Shortness of breath

Hi, I received a pacemaker in June as a result of sudden total heart block.  I developed a blood clot in my left ventricle 1 month later, and was hospitalized for 9 days before it "disappeared" after heparin and antibiotics (initially prescribed since the doctors thought I had an infection). Am on Xarelto and Atelonol (weaning off the latter).  
i am trying my best to return to a normal life, but am finding that I have increasing shortness of breath with regular household chores.  I also have it at the beginning of walks, but usually find that my breathing improves after continued walking.  
My pacemaker has been checked twice, my EKG is normal and my resting heart rate is fine (61).  My BP is fine as well.  My pacemaker is pacing the atria only 2% of the time, the ventricle 98% of the time. Is it possible that the SOB is a result of lack of synchrony between the 2 chambers?  My EP said "no such thing" and that the SOB was likely due to the beta blocker.  
i am finding it hard to get any response from my cardiologist ahead of my scheduled appointment (3 weeks from now). 
Is it reasonable to expect to return to pre-pacemaker condition after a few months or is SOB part of the "new after-pacemaker normal" that I have to accept going forward?  Any thoughts about why it would be worsening over time?  Can weaning off the beta bliocker be the culprit?

Any advice would be appreciated.  

 

4 Comments

Shortness of Breath (SOB)

by Gemita - 2021-10-30 09:41:34

Francophone

My immediate thought is has your blood clot really resolved?  I realise you are on Xarelto which will be protecting you, but you may wish to ask whether all is well in this area by visiting your general doctor for some additional checks.  Could you be anaemic for example?  There are many causes for shortness of breath and he may wish to check for other causes too.  

I am reassured though that your EP doesn’t seem worried from a pacing or heart point of view and is happy to wait to see you, so I am assuming they have checked your pacemaker data for anything significant like a tachycardia, since that can certainly take my breath away.  

I note you are weaning off Atenolol and that Atenolol can cause side effects like SOB but it is hard to know what is causing your SOB.  I certainly had this problem when I first got my pacemaker but once I had received some pacing changes, and my arrhythmias had settled down, the SOB generally resolved.  I still get this problem with my arrhythmias but that is normal.  My beta blocker doesn’t cause SOB for me.

Going forward, the SOB will not be there for ever, especially if the cause is found and can be corrected.  Hopefully it will be a simple settings change.  I believe it is possible to expect to return to your pre-pacemaker condition after a few months and that the “new after-pacemaker SOB symptom" is not your new normal.

Shortness of breath

by Julros - 2021-10-30 17:10:38

As Gemita states, there are many causes of shortness of breath, and it would seem natural to associate it's onset with other recent changes, such as your pacemaker. Knowing that your pacemaker has been checked, is reassuring. Have they optimized the settings for activity? I know I had to push to get mine adjusted. Intiially it would hardly increase in rate at all. The office said they never just offer to customize setting "because no one ever asks." 

And yes, a beta blocker can, but not always, induce shortness of breath. It blocks the efffect of adrenaline, and there is a receptor in your air passages that causes bronchodialation. So if you block that receptor, your air passages don't dilate when you need them to, like during exercise. 

Other things to keep watch for is unexplained weight gain or swelling in your legs or around your middle, signs of fluid retention. 

As for lack of sychrony between the upper and lower chambers, this is something that your pacer is specifically set to treat and is always checked. Lack of synchrony can be a problem between the two large lower chambers, the right and left ventricles. This would be determined by your ejection fraction, and would be treated by placing a third wire to pace your left ventricle. 

Thanks for the responses

by Francophone - 2021-10-30 20:17:30

Thanks so much for these responses.  I appreciate the support.  It is hard not to feel alone when coping with troubling symptoms on a day-to-day basis. 
i will give my cardiologist a call on Monday and hope he can give me advice. Unfortunately, my internist is hard to get in to see as well (I have a physical scheduled with her on December 1st).

Before I was discharged from the hospital, I had a transesophageal echocardiogram, cat scans with contrast, and ultrasounds of extremities. They looked everywhere for remnants of the clot. I was happy to avoid open heart surgery when it was "gone", but it is hard to put it completely out of mind.  Nor does the cardiology team have an explanation of why it formed in the first place.

SOB

by ROBO Pop - 2021-10-31 13:58:42

I had a real problem with shortness of breath especially at night. The Dr couldn't figure it out until we realized it was the pillow my wife held over my face. I'm breathing free and easy since the divorce...

Nah just kidding. I struggle with SOB due to congestive heart failure with an Ejection Fraction of 10 - 15% so I know how defbillitating it can be. If you suspect asynchronous ventricles (LBBB or RBBB) THEY CAN EASILY SEE THAT ON AN EKG. Sorry for caps. If you do have one of those a CRT could help, but not guaranteed. Mine doesn't help due to Mitral valve prolapse. 

Like somebody else said, lot of potential causes so work with your Cardio or EP to sort it. Who knows, could be the old pillow trick. 

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