First visit after having PM fitted - Feeling 'drunk'!

Hi all

I had my PM fitted on 8.3.21. My Diagnosis is for sinus bradycardia (resting HR about 45) and chronotropic incompetence. I know that on implantation, my basic HR setting was set to 60bpm and my mode is set to AAIR-DDDR. At this stage, I dont know for sure what other settings were made. Several people were kind enough to reply to my initial post and, as a result, I have a whole host of questions to ask at my follow-up appointment on the 29th March.

In the two weeks or more since having the PM fitted, I have confined my exercise to flat walking of 4/5 miles each day. I have noticed that during this my HR will increase to around 130bpm and, as it does so I feel increasingly light headed, tired and walk increasingly clumsily, as though I am drunk. After a couple of miles, I stop and have a rest for 20 minutes during which my HR will fall to 75 or so and then I walk back. Bizarrely, very often, when I walk back, my HR will not rise above 95 or so and I feel so much better. Quite often, I am  able to walk much more briskly and purposefully. My gait is much more normal and I feel nothing like as tired or 'drunk'. 

My questions therefore are these.

1. Is it possible (or usual) to feel increasingly more tired and uncoordinated as your HR rises as you exercise? (I thought an increase in HR meant more oxygen being pumped round the body so that the muscles could work more efficiently as the exercise calls on them to do more) and

2. Why could it be that when I do the same walk but more briskly, my HR doesnt increase to the same level on occasions, and I therefore feel better?

3. I guess the third question is that could these HR responses be as a result of some particular setting on the PM?

Thanks in advance for any replies. I am still trying to understand my diagnosis and PM and the above scenario and questions are what I have particularly noticed in the short time my PM has been  fitted. 

3 Comments

Drunk

by AgentX86 - 2021-03-24 16:59:52

Yes, it is counterintuitive but these sorts of symptoms can indeed be caused by a PM's rate response being set too agressively.  Too much oxygen can cause similar symptoms to too little.  You've certainly heard of a "black-out", well, there is a similar phenomenon called a "red-out" where you get too much oxygen and can be caused by hyperventilation.  Divers (or astronaughts) breathing pure oxygen can have the same mental imparement as high altitude pilots without oxygen or pressurized cabins.

With these much smaller changes, the chances that you'll "get used to it" are high but why?  You shouldn't have to and, yes, the solution is a setting or two away.  A heart rate of 130 when flat walking is quite high.  I generally get to 105-110, which is more normal. 

Changing these settings is perfectly normal and you may have to go through a few (or several, depending on your level of activity) before you "get it right".  I've asked that my rate response be set quicker (faster to respond and faster slope) several time and each time they increase these settings a little.  The last time I felt "weird" driving home and realized it was the higher sensitivity of my RR and the bumpy road boosting my heart rate.  "OK, I can live with that."  I don't feel it anymore but I think the settings helped.

as far as why it sometimes is more pronounced? Perhaps you're walking with harder foot-falls?  Or on different roads with more bumps?  Rate response is controlled by an accelerometer in the pacemaker, trying to mimic what the SI does directly (maintain blood oxygen levels).  It can't do what the SI node does so has to kinda guess from the motion of your body.  Change that motion, and you'll change the response to it.

All of this, sensitivity to motion, time in motion before rate increases, rate of increase, plateau, rate of increase after the plateau, max rate, and all of the opposite coming back down.  There are a lot of settings to get right for you. An atletic person will need the optimized more than a couch potato.

Thanks

by chris1850 - 2021-03-26 16:50:33

Thanks AgentX86. That is good information - many thanks for taking the trouble to post

running up the stairs

by Snake - 2021-04-05 12:51:41

I recognise the drunk feeling.

Especially when walking up the stairs. Your body needs more oxigen, but the controll of the PM has no clue that you do real excersize, because you are moving up slowly.

Of course playing with the settings helps as AgentX86 already explained, a faster rate response could work.

I found out by experience, that running up the stairs is easier then walking. Sounds strange, but you get less tired, since the PM recognises you are moving and shaking and pumps up the rythm.

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