Breathless on exertion after pacemaker

Hi all,

I'm wondering has anyone experienced a tightening of the chest post pacemaker surgery, as though you cannot get enough air into your lungs.

Particularly happens on exertion, even light exercise i.e. walking my dog less than quarter mile. If I ignore initially and continue to work my heart for example cutting a large lawn then the feeling becomes quite severe and I get an ache in the upper right side of my chest. It takes me a few hours to feel 'normal' again.

I had a Medtronic pacemaker fitted in Feb 2020 due to a very low heart rate (Bradycardia - 34bpm) but this is something that seems to have come on approximately 2 - 3 weeks after surgery and is affecting my lifestyle as I'm unable to do much without feeling unwell

Medtronic have tested the device which they say is doing it's job... and I've had an ECG which also indicates said pacemaker is working within its defined parameters. However I had to present to the ED (within the past week) when the feelings of being breathless continued to escalate

I'm due for an Echo within the next day or so. I had an angiogram which didn't show any blockages a subsequent CT showed no clots on my lungs either.

Three months on I would have thought things would be better. I'm 57. If the hospital send me away happy that heart, lungs etc are ok, is this something I just need to adapt to and maybe increase physical activity i.e. get fit(ter)




by Tracey_E - 2020-05-04 09:35:43

You don't say in your profile why you have the pacer. That would help answer your questions. It's not at all uncommon to need the settings fine tuned once we get it. The pacer can be working great, but that doesn't necessarily mean it's optimized for your needs. Have you had a stress test? Get on a treadmill and have them watch what is happening real time.  

When you get tired and short of breath, stop and count your heart rate. Manually, monitors are notoriously inaccurate with us. Is it always the same? 

Until you figure it out, getting chest pain and being breathless are warning signs from your body to stop. I would not push through until you know why it's happening. 

Had the same problem

by Theknotguy - 2020-05-04 09:57:43

Had the same problem.  I volunteer at a hospital and the back hallway is about 1000 feet.  Would run out of air after walking the length of the hallway.  Mowing the lawn I'd have to stop because I'd run out of air.  Talked to my EP.  They did some tests.  

Turns out my exercise level increased because I was feeling better and my pacemaker wasn't bringing my heart rate up to the level to sustain my new level of activity.  Had a couple of adjustments made by the pacemaker techs.  Feeling a lot better because my pacemaker responds adequately to my increased level of activity and it keeps the blood flow going so I'm no longer running out of air and gasping for breath.  I also get the pain in my back when I was running out of air.  And that's gone away too.  

Hope you can get some help soon.  


by paulh - 2020-05-04 10:28:56

thank you for your comments, in relation to a couple of things raised. The device was fitted due to Bradycardia, I was as low as 34 bpm at one stage.

I've had a stress test, which was done a few weeks ago because of the breathless symptom and while having this it was discovered that at rates above 120 bpm I had an extra beat (lucky me). I was prescribed Bisop 2.5mg for the extra heartbeat. 

The pacemaker has been 'optimised' twice now and still the problem persists. The Medtronic rep said the device is set to operate at 50bpm and this was mainly occuring at nightime. All other times my heart is doing its designed job.


by Tracey_E - 2020-05-04 11:54:36

What is the cause of the bradycardia? That's more of a symptom, the low heart rate. Different things cause it and they have different fixes. Sick sinus, heart block? 

Does the bisprolol help with the extra beats? It's also going to prevent your rate from going up which may make the breathlessness worse, if it's caused by rate not being high enough. 

Keeping your rate from getting under 50 is one thing the pacer does. The other thing it can do is get you up on exertion. When you were on the treadmill and got breathless, what was your rate and were you pacing? Was the doctor there or just a tech?


by WazzA - 2020-05-04 13:26:24

You are certainly not alone in feeling starved of air! I'm 7 months post PM implant for Bradycardia & am hoping pacing team can find a resolution to my own experience of it.

Overall I am much improved given that I had become UNFIT in the lead upto my heart problems being treated & I am aware it will take time to regain that level.

I listen to what my body is telling me & certainly try NOT to reach a point that leaves me stuggling.  

Chest pain on excertion

by Selwyn - 2020-05-04 15:27:54

Unfortunately a normal angiogram does not rule out angina pectoris. Chest pain on excertion is different to shortness of breath.

I suggest you read :

on microvascular angina ( if used to be called Cardiac Syndrome X). Note beta blockers may worsen! Glyceryl trinitrate may not help.

I would be wanting to see my cardiologist ( hopefully, a senior doctor, with a brain!!) and having a frank discussion about this.

Do not be fobbed off by negative investigations- it is the patient that is important not the tests! 

The increase in heart rate brought on by the pacemaker may have unmasked this.

For heavens sake, follow TracyE's advice and take it easy until this is sorted.

Love to know the outcome ( by all means sent me a private message)- thanks.



by arentas80 - 2020-05-04 22:36:37

I'm 39 and had a PM put in 12/30/2019. I'm exeperiencing the same thing you are. Quick movements, short walks, bending over to wipe my dogs paws can make my chest tight and leave me SOB. If I push I feel dizzy like I will pass out. I'm scheduled for a Tilt Table Test on the 27th and a Cardiopulmonary Exercise Test on the 13th. Please let me know what you find out. All these docs say I'm ok and I know I'm not. I'm even getting dizzy daily now and lightheaded. I sometimes wonder if this was even worth doing. I had an EP tell me he's had patients with Brady and pausing up to 13 seconds and have been fine for years. It's so frustrating how they default to the TESTS and not the patients. We aren't robots! Anyhow PLEASE let us know what you find out. I'm really interested to see what happens in your case. All the best!


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