Pacemaker? Leads?

My experience(s): Nov '18 - Treadmill stress test, no big deal. Excercise for me at that time was 1-hr. on the treadmill at 3.5 mph & slight incline followed by 2 mile walking track thingy, 5-6 times per week. EP replaced my 3 lead PM - due to low batt - on Nov 30 '18 with a 3 lead PM defib. The following month, I had 3 periods of excitement - diverticulitis followed by a C-Diff infection followed by a pneumonia.  Mid Jan. '19 I was finally kinda normal except: exercise 45 min at 2.5 mph 4 times/week and NO walking track use. Daily fatigue set in. Currently, the EP wants to go in for a look 'cuz "that third lead isn't working."  Could the new Medtronic PM w/cardiac resynchronization capability be not functioning as it should? I've had numerous device checks through 2019 along with a 48 hr. Holter monitor survey.  Would any of this have caught a malfunctioning PM? My look at the Holter report reveals things like "Number of longest Ventricular beats: 9 - Number of Ventricular ectopics: 33,791 and so on. Nothing that points to how the third lead is involved.   FWIW: The first Doc who suggested what my current issue is was my Dermatologist, Mary Evers, DO. I disrobed for a skin check and she took one look at my torso and muttered "Cardiac Cachexia"  Not one cardio Doc had mentioned that condition earlier. Whatcha think? 

5 Comments

Heart failure

by AgentX86 - 2020-02-19 12:21:41

You didn't say, but it sounds like you have heart failure with diminished LVEF (new CRT-D, hint of cardiac cachexia). The third lead not working won't help but, alone, it shouldn't cause your symptoms (not a doctor,  though). Cardiac cachexia does explain a lot, though I don't think your doctor would just mumble if it were a fact. Have you been losing weight?

Yes, a pacemaker interrogation will find a defective lead. It's one of the reasons we have them.

Weight Loss

by Dave H - 2020-02-19 15:49:09

Yes, I have been losing weight.  180 lbs in Jan 2019 that fell to 151 lbs this past Xmas (when again I experienced a diverticulitis event!)  Since Xmas, I've gotten my weight up to 160 and aiming for 165 next through nutrition and exercise.  Colonoscopy also in the cards.  Interesting note: In 2012 when I received my first PM, I weighted 240 lbs.  I went on a exercise binge and gradually shed 60 pounds over the years - then the unintentional weight loss began early 2019. The most annoying thing is the "fat" that holds ones eustachian tubes closed has shrank and my tubes are always open causing autophony (you can hear yourself breathe and speak) along with the "Auschwitz refuge look."  I have to change my exercise regine though. From the waist down - due to treadmilling - I look normal. Torso is bony and arms are thin with no muscle mass.  I have to work on that!

"Unexplained weight loss"

by AgentX86 - 2020-02-20 08:37:07

Unexplained weight loss is one of the symptoms of cardiac cachexia. Since it was a dermatologist who whispered it, I wouldn't be in a panic but I'd certainly raise the issue with my cardiologist.

Weight Loss

by Dave H - 2020-02-20 12:55:31

My primary Doc tended to agree with the dermotologist's comment.  Subsequent Cardio Docs have just lightly mentioned any comment regarding cachexia. Heart Failure Doc has been pushing for me to get an LVAD - which I'm hesitant to do. LVAD implant requires about a three week hospital stay (a dangerous place to visit) followed by healing and LVAD maintenance. BTW, my Dermo Doc is pretty sharp - at my first visit with her years ago, I mentioned I had a case of Valley Fever while staying in the Gold Canyon area of Arizona.  She said, "Yeah. The SW U.S. desert is infested with Coccidioides immitis or Coccidioides posadasii fungi - how did you deal with it?" I said it gave me a pleural effusion that went away after I got the hell out of AZ!  She said, "Good move!  To the unknowing eye, a chest X-ray of a person with Valley Fever looks like lung cancer - all kinds of nasty things follow that misdiagnosis!"

Pacemaker? Leads?

by Dave H - 2020-02-23 21:44:42

One Doc I've been looking for lately.................whose business card states, XXX  XXXXXX, MD echocardiography. The Doc I was referred to in 2017 had these credentials.  Wife asked him, "Are you an EP?" He answered, "No! But I can read an echo better than any of the guys your hubby's been seeing!"  And he was right on! Major improvement  after his optimization.  Then he went and retired last year!  Arrrgh! Oh, well.

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Life does not stop with a pacemaker, even though it caught me off guard.