Today is post op day 8...

So why do I have to be an oddball and feel bad? Here is the story. At the age of 38 I had my first EP and tilt table study with an ablation of AVNRT. We did the EP because of multiple syncopal episodes, sustained svt and recordings of 12 to 15 beats of VT. I am now 42 and had my first PM put in last Monday. The procedure was a perfect text book case. I have a top notch doc. I had my Medtronic Reveal removed and the PM put in. The Reveal recorded, nicely, SSS (HR 170 to 32 in 9 seconds) in addition to paroxysmal A fib/flutter and pauses up to 3 sec. I went home the next afternoon set at 60-130, demand on. I did not ask about any of the other settings. Shame on me I should know better, but was just caught up being a recovering patient. I know they turned up the gain on the leads a little because they wanted good adherence. Discharged home and all seemed great until about 9PM. I started palpitating. The closest analogy would be a boxing match between the Atria and Ventricles, as this continued each ventricular beat started stabbing in the center of my chest, sub sternal, then progressed between my shoulder blades in my back, then right upper chest along my clavicle to my right shoulder and down my right arm making it increasingly harder to breath. Called 911 cause it was not easing after 15minutes. Unfortunately I was taken to the worst ER, not my hospital. Minimal workup showed nothing other than being A paced. CXR good. I was given lots of pain meds and sent home. Next day echo looked good, EF lower then before?. Interrogation showed some PVC's and my parameters were reset to 50- 130 and gain turned down. Sharp stab and ache in center of chest during V pacing interrogation. Like stabbing a bruise.
Was this all just Pacemaker Syndrome?
Sent back home. Had another big event and this time I had my hubby drive me to my hospital. D-Dimmer high (higher than before) - CTA negative for PE but showed sm. right effusion. The actual PM site and incision to remove the reveal are feeling pretty good. I'm only more perplexed and have more questions? Anyone's thoughts...

2 Comments

DR is only my initials...

by donr - 2013-09-24 09:09:33

...but I have an opinion. Realize that opinions asre like noses - everyone has one & some are just uglier than others.

1) I'm sorta amazed that you waited 15 min before calling 911. As you describe it, that was some serious pain that could well have indicated serious trouble.

2) Turning the gain up is not going to make the leads adhere any better. They will heal at their own rate.

3) I assume the cardiac X-Ray was to determine if you had any fluid around the heart due perhaps to a lead that perforated the heart wall.

4) They did NOT perform a blood test for enzymes, looking for a heart attack? We had a woman who spent a night in an ER for repeated blood work to rule out that. That sounds to me like the worst ER.

5) If you are only being Atrially paced, why did you feel something when the ventricles contracted?

6) What is "V Pacing Interrogation"? Unless they are performing a test during a download, the interrogation is totally passive & only accesses the memory during that phase. They can check out V lead parameters & it seems to me that unless they change the pacing voltage, that would all be passive, also.

6) D-Dimmer test - I assume that is a blood test looking for protein resulting from the body resolving a clot on its own. If it's higher, should not someone get a bit excited? You should not normally have clots w/o something untoward occurring.

7) CT scan: Hmmm - again, an abnormality. You should not have any effusions - unless something went astray w/ the implant. We read about that happening occasionally. No Pulmonary embolism - that's good, but no excitement over the effusion? Where was that located? in the sac containing the heart or out in the lungs somewhere.

All that you tell me would get me excited a bit Sorta like blood in the urine - just plain NOT supposed to be there.

Wish you the best in sorting this mess out.

Don

Post op day 24

by Danise - 2013-10-10 03:10:23

Update:
Q: How does the pacer pace during arrhythmias?
Example: junctional/juctional tach?
Q: Can it be programed to pace me out of an arrhythmia?

I'm still having occasional episodes of chest pressure, palpitations and pain. I have a right pleural effusion with pleurisy which started 24 hours after PM insertion but told it is completely unrelated to the PM insertion. Cardiac enzymes good. No one checked a BNP. PCP started me on steroids against the Cardiologists opinion. Says I should just take Motrin. I only see red cause I'm too young for this and no one seems to have an answer for Why?

EKG says suspect anterior/inferior infarct but I do not see any EKG changes (ST) personally. MD says CT angio done 3 years ago show 0% calcium score, so no reason at ALL to think I have CVD or follow up with other testing. He was vague during PM interrogation and says I need to just forget about it and not focus on it! I'm told I need to go back to work. Not excited about lifting 100+lbs only four weeks Post op. Hubby thinks I should see an EP...I'm so confused and not feeling well.

Thanks in advance for your opinion,
D

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