Chest Discomfort and Shortness of Breath

Hi, I'm new to the club. I'm a 53 yo male, very active and workout 5-6 days/week. My resting HR was typically around 42-45 bpms. In mid January, I went to the cardiologist for a routine check-up. The EKG showed an abnormal pause in my heartbeat, which concerned my doctor. A holter confirmed I was experiencing pauses of up to 2.3 seconds, but was not experiencing any symptoms. He immediately sent me to see an EP,  who diagnosed Sick Sinus Syndrome and told me I was eventually going to need a PPM. On Feb 19, he performed an EP study, which confirmed his initial diagnosis. He decided not to insert a PPM, because I was totally absent of symptoms. However, he cautioned that should symptoms start presenting themselves, I was going to need one immediately. Approximately one week after the EP study, I started experiencing near syncope correlated to long sinus pauses. On March 23, I had a second holter done, which indicated my pauses were up to 4.2 secs. On March 31 (3 days ago) my EP implanted a Medtronic Azure XT DM MRI SureScan dual ch PPM. I felt great the first two days and then last night, as soon as I went to bed, I felt mild chest pressure, strong palpitations and shortness of breath, which lasted a few seconds. I fell asleep afterwards and slept fine. However, I'm still experiencing shortness of breath when I go up a flight of stairs (not normal for me.) I spoke to my cardiologist this morning and he told me that my PPM was probably at standard settings and will need to be adjusted. I believe the min HR is set at 60 bpms, because my iWatch and Fitbit reflect my current resting HR is 60. He did caution, if the palpitations were to persist for minutes at a time, to contact him immediately or to go the ER. I'm wondering if this is normal for first time PPM patients and hope to resume my active lifestyle, once my recovery period is over.






by AgentX86 - 2021-04-03 19:52:55

First, welcome to the club.  No one else wants to be a member of this club either but here we are.

Sinus pauses and the associated SSS are one of the more common reasons we're here.  Pauses above about five seconds mean a pacemaker is in the immediate future. Near syncope means much sooner than later.  Syncope can be deadly, not only to you but others.

Palpatations certainly aren't rare.  The heart has been injured and it takes little while for it to recover.  It can also take a little while to get used to being paced.  Very often it'll throw PVCs (premature ventricular contractions), which can feel awful.  Everyone (even healthy people) have PVCs once in a while.  An isolated one can usually be felt but we tend to ignore it as our imagination because it doesn't happen again for some time.  After a pacemaker, it's not all that unusual to get strings of these or what they call "bigeminy", litterally pairs (as in Gemini, the zodiac sign), where there is a PVC, normal beat, PVC,...

The key is to keep properly hydrated and make sure you have the appropriate minerals (the metals, sodium, potassium, and magnesium).  Dehydration can deplete these, which are crucial to normal nerve action, particlarly the heart's electrical system.  Too little or too much is bad but there is a pretty wide middle road.  This might not be the cause of your problem but it's critical in any case.

PVCs can easily cause your fatigue because your body isn't getting the oxygen it needs.  Think of a PVC as a "half" beat but your pacemaker is counting it as a full beat.

He's not wrong abou the settings.  Since you have SSS there is a good possibility that your what is called chronotropically incompetent (heart rate doesn't track oxygen demand.  Your pacemaker has a repacement for this function but it's certainly not perfect.  There are at least a dozen settings that have to be right for optimum performance. 

If you're atletic, it may take some time to dial this in but it will likely never be perfect.  If you're somewhat less than an atlete it can usually be set "good enough".  I'm not exactly athletic; my "thing" is walking (10mi/day) and have very little trouble at this level.  Multiple flights of stairs can be problematic, however.  Everyone is different and it may take a little work to get right.  It's key to let your EP know about your lifestyle.  You may need to push to get everything perfect.  Others here can describe their experiences.

Again, welcome to the club and hope you get through the immediate problems quickly.  It's very good news that you were much better before these palpatations.  Your EP will figure out how to lick them.



by Ccases99 - 2021-04-05 16:29:21

Thank you so much. I feel a lot better and have not experienced any additional episodes or discomfort. Yesterday I went up seven flights of stairs, at a pretty quick pace, without any issues or shortness of breath.

Seven flights of stairs

by AgentX86 - 2021-04-05 17:40:56

That's pretty impressive.  I wish I could do that but after two, I sure don't feel like more.  My legs are in good shape (walk 10mi every morning) but my PM can't keep up on stairs.


by MARCH2021 - 2021-04-07 11:32:32

HI there, I'm new to the club as well - 3 weeks actually! Your story is so similar to mine. I just turned 52 last week and had the pacemaker put in on March 12th. 

I had always felt good, work out 4-5 times a week but my resting heart rate has been in the mid 30s for the last three years. After a routine yearly check up with my cardiologist, this time around after wearing the halter for 24 hrs, they also noticed a 2.5 second pause which occured a few times in that 24 hour period. That's what really concerned me because that pause can become 3, 4 5 seconds and then you'll eventually pass out and God forbid your driving or doign something that can be hazaourdous to others as well.

My proceduere was on a Friday and for the first 2-3 days, I also felt very short of breath when talking or walking up the stairs to my bedroom. By mid week, I started feeling just fine and by the weekend, felt more energetic than I had in years actually.

I'm in my second week now of doing my 30-45 min Peloton Cycling class at home and feeling just fine. I'm not pushing myself as I used to, but getting my heart rate up to 150 without any issues. Lastly, I do feel that I'm sleeping much better and deeper at night too now.

I feel lucky to have found this forum as well since it's nice to know we're not the only ones going through this and knowing that with time, we can resume life they way it was before.

Stay healthy and safe


by Ccases99 - 2021-04-08 17:54:47

MARCH2021, thank you for your response. I have been feeling better everyday and will start my Peloton routine next week (giving additional time for the incision to heal. It's very interesting our heart conditions and experiences post-pacemaker are so similar.


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