Dizziness

I'm new to this forum, and thank LondonAndy for telling me about it. 

On May 30, I got a St. Jude PM implanted. 

I've had some major issues with arrhythmia, still have bigeminy (and possibly PVCs again), and was taking Verapamil for a few weeks befor surgery. It made me dizzy, and my EP reduced the dose. 

My heart rate was around 50 normally, for the months before I got my PM. It was dipping into the 40s, then the 30s, and my EP decided that it was time to implant a PM.  I called the EP to again mention that my heart rate was in the 30s -- one hour later, at his suggestion, I was at the hospital. About two hours later, I had my PM implanted and was in Post-Op. A couple hours later, I was released and took Uber home. 

Here's my question: post-op I was still taking verapamil. One of the side effects was dizziness. I was dizzy standing, extremely dizzy trying to walk, and slightly dizzy when sitting. If I moved quickly, I would lose my balance. I fell a few times. 

The EP didn't think that the reason was medication. My neurologist cleared me - it wasn't neurological. A phone consultation with an ENT didn't show any reason for dizziness. Physical therapy consult, over the phone, didn't point to anything specific. 

While my body is adjusting to the pacemaker, my dizziness has mostly resolved. 

So I'm curious -- have you experienced dizziness following PM implantation?  If so, how long did it last?  Did it completely resolve, or are you still dealing with it? Is there a medication that you think may have contributed to your dizziness?

Thanks


9 Comments

Dizziness

by Gemita - 2020-06-28 16:58:46

Hello Protimenow,

Welcome.  I had my pacemaker (dual chamber) implanted in 2018.  I too have arrhythmias and arrhythmias can certainly make us feel dizzy, off balance and unstable.  However since my pacemaker implant my arrhythmias are so much quieter and certainly less frequent so I am well happy with the outcome.  A pacemaker is not a cure for our arrhythmias but it may help us to feel our arrhythmias less.

In answer to your specific questions:

Yes I have experienced dizziness since implant - quite severe almost to the point of collapse during two non sustained ventricular tachycardia episodes.  

The instability/dizziness lasted for several minutes and I had to rest to recover and felt quite unstable on first rising.

On termination of arrhythmia(s) the instability/dizziness resolved.

I was taking Flecainide and Digoxin together with Bisoprolol at the time.  Both my EP and I decided that Flecainide was pro arrhythmic for me and also tended to increase my heart rate during an arrhythmia like Atrial Fibrillation.  After one year with my pacemaker I was able to stop both Flecainide and Digoxin and am now only on low dose Bisoprolol (a beta blocker). 

I do believe anti arrhythmic meds cause many unwanted symptoms, including dizziness.  I have never tried Verapamil but if you feel it is causing problems I would ask to try something else to see if your dizziness stops.  Many rate control meds will also lower our blood pressure (which cannot be controlled by our pacemaker) and this can lead to dizzy spells.  There are many meds that can treat irregular heart beats and it can be so trial and error until we find something suitable..  Please let me know if I can help further

 

 

No dosage change...

by Protimenow - 2020-06-28 19:23:08

I complained to my EP about dizziness when I was taking 180mg extended release Verapamil. He dropped my dose to 80 mg twice a day. I complained again, and he prescibed 40 mg in the morning and 80 mg in the evening. 

After a few weeks, and also a few weeks post-op, the dizziness became less frequent (but still there). I suspect that getting used to the Verapamil had more of an effect on the dizziness than the PM did. 

If I have no issues, I see the EP again on July 6 -- 5 weeks, two days after the PM was implanted. 

 

Lightheadedness/Dizziness as Medication Side Effect

by Marybird - 2020-06-28 22:00:41

Dizziness is listed right up there at the top of the list of side effects for calcium channel blockers-of which verapamil is one.

I don't have experience with verapamil, I take diltiazem, another calcium channel blocker, to control my atrial tachycardia and high blood pressure. When I started taking diltiazem a year ago- to see if it might be a satisfactory replacement for metoprolol, I felt lightheaded/dizzy much of the time. In my case it was hard to be certain if it was due to the medication, or symptomatic of the bradycardia I had when I wasn't having tachycardia ( which can make you dizzy too). But I felt that some of those dizzies were related to the medication.

In my case the diltiazem alone wasn't all that effective in controlling the tachycardia, and I still had bradycardia,  so after my pacemaker was implanted in June 2019, the EP added metoprolol ( 50 mg/day) to the diltiazem ( 180 mg/day) I was taking, and this combination seemed to work well to control the tachycardia.

I seem to think it took me maybe 3 months to get over the side effects of the diltiazem and my other meds, but I have very few if any side effects now. 

Interestingly, at my last EP visit in January, he doubled my diltiazem from 180 to 360mg/day, to try and get better control of my runaway blood pressure. I thought for sure that increased dosage might throw me for a loop, with more side effects. But it has not done so, and it seems he was probably right in that it's helped the blood pressure-and the tachycardia breakthroughs. I take an extended release 180 mg capsule twice a day of the diltiazem. 

It may be that you're still getting used to the verapamil and when you do, the dizziness will get better. Maybe your EP lowering the dosage will help that, and should you need a higher dose to control your tachycardia, he can kind of titrate the amount back up to where it needs to be, without your having bad side effects. 

Good luck!

 

 

 

It's back - and I don't know wny

by Protimenow - 2020-06-29 13:34:41

I thought that I had a good handle on the dizziness. I woke up this morning, and was fine, but a half hour later, the dizziness returned. 

And I'm not sure why. My plans for this morning have changed - I'm staying around the house, not moving around much, and avoiding things that can throw me off balance. 

This is such a pain. I'll try some of the usual stuff - making sure that I'm not hungry, taking an anti-allregy medication - checking my posture. 

Although I told myself to slow down, I still found myself falling. 

Any further suggestions would be appreciated. 

More thoughts

by Gemita - 2020-06-29 15:12:38

If you didn’t have arrhythmias, I would suggest you continue to look elsewhere for answers but you do have arrhythmias and I still feel these are causing some of your dizziness when combined with any medication.  From personal experience with the so called benign ectopics, PVCs and PACs, these can really mess with my circulation just as much as when I am in AFib, Flutter or experiencing other atrial tachycardias or having runs of NSVT (non sustained ventricular tachycardia).  Ectopics leave me feeling weak and unstable especially when they are continuous. 

How is your blood pressure?  Mine fluctuates wildly during arrhythmias and of course the pacemaker cannot control our blood pressure.  I wonder if a 24 hour blood pressure check or a longer term heart monitor (say 10 days) might pick up something more revealing?  Do you have home monitoring with your pacemaker and could you do a download when you are getting symptoms of dizziness for your clinic to correlate with any rhythm irregularity?  Are your bigeminy PVCs perhaps developing into NSVT episodes for example?  Groups of three abnormal beats (triplets) at a ventricular rate of more than 100+ bpm are I believe considered a brief run of NSVT and if the grouping lasts for more than 30 seconds, it is VT.  My PVCs can develop into NSVT runs and this can really destabilise me especially if my atrial tachy arrhythmias are present at the same time.

Have you checked your electrolytes.  Potassium and magnesium deficiencies can be common causes for PVCs.  So can stimulants like caffeine.  Do you have ischaemic heart disease ?  My EP did an angiogram to look at my arteries as a potential cause for my arrhythmias plus he ordered an electrophysiology study to also look for causes.

Finally, my EP felt that my arrhythmias were predominantly triggered by falling heart rates and long pauses and by setting my heart rate higher (at 70 bpm), my arrhythmias could potentially be outpaced and cause fewer symptoms.  This has clearly been the result for me.  What is your minimum heart rate set at ?  Maybe consider something a bit higher ??

Oh and make sure you stay well hydrated.  Dehydration is a strong cause for rhythm irregularities.  Also check for sleep apnea and any hidden infection somewhere.  Check thyroid too.  All of these can cause arrhythmias.  Maybe get some bloods done to check for anaemia or low glucose levels (or high) too !

I hope you get answers soon

 

Great message - some responses

by Protimenow - 2020-06-29 17:00:25

Gernita - what a great message. I'm truly impressed. 

As far as blood electrolytes, the three times (not including when I got my PM implanted) showed that my electrolytes were fine. That said, I'm drinking Powerade which provides some extra electrolytes. I also take Magnesium daily. 

I've had a lot of different arrhythmias, and some were resoled with an ablation. I still had a lot of PVCs that couldn't be safely ablated. After my PM was installed, I saw the EP a few days later, and it looked as if, with a rate of 70, my PVCs were gone. 

I don't know if, once my heart adjusted to the effects of the PM, some of this stuff started again. As many (most?) of know, PMs don't affect arrhythmias - I'm still having bigeminy and other arrhythmias. 

I'll know more next Monday, when the EP takes another EKG to see my heart rate. 

I have a Merlin at Home that sends a report from a night reading, to my EP. So far, I've heard nothing indicating a problem. I don't know if I can interrogate the PM on demand.Perhaps the EP can ask for an instant reading, and will walk me through the buttons I should press to get an instant reading. 

I don't know of a consumer app that will let me see any of the PM data. 

I'm not sure about hydration, but I don't think this is a problem. 

I had just come in from outside the house, and the problem seemed to develop once I came in from outside - perhaps something about going from brightness into not-so-bright had something to do with it?

My wife thought that it might be a delayed reaction to some spices on food that I ate yesterday. It's a long delay, but may have been slow to mess with my system. I don't know. 

I may try the Light to Dark test again, although I haven't heard of this affecting BP or heart rate. My BP DOES fluctuate - from about 150/90 down as low as 109/70. I suspect that my brief time outside raised the pressure - but the pressure when I sat down was still high. 

The EP may run another 24 hour holter to see what's going on. 

Any other thoughts are welcome. 

I really appreciate your comments.

Dizzinss

by AgentX86 - 2020-06-29 21:39:47

All sorts of stuff here.

Electrolytes can certainly cause all sorts of arrhythmias but you should be able to detect these arrhythmias when you're having these dizzy spells.  Your electrolytes are fine, though, and you're taking magnesium.  What sort of magnesium (oxide is useless for anything other than cleaning you out).  Also, forget Powerade or any of that stuff (coconut water is a good source of magnesium and potassium).  It's all sugar and salt.  Neither is a good idea.

If light to dark does this, I'd suspect a some sort of epilepsy.  You said that a neurological exam found nothing but IME neurologists never find anything unless it bites them on the butt. Not their fault but there is too little known about the brain and they have too little data.

Catch it in the act

by CyborgMike - 2020-06-29 22:34:05

Protimenow, I read your bio and you do have a lot going on with your heart and meds, so the dizziness could be caused by any number of factors. If it were me... I would want to see exactly what is going on with my heart during a dizzy spell. You can get a $100 three lead ecg from ebay or the latest (s4/s5) Apple watches have a high precision one lead ECG. After the ECG I would take my blood pressure. If the heart rythm is normal during dizzy spells and your BP is normal then you know it is something else (Meds, electrolytes, nuerological, etc.). Getting an ECG from an EP when you are feeling fine isn't likely to provide the clues you need. I would want to "catch it in the act".  

Merlin at Home transmission

by Marybird - 2020-06-29 23:25:11

Protimenow, although the Merlin at home transmitter collects transmissions from your pacemaker and automatically transmits them to the Merlin.net site at Abbott ( St. Jude), in the event there is an indication for you to send a manual transmission for your doctor to see, say during an arrhythmic event, there is an easy way to do it.

The instructions include sitting within a couple feet of the transmitter, ( within range of the pacemaker to communicate with the transmitter), and pushing the large white button ( transmission button) on the left side of the transmitter right under the figure with the heart icon. You will see each icon light up as the transmitter reads the pacer report, transmits it to the Merlin.net, and transmission is successfully completed. 

You'd only do that with instructions from your EP to do so, and probably a call to the St. Jude ( Abbott) technical service before you send a transmission so they know it's coming and can send it to your doctor.

 

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