe I'm off base here.....I don't think anyone should be on BOTH Coumadin and Plavix at the same time. You need to talk to both your pharmacist and your Dr. or the Dr's P.A. That is my biggest concern over ypu, now...breathing is absolutely a necessity, You need to see someone immediately for that too. Does your Primary Dr. watch all this? Call someone! Best of luck Please act...and then REACT. Get yourself some help! Bev

Helllo

by mytrose43 - 2013-08-07 11:08:33

i totally agree with bev taking both coumadin and plavix as well as asprin does not sound right to me I took coumadin for years and was recently changed to xarelto my cardio said i could take a baby asprin a day but but no more than 81mg as far as the breathing you need to see a respioritiry specialist i think that needs to be handled asap also Good luck Valerie

Rate response

by golden_snitch - 2013-08-08 02:08:03

Hi!

Smitty is right: Be careful with the advice you give - just because something doesn't sound right to you, it need not be wrong. Better research it, like Smitty did, because otherwise you can cause confusion and make the person who asked a question feel like he/she is not treated correctly. There are some people with severe clotting disorders who really need aspirin, plavix and coumadin. It is definitely not unheard of. I know one patient who's on all three. You also have to understand that those drugs work differently, and that coumadin is usually given for clots in VEINS, while plavix and aspirin are given to prevent clots/stenosis in arteries. There are a few exemptions, but what I just said is kind of a general rule. So, if a person has had a stroke, and then also suffers a heart attack, you might need to combine the three drugs.

Now, coming to your original question, AyJay:
You said that your heart rate never goes over 70bpm. That could be an explanation for why you are having those symptoms when you're active. Do you know if your pacemaker's rate response is switched on? If the mode your pacer is programmed in is something with an "R" at the end, it's switched on (e.g. AAIR, DDDR). Can you check your pacemaker report or card for that? If it's not switched on, I'd think that you need it to be on. With the rate response on, the pacemaker will adjust your heart rate according to your level of activity. With a sick sinus node, it can happen that the sinus node no longer manages to adjust the heart rate appropriatly ("chronotopic incompetence").

In case your rate response is already switched on, but your heart rate doesn't go faster than 70bpm, then there could be an issue with the pacemaker itself or with the leads. But it sounds like it's working well at rest, so I would not expect a problem with the leads.

By the way, I was on Sotalol, too, and absolutely hated it. Have been on many different antiarrhythmic drugs, but this was by far the worst. I could hardly leave my apartment. Do you know what kind of arrhythmia you have? You said the ECG showed "high mountains and valleys" which makes me think you have either a ventricular tachycardia or just a lot of premature ventricular contractions (PVCs). That your doctor put you on Sotalol right away, speaks for a ventricular tachycardia.

Little correction

by golden_snitch - 2013-08-08 03:08:21

Ups, sorry: I meant to say, if someone had a venous thrombosis/embolism and also a heart attack that'd be a case where all three drugs are used (like in the patient I know); most strokes are arterial thrombolytic events. You also prescribe coumadin for the latter. Most Afib patients get coumadin to prevent a stroke. But heart attack patients nearly always get a combination of plavix and aspirin. So does my brother who has a stenosis in one of the major arteries in his brain.

Best
Inga

Doctors

by Rog - 2013-08-08 08:08:12

Seems like somebody could figure something out for you!
I was surprised to see all the posts about the coumadin and plavix at the same time- I've been on both for about a year now. They did take the aspirin out of the picture when put on the coumadin.

Medical Problems

by SMITTY - 2013-08-08 12:08:16

Hello Ay-Jay,

You obviously have some heart problems and I agree with what has been said and will add this. I have never heard of a patient receiving Plavix, Coumadin and aspirin at the same time.

After reading what I wrote above I decided to do a little checking and learned again that we must be careful with the advice we give or receive on the PMC. I found at least three cases where people had been prescribed those three medicines at the same time. In each case there was the mention of high stroke risk. And since we do not have a complete medical history for you (not that it would make any difference for me to have it), I don't know if you should, or should not be taking the three medicines at the same time.

I will add that I think the least probability of your problems is a faulty pacemaker. Sure it can happen but I am going to guess that yours needs settings that are better suited for you, rather being faulty. Which another doctor would probably do.

Good luck,

Smitty

Advice?

by Bevof NC - 2013-08-08 12:08:23

The only ADVICE I gave was to call.....I sure won't give anymore " ADVICE" Just want people to be safe. Bev

Ay-jay

by kmom - 2013-08-08 12:08:58

Welcome and I second everything said. Good luck

You know you're wired when...

You have a maintenance schedule just like your car.

Member Quotes

I'm running in the Chicago marathon.