Right side chest pain

Hi, 

I am hoping someone can help me figure out what’s going on. I had my PM implanted on Sept 12, 2019. During the procedure I was under conscious sedation and fell asleep, only to be awakened due to excruciating pain in the right side of my chest. The docs were unable to tell me why I was having so much pain, and in the meantime I could hear them saying that they were having trouble with stopping the bleeding and that the leads needed to be redone. I then fell back to sleep. When I woke up I still kept complaining of the right sided chest pain. The PM was placed on the left side. The EP still had no answer as to why I had this pain. The pain did not get better and I was hospitalized on 9/24/19 to rule out pulmonary embolism,  and after all sorts of tests it still could not tell me anything more than I had some pleural effusion. I just had another chest X-ray on 10/23/19 and it is now showing apical lung consolidation in my right lung. My pain is controlled with ibuprofen, but when I stop taking it, the pain increases. My question is this, could the EP have punctured my lung during the procedure and blood seep into the lung? I am requesting my operative notes from the procedure so that I can find out where the bleed was from. The EP never mentioned that anything went wrong, and I haven’t seen him since the procedure. 


5 Comments

PLEURAL EFFUSION

by Gemita - 2019-10-29 08:52:34

Hello Ddfalco326,

Hubby and I both have pacemakers.  During my husband's implant in March 2018, he suffered a similar experience.  During the procedure he had a pretty nasty bleed due to being on triple therapy (Aspirin, Clopidogrel and Edoxaban) which nursing staff failed to stop well before the procedure.  After numerous tests, including PET scan, he was found to have a pleural effusion with septation and infection, causing pleural thickening, base left lung.  The cause was deemed to be "post cardiac injury syndrome" from pacemaker insertion.  His symptoms were relieved by Ibuprofen and an aspiration of his pleural cavity (which was indeed blood-tinged fluid) but it took months and months to get a diagnosis and months and months to get symptom relief.

I am not suggesting your pleural effusion is the diagnosis and cause for your pain but it might be worth asking to see a respiratory consultant for an opinion if answers are hard to come by.  I note that you have had multiple tests.  Have they tried to drain fluid from your lung to test?  I appreciate it is invasive but that may be the only way to get a clear indication of the likely cause for your continuing symptoms. In any event, if your symptoms do not improve I would consider going back to your doctors, since continuing chest pain should never be ignored.  Good luck

Thank you

by Ddefalco326 - 2019-10-29 10:09:45

Gemita,

Thank you for your response. I know we talked about this previously, right after my surgery. It is now almost 7 weeks post surgery and still not much better concerning right side chest pain. I hope with getting the notes it will shed some light on what if anything out of the ordinary happened during the procedure. I am also waiting on my primary care to refer me to,a pulmonologist, which I believe would be the next step. I am a person that is very in tune with my body, and usually know when something just isn’t right. I also need to switch cardiologists, as I do not feel as if he treats me as more than a number, he barely makes eye contact.  My previous cardiologist retired after being with him for over 20 years. Thank you again for your insight. The Pacemaker Club has been a great source of information and comfort. I am still adjusting to this new way of living! 

 

 

Sorry that it's not getting better

by crustyg - 2019-10-29 18:16:36

We chatted about this on 28th Sep - I'm disappointed for you that it's no better.

As I mentioned before, it's possible to puncture a lung if the stylet goes through the vein, which might well produce lung collapse and haemothorax.  It may be too late to try and aspirate any fluid from around the lung, especially as blood - if there is any - can produce fibrosis which makes a successful tap difficult if not impossible.

If your EP doc has not yet shared exactly what happened during the procedure, and you're having to extract all of the medical/surgical notes through a formal process, that's not a good sign.

What to do? Probably not much you can do at this late stage, except hope that the lung re-expands, which it should do if any puncture has healed and the airway to that lobe is adequate.  The pain you're feeling is *probably* from the inflamed lung covering, the pleura, which is best controlled by a NSAID such as ibuprofen.  It takes time for pleurisy to get better, sometimes a lot longer than we expect.

And change your EP doc.

Crustyg

by Ddefalco326 - 2019-10-29 18:51:59

Hello again, 

Yes, I remember our chat. I agree that I need to change EP, and even cardiologist at this point. I have not seen EP since the PM procedure. I did not know what to expect from anyone, as to follow up appts, pacemaker clinic, etc. My cardiologist actually asked me, “Who is following you?” I was taken aback and replied, “You”. He then told me I should see the EP again. I have an appt with the EP on Nov 25, the earliest I could get, in the meantime, I’ve requested my records. I believe you are correct with the lung puncture, and want to see the notes for myself, to see what was actually documented. I thank you for your support and your insight. In the meantime, it’s ibuprofen for me! 

PLEURAL EFFUSION

by Gemita - 2019-10-30 05:39:52

Hello Ddefalco326,

Yes I do remember our previous posts because your PCIS (post cardiac injury syndrome) attracted my attention.  It is funny how we seem to get placed in the "Syndrome" category when they cannot give us a firm diagnosis/cause for our symptoms.  I really hope you get some answers.

You are absolutely doing the right thing to get another cardiologist to care for you.  Maybe an  ElectrophysiologistCardiologist might be even better to look after you as he/she would have specialist knowledge in pacemaker therapy. When respect, trust and a good rapport with our doctors has broken down it is time to move on.  I had a bad run in with my first cardiologist who seemed to suggest that my arrhythmias were largely of my own making and "were not significant" (actually he used the words "were not exciting") !!  This was hurtful and offensive when I was so symptomatic.  His attitude changed when longer term monitoring picked up a "significant" event necessitating a pacemaker, but I had to fight all the way to be heard and it was a very dark period in my life. I realise now of course that his words were well meant, to reassure me, but there are better ways of speaking to patients.  My current EP is so helpful.

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