exercise after a pacemaker

I had my dual chamber fitted 7weeks ago after a diagnosis of Bradi/Tachi. I haven’t been given a follow up appointment as yet and there are questions I need to ask. I Nordic walk for exercise but not sure how long I need to wait before doing this , a bit worried that the impact of the poles striking the ground might dislodge the wires into my heart.  Although I feel well and quite recovered I have the occasional sudden drop in blood pressure which makes me feel faint and breathless, my blood pressure returns to normal within an hour or two. My pulse rate ranges between 50 and 55 beats/ minute, I take Bisoprolol 2.5mgs daily and Apixaban 5mgs twice a day. Does anyone else experience these symptoms? Thank you


3 Comments

Don't worry about the poles

by crustyg - 2021-03-02 12:43:08

You can stop worrying about your walking poles affecting the leads into your heart - they won't.

Sudden drops in BP, if proven, suggests that you have something else in addition to the need for a PM as the bradycardia (affecting your BP downwards) should be limited by the PM.

There are other contributors here who have a lot of experience with sudden drops of BP as you describe.

Agreed ... don't worry about the Poles ...

by IAN MC - 2021-03-02 14:10:11

with apologies to the citizens of Warsaw of course !

I have done some Nordic walking and there is absolutely no way that the poles could create any risk whatsoever , You never raise them above shoulder height and there is slack built into the leads anyway . Also there is very little tension going into your upper arms and shoulders !

Enjoy !

Ian

Brady/Tachy Syndrome

by Gemita - 2021-03-02 15:24:10

Jessica, I have a dual chamber pacemaker for Brady/Tachy syndrome too.  I find the problem with this condition is that the “swinging” from one extreme to the other can play havoc with both my heart rate and blood pressure.  While the pacemaker can prevent the lower heart rate from dropping below the set minimum, a pacemaker really does nothing to control a faster heart rate or sudden blood pressure changes (either upwards or downwards) in response to any arrhythmia and this can quickly lead to a feeling of faintness/breathlessness.

To control symptoms I take Bisoprolol like you to calm my heart rate during episodes of arrhythmias and by controlling the speed of the arrhythmia, this also helps to prevent my blood pressure from suddenly falling.  I find the arrhythmia is often the cause of my faintness and breathlessness, especially at high speeds. I don't know if this is the same for you too?

The bradycardia will be controlled of course by the pacemaker which prevents your heart rate falling below the set minimum. Your 2.5 mg Bisoprolol which you take to control your heart rate shouldn’t drop your blood pressure too much.  I have had to reduce my Bisoprolol from 2.5mg, 2 x daily, to 1.25 mg daily to help prevent falls in my blood pressure.  The downside is that my tachyarrhythmias aren’t so well controlled on this dose.  It can be a fine balancing act.  Extra fluids (water) can immediately help increase my blood pressure.  I was also advised to increase my salt intake and also to do some simple exercises (tensing muscles and crossing legs when I come over faint to try to ward off an episode.  I may be well off the mark with your situation  but I attach a link of what I was told to do when I had syncope/near syncope in case of help:

https://www.webmd.com/brain/news/20060313/crossing-legs-helps-frequent-fainters

Blood pressure falls are not easy to control Jessica and you need to get a proper diagnosis before you can ever hope to treat the condition.  If the pacemaker fails to stop a syncopal event, due bradycardia induced hypotension or arrhythmias, then you need perhaps to look elsewhere for answers too, since there may be something more going on as crustyg suggests.

For example, I suffer from Reflex syncope, more precisely "situational syncope" which can occur during swallowing of both liquids and solids, and with other gastric movements (stomach emptying/bowel movements).  This was first diagnosed during autonomic testing when my doctors realised that my oesophageal motility problems could cause a sudden drop in my blood pressure, not always, but intermittently.   Unfortunately this problem cannot be controlled or fixed by my pacemaker.

I sometimes get no warning of an impending attack until I am close to passing out during a meal  The mechanism of swallow syncope involves the autonomic nervous system of the oesophagus and heart via the vagus nerve.  A number of arrhythmias have been triggered during my gastric motility difficulties, so there is a clear connection here too.  The proximity of the oesophagus to the heart, both sharing the same nerve pathways is, perhaps, another explanation why oesophageal motility problems can also quickly trigger an arrhythmia which can lead to sudden changes in both heart rate and blood pressure.

I have several times in the past received dilatation of the oesophagus to assist swallowing and help with my motility issues.  It is not a cure for my (now fortunately only occasional) swallow syncope but it has certainly helped control my symptoms which often led to worsening attacks

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But I think it will make me feel a lot better. My stamina to walk is already better, even right after surgery. They had me walk all around the floor before they would release me. I did so without being exhausted and winded the way I had been.