4 weeks post PM and Fast/pounding heart rate and feeling dizzy almost passing out

My husband had his PM implanted 6-14-16

He has been experiencing some dizzy spells where he says he almost feels like he could pass out but doesn't.  This doesn't happen while exerting himself such as running or anything like that.  It happens when he gets up, sits down or just walking around the house.  his pacer is set to not drop below 60.  We have a pulse oximeter and we check his pulse regularly.  It's usuall between 60 and 70.  Occasionally out of no where it shoots over 100 to 120 and even more.  He can feel it pounding and it lasts anywhere from a few seconds to 30 seconds.  He feels fluttering sometimes, which I think is him feeling the pacer kick in, anyone have that feeling and can you explain it?  He says he feels palpitations.  What conerns me is him feeling like he could pass out.  I thought the pacer would stop that.  That's what lead him to get it in the first place.  He passed out and knocked himself out cold, his pulse was in the teens, scary.

 I'm going to call the dr tomorrow.  It's frustrating because he has mentioned this a couple weeks ago and he says there are no alerts when he checks the pacer. HE really has no explanation and my husband is at the point where he doesn't even want to complain anymore about his symptoms because he has no answers. 

Should we consult an EP?  Has anyone experienced this?

He also just recovered from an infection in his blood.  That was a two week ordeal right after surgery. I thought of this pacer as a blessing and aside from his heart rate not dropping super low anymore it seems he is having more problems than before.  He is a fit 35 year old who just ran the LA marathon.  He eats properly and tries to stay in good physical shape. 

Has anyone experienced and of this?  Any suggestions or words of wisdom, encouragement?  I keep telling him his body needs to adjust to it and it will get better.  I just feel so bad for him.  Will it get better or is this just a new way of life?  I thought he could go back to his life, he did too.  We have 4 children ages 3 months to 13.  He tries to be active with them and I can see the exhaustion that just wasn;t there before.  Will this pass?  Does it sound like the pacer needs to be adjusted?  In what way?

Any comments are appreciated.

4 Comments

call the doctor

by Tracey_E - 2016-07-11 08:18:48

It sounds like the settings need to be adjusted. Also, infections can take a lot longer than two weeks to heal. He should take it easy until they figure out what is going on.

No alerts means the pacer is pacing. It can be programmed to alert them when we have afib or vtach, things like that. So, no alerts just means it's working and he hasn't had anything happend that it was programmed to flag. That does not mean the settings are where they need to be. It's pretty common to take a few tries to get the settings right, esp when we are young and active. Default settings are for the older and sedentary. We are all different so there is no one size fits all. If they've tried more than once and it's still not right, it can be helpful to get on a treadmill while on the pacer computer so they can see exactly what is going on, adjust and try it, then adjust again. 

Do you know what caused the low rates, was it sinus issues or heart block? 

Heart block

by Nr137 - 2016-07-11 11:25:09

Thank you for your comment. He had 2nd degree heart block.  

heart block

by Tracey_E - 2016-07-11 14:47:02

I have that, too, but mine is 3rd degree. When my pacer was new, I almost passed out the first time I went out and about on my own. It was two things going on. One, with heart block our atria (theoretically) works normally, our problem is the signal doesnt make it to the ventricles so our pulse drops. The pacer will only pace the ventricles up to the upper limit. Often this is 120 - 130 to start. So, I worked out, my sinus/atrial  rate went to 150, the pacer could only get up to 120, boom, end of workout. They moved the upper limit to 160, problem solved.

My second problem was sometimes my atrial rate is cruising along like it's supposed to but then it tanks for a few seconds. Because I was in block, my pulse never changed so we had no idea I had this other problem. They turned on a feature that kicks in atrial pacing and keeps my rate up if it drops too suddenly. Another easy fix once we figured out what was going on.

A third thing that can be common with new patients with heart block is the pacer may be set to detect afib. So, he works out, his heart goes fast (like it should on exertion!) but the pacer thinks oh my! afib! So it suddenly puts us in an artificial block and paces 2:1 so we are doing 150 one minute, the next it's pacing us at 75. This is great when we are in afib because the pulse tends to be too high but if you are out for a run it will make you feel like you are going to pass out, btdt! If there is no history of afib, they can turn this feature off. 

If he has a home monitor, you may be able to press a button and initate a download right after an episode happens. If not, write down the day/time and tell the tech when the do his next check. I'm no doctor, but it sure sounds like there's a high probability the settings just need tweaked. Some offices are better at this than others. If they write it off, if they aren't willing to investigate beyond a glance at the pacer report, it may be time to find a new doctor. Most offices don't have a lot of young, active patients so it's not surprising we throw them a curveball occasionally. Or a lot :)  That's ok, but we need a doctor who's willing to do some research to find out what needs to be done, not say too bad and send us home. When they write is off and aren't willing to fight to find a solution, that's when it's time to move on. My doc doesn't have any other patients like me, but my SJM rep covers a large territory and has been doing this for 30 years so has a lot of active patients as well as a network of resources. You need someone with the knowlege and resources to figure out what's going on- because something for sure is going on- then find a fix. 

sounds like...

by Cabg Patch - 2016-07-11 23:34:25

Sounds like a possible PMT (Pacemaker Mediated Tachycardia) issue. Call the Dr and tell them what's going on. The manufacturer's reps should be able to diagnose and fix this problem with a simple adjustment to setting on Rate Response. and he should be seeing an EP until everything is resolved...

Most Cardiologists are shall we say not well versed in the electrical system. That's what EPs specialize in so logic says that's who should be working with him on this problem.

Good luck

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