Dizziness when standing again

Evening all

I'm now getting lightheaded when standing from crouching. I was fitting skirting board today and it was quite hard as every time I stood up I felt it.

I spoke to the EP on Friday after sending a download and he said it was not the pacemaker. He said I might have low blood pressure.

Never had low blood pressure in 45 years. Never felt dizzy when standing in 45 years so it is extremely likely to be the pacemaker settings but he stated he so no reason to change the settings.

I am yet to actually receive my settings summary.

Would you think it is the AV delay being set at 500ms? Why would it suddenly start causing dizziness? Is it possible my PR interval has lengthened since December or some other setting the culprit?

Thanks

John


13 Comments

Dizzy

by Mike417 - 2021-03-13 16:13:32

John,

Some things to check.  Use a pulse oximeter to monitor what happens to your pulse on standing up, and see if your SPO2 drops.  There are some wrist cuffs that have a rapid measurement cycle, see if you BP drops suddenly.   Take some deep breaths before standing up.  Drink more fluids, if you are low on fluids you may not feel thirsty, but it becomes harder for your pressure to change.

I had identical symptoms, and I think it was attributable to being low on fluids.

 

Take care,

Mike

I agree with Mike, plus I would . . .

by Gemita - 2021-03-13 17:40:06

Check for tachycardia/arrhythmia on rising as a cause for your symptoms too as well as an increase in blood pressure. Both high/low blood pressure can cause dizzy spells.  I believe you got tachy before Christmas?

It could well be Settings triggering these unwanted symptoms but which ones?  You need stability now with these to give your body a chance to settle down.  Did you discuss reducing length AV delay with your new EP technician?  You really need "external" monitoring when you are actually experiencing these symptoms to give more information.  Pacemaker downloads won't necessarily give such detail.  Was your RR switched on in the end and are settings too sensitive for you perhaps or not giving you enough power when you most need it  - say from crouching to standing?

Otherwise we are back to checking bloods for electrolytes, thyroid, infection, anaemia and looking for other clues John.

What about your autoimmune condition ankylosing spondylitis - has this ever presented in this way or has it started causing postural dizziness I wonder?

Also perhaps consider POTS - postural tachycardia syndrome/Orthostatic hypotension.  As Mike suggests monitor your heart rate/blood pressure on sitting and then on standing to look for sudden changes. 

I wouldn't rush in and change too much too quickly.  I would consult GP for some additional checks first John if dizziness continues under different circumstances. If that draws blanks then you can look with confidence at Settings + pacemaker for answers.  I was so hopeful you were getting somewhere with your new EP.  

I get this quite a lot

by crustyg - 2021-03-13 18:16:01

Because my resting HR is low and my PM doesn't notice me rising from kneeling/crouching, I get this quite a lot.  It's much worse if I'm a little dry/dehydrated as there isn't enough venous return to fill my atria=>ventricles so my BP doesn't rise up as quickly as I have.  So this would be worse if you've been working in a hot environment, sweating as you work and not stopping for a drink every so often.

And depending on how you've been crouching, you can really squeeze the IVC which makes the reduced cardiac output worse.  Squatting by putting your glutes on your heels is better then bending forward from a kneeling position, but it's tough on the knee joints and lower legs.

At least in theory, you might get some benefit from a couple of hard sniffs just before you rise - it really pulls blood into your chest from the abdomen ready to increase your cardiac output as you stand.

Similar

by Persephone - 2021-03-13 18:58:34

Hi Quik - I had similar symptoms in year 1 post-implant, just from standing from a seated position at my desk at work, where I was supposed to adequately function.  Not fun.  Setting adjustments helped me get back to (almost) pre-PM levels.  Keep trying to work with your docs to help you feel better.

Dizziness from the crouched position on standing.

by Selwyn - 2021-03-14 14:34:50

John, 

It is almost certain you are suffering from a bit of postural hypotension ( low blood pressure). CrustyG seems to understand these things.

When you go from crouching to standing your blood then escapes into your legs. The normal reflex is for

1. Blood vessels in the legs to contract

2. The heart rate to raise ( this increases cardiac output - BP= CO x PR , where PR is peripheral resistance ie contraction of blood vessels . CO = HR X SV where HR is heart rate and SV is stroke volume of the heart pump).

Your pacemaker does not cope with sudden falls in BP. It is a common problem, especially after a period of rest after exercise ( then one may be a little dehydrated, the blood vessels in the legs are dilated as you are hot, and going from a sitting to standing position causes more of a BP drop as blood pools in the legs). 

Keep well hydrated - this helps.

Take you time and wait before moving off ( otherwise the blood is shunted to your legs further and you can pass out) and take a few big breaths to encourage venous return.  

Think about a few extra beats for your resting pulse  ( I got an extra 5  for stairs and a similar problem of postural hypotension).

Like a fighter-pilot, you need a G suit! Increased gravity causes blood pooling in the lower limbs and a similar problem.

https://en.wikipedia.org/wiki/G-suit

A few things for me to consider there.

by quikjraw - 2021-03-14 17:57:08

Some great things to consider there, it was quite noticeable and every time I stood up which was very unusual and the only time I have had this was two days before having my PM implant  but it was not quite as bad as this.

I was hydrated sufficiently as I had been drinking sparkling water all day whilst doing the skirting board so unlikely to be that. 

I need to buy a pulse oximeter and blood pressure cuff as these may give some useful infomation.

My heart rate should have no problem rising as I only have heart block and Therese I have found out that RR is not active (they said on the phone a few weeks back). 

My ankolysing spondylitis has never caused anything like this so I suppose we can rule that out.

I agree Therese,  I think that my 2nd degree block may be the same but my PR interval (first degree block) has changed meaning that 500ms AV delay is now simply too long for most of my intrinsic beats. 

I suppose I am trying to balance too many things at the minute and it is clearly not working. Even with my increased AV delay to 500ms, this combined with my minimum heart rate of 40 did not reduce %V pacing it doubled it. I still feel dizzy and my exercise is laboured.

Yes indeed you have done well with diagnoses!

by Gemita - 2021-03-14 22:07:25

John I think you have got some really excellent answers here and perhaps you don't have to visit your GP after all thanks to crustyg and Selwyn and to the contributions from the three of us!  Seriously I think the truth lies somewhere between us all, including within your own questions about your pacemaker settings.  If I may say, you have pushed for a number of adjustments since implant but I don't feel they are quite right yet and as you say, you are perhaps trying to change too much at once, but I am confident you will get there.

I see Persephone worked with her doctors until she achieved a level of adjustment she could comfortably live with.  I did the opposite, I did nothing even though my symptoms were far worse after pacemaker implant than before but this turned out to be the best policy for me because I am now completely free from symptoms between episodes of arrhythmias.  The only thing I changed was my medication because post implant I needed less of it. 

When you get your data it will help you to have that meaningful chat with your new EP (I am still waiting for mine John too).  Personally I would ask about increasing lower rate to 60 bpm (or at least 50 bpm).  That should make a noticeable difference quickly.  I would do that even before looking at AV delay.  I would do everything one step at a time from now on and then assess any improvement.  If you change too many things at once you will never know which setting made the difference.  

Patience and adjustments

by Persephone - 2021-03-15 15:15:19

Just want to note that I waited over 1 year after implant before seeking adjustments.  While the delay was my choice to see how things settled in, I wasn't feeling all that well over that period of time.  I agree that a wait-and-see approach has merits, and there is no logic to making multiple adjustments so close together that the individual results cannot be discerned, but this should all be balanced against one's needs. 

I agree about the lower setting

by quikjraw - 2021-03-16 05:32:20

Looking at what others post on here and my own experience I would think that we would all do much better after pacemaker fitment if someone took the time to explain each setting, what they were set to and why they are set to that level.

If this forum did not exist and the internet I would be virtually in the dark about what was going on.

 

 

Lower setting

by AgentX86 - 2021-03-16 17:21:23

I don't think it practical for the medical team to educate us about every setting (there are hundreds), what each one does, and why they're setting it the way they are.  It's just too much information and would take too much time.  Frankly, I doubt they understand all of it.  The company's rep knows more and are often available for consultation.  They're full-time (though still PM manufacturer's employees) in the larger hospitals.

Frequent changes can be made.  Sure, there is some "settling in" but many changes are pretty obvious right away.  I have something changed almost every time I go in for an interrogation (its clock, for one ;-).  Optimizing RR is an ongoing affair and we're always playing with it.  Sometimes they don't want to move the dials too far, so to getting where I want to be may take more than one trip.  The last time we pushed RR dwell and slope pretty hard.  Hard enough that I felt the rush driving home.  I got used to that pretty quickly, though. So, yes, there is settling in but there is no reason that some changes can't be modified in short succession. If it feels good, do it.

Adjustments

by Blondpacer - 2021-03-17 14:34:50

I have a pacemaker for Neurocardiogenic syncope/low blood pressure. Sometimes blood pressure can change over the years. The pacemaker can be adjusted according. He should be looking into pacemaker reading checks. With low blood pressure you can get dizzy when standing. I told my doctor about racing heart. He blew me off. Then pacemaker clinic nurse told me several incidents of tachycardia which I never had before. It tells you how much these doctors are looking at our pacemaker checks they sign off on. 

I'm with you there

by quikjraw - 2021-03-18 05:17:15

I don't want to go into full moaning mode about Drs and the medical industry but I am with you there Blondpacer.

I had my first implant follow up telephone call (because of COVID) with the cardiologist in February and it was a complete waste of time. I had diligently sent some questions in advance of the call (two weeks) but none of the questions were answered on the call and the Dr admitted that she did not have my notes in front of her so was literally working from memory of an event that happened in November, completely unacceptable.

I lied, I did go into full moaning mode! :) 

 

I hate this

by CharlieBuckets1 - 2021-03-19 14:30:19

Happens to me all the time now. My heart rate is set for 80, but would typically run aroiund 65 prior to getting my PM/ICD. I've noticed keeping my fluids up has helped. But I still hate it becuase its the same exactly feeling I would get before I would go into V-fib..so for now you'll see me at least once a day grab on to the nearest sturdy thing for dear life till it passes lol

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