Feeling of Tightness in chest – can that be from t

My heart checks out as okay. I had five vessel open heart surgery and there is only one small area that may not get adequate blood. The pacemaker is for brachacardia
You know the feeling when they turn up your pacemaker to see if it works, I seem to get that a good portion of the time. I wonder if the voltage is set too high. Recent changes, I have trouble getting my heartrate over 120 and just had the MV setting turned on.
History:
7/11 Stroke, lost use of left hand and leg, while an inpatient they kept asking me if I was an athlete, my heart rate would go below 50 and that is when the machine beeps. While learning to walk and use my hand, fatigue, had real trouble getting heartrate to go over 100. I was 58 and was active, surfing, hiking, etc.
10/11 Pacemaker installed, disappointed- no gain in energy
12/11 Blood clot on pacemaker wire, left side pain increased dramatically and pain never went away. Last month new evidence of blood clots on different area of pacemaker wire, but clots not going into my lungs.
10/12 Five vessel open heart surgery, disappointed- no gain in energy
I also have fatigue that slowed down my exercise program. No adjustments were ever made to my pacemaker and after changing to a better cardiologist, he checked out the heart and thought we should try using the pacemaker to allow me to get back to a more active lifestyle. I was only using the pacemaker 4% of the time. Turned on the MV sensor, increased max to 150.
I think it is helping, but there is an increase in the pain/tightness feeling. Not a normal feeling.
Will go in for a treadmill stress test with the pacemaker rep to further adjust settings next month. That gives me a month to work myself into shape. I still have that tightness feeling sometimes when I run, some pain in the jaw and shoulder, but again, my heart checks out fine so I assume it is from the pacemaker. I get that feeling just sitting in front of the computer, I doubt the pacemaker is doing anything.
1. Is that a normal feeling, do you always feel like something is going on or can’t you even tell you have a pacemaker.
2. Can this be a struggle between my natural sinus node rhythm and the pacemaker?
3. Can the current be turned down.
4. I guess one way to find out is to have them turn the pacemaker off, or only to use it if my heartrate falls below 30 or whatever the lowest setting is and see if I feel better and the feeling goes away. Can experiment for a month.

The good news is that I found this forum. Finally there are no more excuses for not optimizing the pacemaker settings and I have a good medical team. I do not know if you can ask for a particular pacemaker rep, some are not helpful

4 Comments

Other options

by Theknotguy - 2014-03-04 09:03:58

I had a lot of trauma before getting my PM so I've experienced some of the problems you've mentioned. Pain in jaw and tightness in chest - i.e. angina.

The pain in my jaw went away after they dropped the voltage in my PM at 90 days. The tightness in my chest - i.e. angina, shortness of breath, and pain in my jaw went away during cardiac rehab. Since I've had my PM for five months, I still know I have it, but the times are getting longer when I don't notice it's there.

Heart disease for me is a moving target. You get one problem addressed then another crops up. So I'm getting different feelings from both my heart and my PM.

As far as the tightness and angina when you run, I was getting the same thing during my cardio rehab. The angina (pain/tightness in chest) was due to muscle atrophy during my stay in the hospital. The heart muscle was protesting being exercised at that level. Plus I wasn't getting enough oxygen to the heart because of my breathing - or lack of it.

During cardiac rehab, I was able to monitor my heart rate. They wanted me to exercise up to the level angina then back off. I would be walking on the treadmill and be watching my heart rate at the same time. My heart rate would go up to 120 and I would be in angina. I also had the pain and thumping in my jaw at that time too. The cardio nurses would have me drop back down to a rate where I wouldn't be in angina, then work at that level.

It's really hard at first to drop back to a lower level and exercise there. I was brought up in the age of "no pain, no gain" so I felt I was slacking off. However I had to stay at that level for six sessions. Gradually the angina level went up.

Because of the trauma I received (CPR, Broken rib, cracked rib, collapsed lung, and chest tube.) I had to learn to breath all over again. So some of the angina was caused because I simply wasn't getting enough air as I was exercising.

About half way through my cardio rehab I started rehab on my shoulder because a previous injury had been reinjured during CPR. The shoulder therapy helped with breathing.

You didn't mention medications, if any. I'm on two medications (Cardizem and Metoprolol) to slow my heart down to reduce chances of a-fib. I can tell what effect the medications have on my exercise just by watching the heart monitor. For a while, the medications wouldn't let me go above a heart rate of 120 bpm.

I'm almost finished with 12 weeks of cardio rehab. My angina has been pushed up to above 124 bpm. I can go 20 minutes on the treadmill at 3.2 mph with a grade of 6.5 percent. Doesn't seem like much for some, but it's way beyond where I started. I do 20 minutes treadmill, 20 minutes stationary bike,and three plus minutes elliptical. The only reason I don't go longer is our sessions are limited to 40 minutes. It's hard for me to go above 124 bpm because of the medications.

To answer your questions:

Q:)1. Is that a normal feeling, do you always feel like something is going on or can you even tell you have a pacemaker.
A:) After rehab, I don't feel my pacemaker. In fact I feel better because I'm getting a full heartbeat. I have periods where I forget I have a pacemaker but I almost always know it's there. Do I care, no. My other options are very grim.

Q:) 2. Can this be a struggle between my natural sinus node rhythm and the pacemaker?
A:) Don't know as I'm not a medical person. But I feel it's more of a training and exercise issue. I feel if you can monitor your exercise sessions and see where you're going into angina you can then train yourself out of them.

Q:) 3. Can the current be turned down.
A:) Amperage on your PM can be turned down but you're past the 90 day period so it may have been turned down already. It's a discussion to have with your EP. Obviously they won't turn it down below the level at which it will initiate a heart beat.

Q:) 4. I guess one way to find out is to have them turn the pacemaker off, or only to use it if my heartrate falls below 30 or whatever the lowest setting is and see if I feel better and the feeling goes away. Can experiment for a month.
A:) Doctors are very reluctant to turn off a pacemaker. A short search on the Internet indicates it's a bad idea to do so. Based upon my personal experience I feel you have other options before you attempt to go to the extreme of turning off your pacemaker.

Hope this helps.

Theknotguy

what should be the current level

by ejs - 2014-03-04 11:03:11

I did the cardio rehab more than a year ago where they monitor you while exercising and my ability to exercise has been going up and down the last two years.

What should the current be when they turn it down after 90 days?

Finally got them to turn on the MV sensor last week, but it doesn't seem like they even consider using that active lifestyle function that supposedly has a workable algorithm to optimize settings.

I quit taking all medication other than aspirin and lipitor in January to take medication out of the equation.

The chest pain is at rest. If I am not bouncing while exercising it seems to be ok.

The last two years the pacemaker has not been doing anything but keeping my heart rate from falling below 60 so I have no problem turning the pacemaker down to 50 to see if that is the cause of chest tightness.

My heart is strong, already had the bypass stuff so I am not worried about that. I will get as much exercise as I can prior to the next appointment to change settings.

I am still reading old posts to learn as much about what to tweak as I can now that my doctors are out of other ideas and want to optimize the settings. Forum is indespensable as a resource. Thank you to all contributors.

I used adderall for a year to combat fatigue, stopped that in January and as I have a pacemaker, I think I might as well try and use that rather than drugs.

PM voltage levels

by Theknotguy - 2014-03-05 04:03:32

Voltage levels will be different from individual to individual. Mine are set at .875 volts Atrial and .625 volts on the V side. Lead impedance is 475 ohms Atrial and 551 ohms on the V side.

Low rate on the PM is 60 and high rate is 130. I do more weight lifting type of exercise so the high rate is good for me.

Hope this helps.

Theknotguy

Voltage settings- where on report

by ejs - 2014-03-06 01:03:16

Yes it helps, so does the story about what everyone else went thru. I am still on the bottom of the learning curve figuring out what the report means and what to ask to optimize settings. When they had the MV sensor turned off I did not have the chest pain.

I am looking for the voltage readings, and assume they are the same for the MV sensor as they are for the accelerometer.

Boston Scientific S606 , 310/470 impedance Amplitude 2.0/2.0 current 6/4

at implant impedance atrium 440, ventricle 530, threshold atrium 1.00 ventricle 12 mV

The 60 min/ 130 max seem like default settings. My doctor had to ask the rep, can you turn that up? and then agreed we should go to 150, wanted to turn down the lower end but the rep said they could not due to the increase. I have trouble sleeping at thought it might help w fatigue if at night I go back to 50.

With the MV sensor on, currently I can do 20 minutes on the treadmill with 2 minutes running at 5.6, will try and improve on that prior to the stress echo. The main problem is that my chest is always tight at rest, do not notice it with exercise. I do weights after treadmill and for the first time in a long time, I am sore today.

So increased exercise capacity with the MV sensor turned on, but almost constant chest tightness at rest that was not there before.

Getting a neck epidural today so will see if the shoulder pain goes away, still think it was the bouncing.

I was thinking like Theknotguy in that I just need to work myself into shape, the problem is that there is tightness at rest. Since turning on the sensor I think I have more energy and my pacemaker is letting me kick up my heartrate. Going to the gym 5 times a week before my next stress echo where they will make adjustments.

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