Query re settings

Hi
Just wondering if anyone could explain why I might be still getting breathless on exertion i.e while out walking or going up a stairs...I had pacemaker inserted in Dec 2105 for SSS....I know lower rate is set at 60 but don't know upper rate...I know from card that rate response is on....I am due back to pacing clinic and doctor in 2 weeks time....Just trying to figure it out for myself...
Thanks in advance

11 Comments

Possibly

by IAN MC - 2016-01-04 08:01:26

You have Rate Response switched on which is usually the case for SSS ( but not always ). You are probably " chronotropically incompetent " which means that your sinus node is lazy and is not increasing your heart-rate as it should when you exercise. RR puts in extra heartbeats when you exercise if your sinus node refuses.to do so.

The RR function has several different settings, it can be made to kick in for very mild exercise ( such as walking upstairs ) or for moderate exercise or only for quite vigorous exercise. One possibility is that your RR needs adjusting to a more sensitive setting.

.. But that is just one possibility !

Best of luck

Ian

Thank you Ian

by mnoshea - 2016-01-04 09:01:53

Thank you Ian for your detailed reply.....I am still trying to get my head around the workings of the pacemaker as was discharged with no information....trying to educate myself as much as possible before my appointment....
Can I ask ,if you could explain if possible what you mean 're possibility it needs adjusting to more sensitive settings....What would be the benefits and how would it work....
Many Thanks again...

body jerks

by emabo - 2016-01-05 01:01:30

I feel a very sharp, bold jerk near my stomach always, when I am lying down, ready to fall asleep. Sometimes before pacemaker was put in. I would feel a smaller jerk, I think that feeling is normal. there is a name that, I cannot remember the name, but with pacemaker this is very very strong. Could this jolt be from pacemaker in some way? Also I have been receiving shocks many many times,when I touch metal or light switches,Should I be concerned?, I quess it might be something else causing this problem. Anybody else feel this?

Emabo

by BillH - 2016-01-05 02:01:13

It is best to start a new thread insteading of tacking it on to an existing one. It is too easy to get lost.

What you are talking about is an Hypnic Jerk or sleep start.

The PM does not affect this.

http://www.sleepeducation.org/news/2013/08/22/sleep-starts

"Also I have been receiving shocks many many times,when I touch metal or light switches,Should I be concerned?, I quess it might be something else causing this problem."

Yes, it is called winter, low humidity, and static electricity.

Both of these are common. Most like with your are becoming more observant. Not because of the PM, but rather because of the need for the PM.

Rate Response and breathlessness

by Selwyn - 2016-01-05 04:01:49

The advice to get the rate response (RR) checked is good advice. There are slow, medium, and fast response settings, and likewise to slow down after exercise.

My pacemaker was implanted for SSS and asystoles. My RR is set to fast onset. I still get breathless on short runs up stairs, and especially carrying a weight load.

I think that the RR may not 'click in' for the few seconds it takes me to run up stairs, and in any event it works off movement, for my St Jude pacemaker, so carrying a load fixes the arms and upper body and the legs do the work- no increase in cardiac rate!

If you are OK once you get going, it means that it is a signalling problem rather than a primary heart problem.

Let us know the outcome.

Kind regards,
Selwyn

mnoshea

by IAN MC - 2016-01-05 09:01:12

You don't say what make of PM you have. Different makes have different types of sensor for Rate Response

Most have a sensor which responds to upper body movement. So when you walk upstairs the PM detects your body movement and says " mnoshea is exercising, I had better put in extra heartbeats or he / she will get breathless " . But your PM will only do this if it is set to respond to a minimal amount of exercise.

It is possible that your's is only set to kick in after you have run up 5 flights of stairs in which case you would need it adjusting to a more sensitive setting. The benefit of this to you would be that you could walk upstairs normally and would not get out of breath.

I believe that every PM manufacturer uses slightly different terminology to describe those sensitivity settings

Best of luck
Ian


Thank you

by mnoshea - 2016-01-05 10:01:04

Hi.
Thank you so much for all the replies....When googling a lot of the results can be so technical or not what you want specifically want answered....It's wonderful to get this from the experts...i.e people who live with pacemakers every day....
I have a St Jude's assurity mri pacemaker....
I am slowly getting my head around the finer details....

SSS and SOB

by Sheppey - 2016-01-07 11:01:55

I have Sick Sinus Syndrome, Sinus Pauses, Brady/Tachy and Chronotropic incompetence.
Sorin Reply 200DR implanted December 2015.
Just had it interrogated... Great Sleep Apnea Information for GP. Fast A/Fevents recorded.
This PM will only help my Bradcardia pacing... and allow medication levels to be increased to keep A/F rates manageable.
Prior to this implant... I could only tolerate 1.25mg of Bisoprolol..Any less, Proxysmal Fast A/F: (300)
Any more Absolute Bradycardia (30)

Unfortunately, I am now in persistent A/F ,which is proving difficult to control... 10mg Bisoprolol ... no change in rate: Now taking 250mcg Digoxin as well. HR about 120.... spiking on any exercise or exertion?

Short of breath and severe Retrosternal discomfort.
Am now having a Cardiac Catheter Investigation very soon.
I am informed that the Pacemaker will only control the Bradicardia in my case.
My next option will, perhaps, be an Ablation procedure?




Rate and Rhythm altering drugs

by Selwyn - 2016-01-08 05:01:26

You are on high dose of digoxin. Toxic effects include all sorts of heart arrhythmias. You may want to get your drug levels checked if this has not been done.

Digoxin is OK for the rate of AF, but does nothing to stop it from occurring.

Likewise Bisoprolol is OK for the rate of AF, but does little to stop it from occurring.

The NHS does quite a good leaflet about the differing modes of action of drugs.
http://www.nhs.uk/Conditions/Atrial-fibrillation/Pages/Treatment.aspx

The longer AF goes on the harder it is to reverse. That being said, I have been threatened with cardioversion twice, and on both occasions have attended hospital for it back in sinus rhythm. You just need someone to threaten you!

You could certainly try decaffeination. Trusting someone has checked your thyroid function, done an ECHO cardiogram, and made sure your electrolytes are OK?

Best wishes for a healthy 2016.

Selwyn

Digoxin

by Sheppey - 2016-01-08 11:01:11

Thanks Selwyn, Keeping an eye on ECG signs for digoxin complications. I am having blood levels checked weekly-Should reach required level after two weeks?

As you say, both Bisoprolol and Digoxin are for rate control... if they work successfully? With SSS -HR bouncing up and down continuously.

I do not want a cardioversion... I do not have a stable normal Sinus Rhythm.

My SSS is the direct result of being given Levothyroxine for 5 weeks... later found -I was not underactive thyroid.
I keep away from stimulants like caffeine.

I have had a ECHO Cardiogram.... I have also had a Nuclear Myocardial Perfusion Scan... could only tolerate 3 minutes of IV drug stimulation (instead of the usual 10 minutes) ... Had a AGASTON SCORE of 434.

Been to hospital so many times with this fast A/F and SSS. each visit is a full blood count... They have looked at every possibility... trying to understand and treat this .

I really appreciate your views and advice, and indeed ,anyone's advice... to help understand better this rogue condition.

SSS and SA Node

by Sheppey - 2016-01-08 12:01:57

After my DDDR PM implant for a few days my HR was very good, regular and increased with exercise etc.
This was on Sinus Rhythm.. no problems.
2.5mg Bisoprolol was keeping it in check?

Soon, It changed to persistent A/F.. HR fluctuating constantly... pick a number?
When it goes into Fast A/F ... Off to Hospital Resus again.
New Years Eve...Fast A/F ... that cannot be controlled by drugs? Taking maximum Bisoprolol plus Digoxin.

The SOB and Chest pain has vastly increased since I have been on persistent A/F.
Hoping it may go back to Sinus rhythm once again?
Think cardio conversion is a quick fix? Would rather opt for an ablation.... Drugs regime too high!

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