Pacemaker and shortness of breath
I have posted on this forum in the past since receiving my dual chamber implantable device more than 3 years ago. Form the beginning, it became plausible that they may have made a mistake. I was found not to have the diagnosis (SSS) that paved the way for the original unit. Furthermore, my EP determined that I was symptomatic when my PM was pacing, despite my periodic slow beat. Also, the rate response setting was throwing me into Ventricular Tachycardia on a repeated basis. We turned off the RR and rolled the settings back so that my pm would only engage below 30 bpm.
After that, i titrated off the medications related to the pm, includingh flecainide. Over the months my heart rhythm became nearly perfect (thanks largely to my new whole foods diet and magnesium citrate supplementation). My device sat idle (or so I thought) and I took joy just listening to my smooth heartbeat which loves the mid 50s. All symptoms went away. I felt nearly perfect. But then ...
The one symptom that wouldn't go away, and only got worse, was a labored breathing. It was so intermittent that I thought my heart just needed more time away from all the treatments. I resumed frequent cycling hoping that would help my heart get back to normal. But the frequency only incfeased and the period of labored breathing became longer. I went to my cardiologist, who did an echo and EEG and said my heart was pumping better than it ever had. I was not pacing in either chamber and my ejection fraction had improved, believe it or not, to near normal levels. My heart was structurally in a better place than even before my PM. So, why did I feel worse than before?
My cardiologist reminded me that I was 60 years old and that I shouldn't hold out for perfection at my age. I leaned into him and said that wasn't acceptable. Why is breathing so hard for me!!!
Here's the thing. And it IS a thing. A dual chamber PM requires a lead to be placed in the ventricle. To get there, it has to pass through the tricuspid valve. They call it the forgotten valve because it hasnt been studied nearly like the others. What that lead will sometimes do is interfere with leaflets as blood moves through it. That interferance will come in many different ways -- anything from fusing to the leaflets to dynamic looping to simply finding an out-of-the-way place between the leaflets to cuase no discernible problem (this seems to be the most common). But for the extreme interaction, what may have been an acceptable tricuspid regurgitation becomes one that throws off noticeable symptoms, primary of which is a labored breathing.
So, a dual chamber pacemaker never just sits there. Even if your heart never requires a pace or a tachycardia paceout, it is interracting with your heart. I'm not sure if doctors just don't know that, or they just don't want to talk about it. It seems like it shold be part of the discussion, before and after an implantation. One shouldn't have to find out about this THING on his own form the American College of Cardiology and other places.
I'm not done getting answers. In the meantime, in the quiet time just before I fall asleep I listen to my heart beat with all its perfect imperfections.