SOB - New Pacemaker Implant

So I am 52 years old and have a CRT-D.  I have had cardiomyopathy for 30 years.  EF down to 20% but prior to PM implant (Sep 8 2020) I had a pretty good exercise tolerance.  I could sustain 120bpm for 40 mins no problem.   

So since I've started exercising, I have ZERO tolerance.  Walking uphill (moderate incline) is a struggle.  On most moderate hills I have to stop and catch my breath.  I feel like my HR immediately skyrockets upon starting to exert myself.  Just prior to my implant I was hiking and felt great...It is so aggravating to be SOB.  I never experienced it in 30 years with my condition.  I went to see my EP after a week for a checkup and he bumped up my HR max to 140 and made some other adjustments (after I told him about my SOB upon exercise).  I am frustrated.  My muscles feel weak when exercising as well.  I'm not an athlete but I thought I could tolerate most moderate exercise for my condition.      

I wear a Garmin forerunner which tracks HR.  Prior to PM implant my heart rate would gradually increase.  Again, now it seems like light to moderate exercise has me maxed out.  As soon as I pause my pulse drops quickly.  From say 140 to 100.  Again according to my Garmin but my breathing seems to be in line with that.  

I do have to mention that I feel great otherwise.  Palpitations are minimal and I'm not exhausted at the end of the day.  No more naps.   So its working and probably needs to be tweaked?  

What kind of questions should I ask when I see my EP.  What is a key setting related to what I'm experiencing?  Boston Scientific Device G247 Model.  I called the rep from Boston Scientific and he said he would take a look at latest interrogation and come up with a plan along with EP.  

Thanks in advance for your help. Its great to have forums like these and support from folks who are experiencing the same issues.  

3 Comments

new pacemaker implant

by Gemita - 2020-10-11 11:25:11

Hello LD1708,

Thank you for your post and for all your information.  Welcome.  I really hope, as you do, that your CRT-D (Cardiac Resynchronisation Therapy - Defibrillator) will help your EF to improve so that you can continue to do the activities that you enjoy.

My immediate observation is that your implant is a very recent one and you are still healing from your procedure and your heart is still adjusting to pacing, so a little patience and understanding is required.  It actually took me three months to adjust, for my tiny heart to settle down.  I too found myself breathless doing my usual activities and I felt disillusioned and disappointed with my little device at first. In my case though my breathlessness was being caused by my arrhythmias which were very active immediately after my procedure and continued to be so for a couple of months.

I do not have a Boston Scientific pacemaker but I hope other forum members who do have, will be able to help you with specific settings questions for your EP.  In the meantime, I would start by asking your EP the following:-

.  How much can I expect my EF to improve now that I have CRT pacemaker?

.  How long is this potential improvement likely to take ?

.  Are my present difficulties merely teething problems with settings, requiring perhaps only adjustments, or are these difficulties likely to be more related to my low EF ?

.  Prior to my pacemaker I had good exercise tolerance.  I could sustain 120 bpm for 40 mins without a problem.  Can I expect to get back this level of activity and how soon ?

.  Is my breathlessness caused by an arrhythmia ?

.  Will I need to continue medication for my heart condition long term or can my medication be reduced now that I have a CRT-D?

.  What happens if I receive a shock?  Will I have home monitoring ?  Will I need to send transmissions into the clinic?  Who will be my main clinic contact ?

.  Can I have a copy of my pacemaker data downloads in the future including settings so that I can learn what has been set up and learn what these settings mean.  

The more you can learn, the better for you.  I wish you a very happy journey with your new friend 

 

Eight weeks?

by AgentX86 - 2020-10-11 11:28:43

You're still pretty early in the process.  You don't give a lot of infomation but from what you've said, it sounds like you're chronotropically incompetent (heart doesn't regulate it's own rate).  You don't say, other than cardiomyopathy, why you have a PM.

If the above is true and you seem to be active, it may take a while to get your PM tuned for optimum performance.  Your EP probably has some pretty conservative settings in your PM until your heart gets used to being paced.  He'll probably change these along the line but it's important for you to relay your exercise intolerance to him.  If you were a couch potato, these settings would be simple but since you aren't, it may take some time.  Have patience.

Why do I have PM?

by ld1708 - 2020-10-20 11:49:17

That's a good question.  Low EF of 20%.  Resting pulse was in 40s.  Episodes of non-sustained VT.  QRS duration of 160ms.  That's about all I know.  Was told that BiV PM would sychronize my out of sync heart.  

I appreciate the comments and question recommendations.  I do understand that I need to have patience.  Just am a bit confused that walking up a minor incline causes SOB to the point where I have to stop a couple of times.  Going up a flight of steps also takes my breath away.  Wasn't expecting this but from reading the forum, this is a process.  

Ever since PM placement, urine output has decreased.  Now experiencing slight edema in ankles....Seeing EP on Thursday.  Will see what they do.  I understand this is a process...

Thanks again to all and I really appreciate having a group like this to sound off of!!

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It may be the first time we've felt a normal heart rhythm in a long time, so of course it seems too fast and too strong.