Recovering from new CRT-D implant on 8/15

Couldn't sleep, eh?

by donr - 2016-08-18 07:58:16

Sabah:  Being on the receiving end is a lot different.  You are not the first nurse to discover that.

Let's talk "Normal."  We are all different in how we react to the residual pain from the surgery.  I walked out of the hosp & survived very ncely on Tylenol.  Had no pains down the arm; no spasms, nothing.  Others are in excruciating pain for days.  We arfe as dfferent as our DNA!

Now I only rec'd a normal PM - two lead type.  You got the third lead for the LV, so they were in there mucking around for a lot longer than when they did my job.   A lot of nerves wander through the section of your body where they go into you - who knows how much localized trauma that little opening suffers?

As to the "THUMPNG," can be all srts of things.  Kinda tickled me that the PM nurse talked to you as he did - "Caught" is a word I'd expect him to use w/ someone w/ zero knowledge of PM's.  The correct PM term is "Capture."  He was trying to find out if your heart captured the pacing spike and contracted as he changed the HR the PM was operating at. They usually set the voltage output a bit high at first to ensure capture, & some people feel the resulting contractions more than others do.  They feel it as a THUMP.  Not unusual.

How we sense events & describe them is also as differrent as our DNA.  Just this week, a woman described her heart as "Doing a double take."  I've heard "Flip-Flops," you name it, they come up w/it.  I scratched my head a bit & decided the double take was her sensing a PVC.  Suggested that to her, she checked w/ her cardio & he confirmed that . 

I assume that you know what a PVC looks like on an ECG print out.  No way on earth that anyone would correlate that trace w/ what you sense when it happens.  Is it possible that you are having PVC's?  They are sensed as a hard THUMP when the first normal beat comes, following the wimpy premature beat - which you may not sense at all, so you think there is a missing beat & then WHAMO! that first normal beat hits you - SURPRISE! It's hard because the ventricles have filled more than normal & the heart is working harder to move the extra blood out.

I understand what you mean about "Inside," as opposed to "On top of."  Alll the muscles are on top of the rib cage.  You are feeling something that is inside the body & there is no visible or sensible twitching spasm in muscles.  That could well be a PVC.  Ask them to check out your PM to see if it is recording PVC's - or check your pulse when you have one.  You sound like they occur in groups, so there just might be a follow on PVC after the first.

It is NOT unusual for new PM hosts to suddenly sense PVC's.  It's just something different & you are now sensitized toward different things occurring.

Wish you the best in your new reality!

Yes, you are young & tough.  I'm nearly 80 - I'm old & tough.  Humans are tough critters!

Donr

5weeks post CRT

by Joro - 2016-08-19 00:14:03

I had a Medtronic 3 lead bi- v CRT-D implanted in 7/12/16. I had quite a bit of muscle &arm soreness initially. I was sent home with Tylenol #3 but I actually found more relief with alternating Ibuprofen  and extra strength Tylenol every 3-4 hours. And I also took Zantac for  my stomach . After about 4-5 days, the pain was much better. And I would say I'm completely healed at this point and have been doing all activities as tolerated for past 2 weeks . 

Good luck for quick healing !!

Thanks for the answers

by Sabah - 2016-08-19 13:58:40

I went in today and had my device interrogated. At first the doctor was thinking the lead had migrated, but an echo ruled that out. For now the setting on one lead (left ventrical I think) was turned down from 3 to 0.5 and the thumping has stopped. Tuesday I am going in for chest fluoroscopy and possable lead revision. The pacemaker nurse said it may be that I am just sensitive to the feelings. When they changed the settings I was able to feel it. At one point the nurse changed my settings without saying anything to see if I would feel it and I did. He said younger people seem to notice the feelings more so it may just be a sensation I will have to learn to live with. As for pain it seems it was only bad for the first 3 days. Today I have not needed anything for pain. I am still using an ice pack because it is itchy and that stops it. Thanks so much for all the responses. It is comforting to hear from people who understand exactly what I am talking about. The doctor said after looking at my echo he thinks it is unlikely I will need lead revision and I really hope he is right. I really do not want to get cut again. 

Thumps

by rnff2 - 2016-08-21 00:16:25

I was able to feel my pacemaker pacing all the time for the first several months.  It is much worse when they are checking it too.  I went in for frequent setting changes the first 3-4 months because I was miserable.  Finally we were able to get the settings to where I was comfortable.  And now I'm super protective and make sure when they do my interrogations they don't change anything.  

I had valve replacement surgery in January and when I woke up post op I asked them why they changed my settings and to please change them back.  They couldn't believe I was able to feel the pacing and that I knew my setting were even changed.  It took 24 hours of my heart pounding (pacing) and they finally changed me back to my original settings.

I have a feeling your just feeling the pacing. If it continues they can tweak your settings and try and get you to a point where your comfortable.  It's a lot of trial and error.  Eventually you feel it less and less.  I'm 3 years out and only feel mine on rare occasions now.  It does get better.

I'm a nurse also and I have learned a lot about pacemakers since getting mine.  It's so different on the other side, and a lot more difficult too.  Good luck with everything! 

Settings changed

by Sabah - 2016-08-24 16:53:49

I went in this past Tuesday for a possable lead revision, but under fluroscope they were able to see that the leads are in good position and they changed my settings to where I have not had any more "thumping" I was able to detect the changes and it was a bit uncomfortabls, but now it is doing well.