Strange pain

Good morning, 

I am hoping someone has experienced something similar so to explain what is occurring, as my doctors are at a loss. I had my pm surgery on Sept 12, 2019. I’m 62 yr old female, with Brady-tachy. PM is set to 60 with rate response, I’m on no heart medications. About 2 monthe ago, I was at my low impact Zumba class when I experienced a tremendous, excruciating pain on the left side of my chest. Pain was so strong, that it took my breathe away. After a few minutes of rest and water, the pain subsided. I called my doctor and he scheduled a pm check, which  turned up nothing. No event was recorded, pm was in perfect working order. I was given the clear to go back to Zumba, which I did. A few weeks later, it happened again, this time, not so intense, since I had been cautious because of the previous event. Again, I called the doctor, he then scheduled a stress test, which I passed with flying colors. Again, the doctor has no ideas and we continue to try to find some correlation with the exercising and the pain. Some of you suggested maybe it was related to sound vibration, nope, doesn’t seem to make a difference. It has only happened during this particular exercise class, and usually about 12 minutes into the class. I’m thinking it may be related to left arm movement. The pain seems to start about 1 inch to the right of the PM toward center of chest, and it is an intense pain that radiates in all directions until I stop moving. I’ve tried to ignore the pain, and work through it, since the doctors said my heart was fine, but the pain didn’t agree. After the event, there is no residual pain or tenderness. It only happens during this class. It only happens once during this class even though I continue exercising for another 30 minutes after it happens and It doesn’t happen every class. Does anyone have any ideas as what it could be?


Sounds as though it's coming from the PM pocket

by crustyg - 2020-02-13 11:33:27

When we Mountain Pose Cactus Arms in yoga I sometimes feel a twinge from my PM pocket: this pose 'opens up the chest', and it certainly stretches across the pectoral muscles as well as moving the upper arms in the shoulder joints.

From your description, it sounds as though you are pulling hard against something - perhaps the big stitch that anchors your PM to the back of the pocket is a little tight when you make certain arm movements.

Usually there is a single, large, non-absorbable stitch, which allows *some* movement of the PM within the pocket but stops it migrating around your chest (which has happened to others in this club when the stitch has failed).  I wonder if your PM has been anchored with two stitches.

Unexplained pain

by Gemita - 2020-02-13 14:31:04

So sorry you are still having these symptoms.  A real mystery.

I do recall you had a diagnosis of PCIS (Post Cardiac Injury Syndrome) which my husband also had following his PM implant.  My husband has now had a nerve block to treat his pain symptoms which has been immensely helpful.  Sometimes the level of pain remaining can exceed that of the initial injury and this may go some way to explaining why you feel so much discomfort without any evidence of a problem.  Frustrating I well know.  Sometimes short term treatment with neuropathic pain meds can help (like Pregabalin) or ask for a referral to a Pain Consultant for further advice.  Also have your doctors ruled out "pleuritic" pain as a cause following your PCIS ?  A short period on an anti inflammatory would help in this regard.

I too feel strongly that something has got trapped and is being pulled, like a nerve or muscle tissue entrapment.  Also could lead wires have got caught up somewhere or have migrated slightly or there is some injury to a nerve, artery or a vein which you feel sometimes on stretching.  But of course all your tests are coming back fine for the heart and pacemaker function which makes it all the more difficult to explain.  

Oh the questions for your PM team are endless I know but I wouldn't stop asking.  What to do about it though ??  I would ask for further imaging if you haven't already done so, to make sure that nothing obvious is being missed.  


pain in the

by ROBO Pop - 2020-02-13 17:27:37

Could be pain in the pocket as crustyg suggested. After 10 years mine still hurt off and on.

Another possibility is unstable Angina. The fact the pain dissipates after a few minutes is a good sign. Angina is chest pain, usually associated with the heart that is typically caused by blockage or a valve issue. I can say from long time experience those can sometimes be debilitating. Your pacemaker will not record those events. Talk to your Cardio about these possibilities

Thank you for your responses

by Ddefalco326 - 2020-02-13 22:02:39

Thank you all for your responses. After reading them, I will ask my EP about the possibility of the pain being associated with the pocket. It makes sense. When it first happened, the pain had radiated so quickly that I couldn't tell where it was starting, but I can now. I hadn't checked to see how they make the pocket or attach it, so I was unaware of the possible issues that could happen. Thanks once more for your help and advice. I really don't know what I would do without you all! Happy Heart month! 


Post implant pain

by Seo - 2020-02-16 00:35:45

You know the old joke - 

Me:  Doc, it hurts when I do this...

Dr :  Don't do that.....

just kidding. I got my implant about 2 months after you did. I still feel some pain in/around the pocket. If it happens to me, it usually feels like something "pulling."  On occasion it can be a rather sharp pain. I need to talk with my EP, but I've tentatively concluded that it's either the suture that helps hold the device in place, and/or  the device itself moving a little, as it isn't fully held in place yet by scar tissue. It's not frequent, but instantly majes you worry if you've damaged something, or pulled a lead. One other possibility - a couple years ago I got a severe cut on my left ring finger. It damaged the nerve at the tip of my finger. As it healed (took over a year) the nerve would occasionally decide to hurt. Annoying, sharp pain. Considering that in forming the device pocket, a nerve may have been irritated or damaged, it may be just that nerve reminding you that it isn't happy. Keep following up with your doc. I've been told by the nurses/technicians that it really can take several months- up to a year to really fully heal.  

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