pacemaker settings

Frequently when I am walking up and down hills my chest starts to hurt. After a couple of minutes the pain stops and i can keep going without further problems. The top # on my pacemaker is set at 150bpm.  This never happens when I am working out at the gym with a trainer. Ekg shows that my rhythm changes for several seconds when my HR reaches around 150.  Could the two be related?  If so, why would my rhythm change.

Thanks, Jim Owings


Doesn't sound good

by crustyg - 2021-03-21 16:42:34

Chest pain on exertion, that gets better when you stop, sounds like heart muscle hurting because of lack of oxygenated blood supply.  Angina Pectoris =>usually/commonly caused by furred up coronary arteries, but can also be caused by effort-related arrhythmia.

Remember that blood supply to the heart muscle through the coronary arteries only flows when the heart muscle is relaxed, and not during contraction.   So as heart rate increases - which means that the heart muscle's *need* for oxygen is increased - the ability to get this vital blood supply is reducing.  Very quickly an increasing HR outstrips blood supply => heart muscle pain.

And for some folk, as you push the heart harder (walking up hills), this extra demand can change the rhythm of the heart - exercise induced arrhythmia.

However, don't let my gloomy analysis stop you from exercising: you need to share this information with your cardiology team and get their assessment.  They may well say 'Keep on exercising but slow down at the first twinges of chest pain.'

doesn't sound good

by jowings - 2021-03-21 17:07:07

Am having a stress test tomorrow. Cardiology team at Hopkins are all scratching their heads. They don't understand why pain lasts only a few seconds (I don't stop walking) and then goes away for the remainder of walk and doesn't happen when exerting myself, even more so, at the gym 3-4 times/week..Pacemaker working fine.  Thank you for your thoughtful response.  This has been happening for the last few years. I feel great otherwise.

Will report back, Jim

Holtor monitor

by barnet38 - 2021-03-21 19:36:26

Have you tried wearing a Holtor monitor?  Perhaps your doctor would be willing to place the monitor on you for 24-48 hours, which would allow you to be monitored as you go about your normal daily activities.  You will be given a journal to make note of your symptoms as they occur.  

Holter monitor sounds a good next step

by crustyg - 2021-03-22 19:02:43

The idea that you may have a short spell of some tachy-arrhythmia makes sense - and it stops spontaneously as you ease back a fraction - heart-related pain tends to do that to people.

Then you're back in normal rhythm, cardiac blood supply improves and the pain stays away.

Glad that you feel great.

Pacemaker mediated weinkebach

by asully - 2021-03-24 13:42:14

If your upper rate limit is set to 150 and your go over that and your seeing a change on ekg it's very likely your pacemaker is mode switching to weinkebach (2:1 conduction between atria and ventricles).  This clearly will cause you to become symptomatic until your HR drops back below the rate limit and your device mode switches back to normal settings.  If I go over my upper rate I get chest pain, SOB, dizziness, and eventually tingling and muscle weakness due to the cardiac output being reduced by the weinkebach.  If the doctors think it is safe for you they can increase your upper rate limit so this mode switch doesn't happen until a higher heart rate.  As a matter of fact my EP called me this morning and told me he wants to increase my upper limit as high as the PM will allow to help stop the mode switch and improve my exercise tolerance.

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Yesterday was my first day mountain biking after my implant. I wiped out several times and everything is fine. There are sports after pacemakers!