Still unsteady

Hi, first post, apologies it may be a bit long but I'm not sure what will prove relevant.

I was admitted to hospital at the end of January after two consecutive days of nearly blacking out and then actually doing so in the street on the third. For the two weeks prior to that I'd been aware of things sometimes not seeming quite right, particularly when out - hard to describe, but the nearest was the lack of balance I felt when first wearing varifocals. Although it seemed clear from early on that I was likely to end up with a pacemaker, I was in for three weeks while they did a battery of exclusionary tests - angiogram, cardiac CT, cardiac MRI. None of them showed up anything problematic. They did catch, on a heart recorder, a bout of "complex tachycardia" that I could confirm was like the ones that I'd had on those three days.  I was diagnosed with a bifascicular block, and fitted with a dual lead pacemaker just over two weeks ago, discharged the same day.

While in hospital I was put on Bisoprolol for the first time (had no regular medication before) and then on statin and aspirin as well.That's brought my blood pressure and heart rate down, but its averaging 130/80 and about 65 resting, so not low. During my stay I was mostly wired up to monitors, so couldn't move around much, though I did go to the toilet /washroom myself. I felt unsteady on my feet, and held on to things for support.

Since the pacemaker I have felt a lot better, but still not completely steady. Before the incident I was only cautious on stairs, using a handrail, but could walk back home from the station a mile or so uphill - I'm 68, overweight and unfit, but didn't feel I had mobility problems. Now I don't feel confident being outside without a stick - I can mostly walk without it, but I have to concentrate, and use the stick if I stop, change direction, etc. Inside I'm OK without it, but again still sometimes have to concentrate (though sometimes, either inside or out, i feel fine). Although I don't feel that I'm going to faint, I do still have a bit of the unsteadiness that I felt before that was like having varifocals for the first time. I originally put it down to muscle wastage, but I can now walk briskly round the block for ten minutes so I don't think it's that.

I'm going to ring the pacing clinic in a couple of days (my follow up appointment isn't until the end of the month), but I'd welcome comments, experiences, questions I should ask. Does this sound to regulars here like a medication problem or a pacing problem, for example?

Thanks in advance.


Feeling unsteady

by Gemita - 2023-03-07 15:14:52

Astolat, no need to apologise for your post.  

You clearly have Bifascicular Block and evidence of a complex tachycardia, so both of these conditions could still be causing problems for you until your pacemaker Settings have been fully optimised.

You are receiving Bisoprolol, a beta blocker for your occasional tachycardia to help to control your heart rate.  A beta blocker, depending on the dose, can initially cause a number of difficult symptoms for some of us.  I was very fatigued and felt a bit unstable on it at first, so did my husband.  I see you are also on an Aspirin and a Statin as well.  Statins, depending on the Statin and dose can also be difficult for some of us to tolerate and in your shoes, I would consider going back to your general doctor as well for advice on whether your medication could be making your instability worse?  Certainly you need to be telling your doctor what you are telling us because clearly your symptoms are not normal and could result in you having a fall.

I will have a look at your history and think about some questions for you to ask your team and let you have these later this evening, or tomorrow, if that is okay.

Good idea to ring the pacing clinic but I would also contact your general doctor to have a few checks.  Until later, I send my best wishes

Just a few questions

by Gemita - 2023-03-07 16:27:51

Astolat, I thought you had a history, or made a post earlier about this, but perhaps I was mistaken.  Based on what you have told me, I would perhaps ask questions like the following:-

Possible questions for your General Doctor/Pacing Clinic:

For the GP:  

You could start by saying, since the pacemaker I have felt better, but I am still not completely steady on my feet and I don't know why.  I certainly don’t feel stable enough to leave home without a stick and this concerns me.  Could I please have a few checks to look for any common causes for my continuing unsteadiness/instability?

Is my unsteadiness likely to be caused by my new medication (?Bisoprolol or the Statin) and if so, could my medication be reviewed please to make sure that the dose and medication I am taking is right for me?

For the Pacemaker Clinic: 

Start by explaining your "unsteadiness/instability" and need for support and then you could ask something like:  are my pacemaker settings sufficiently optimised for me to help with any symptoms I might still be getting from my Bifascicular Block?

Could you also confirm whether any “high heart rate events” have been found on any pacemaker downloads.  If so, could this be the cause for my continuing instability?

With any instability, most caring pacemaker technicians should invite you back to the clinic for some checks, (they did for my husband recently - we both have pacemakers), so please don't be afraid to go back earlier than planned.  However, I think a visit to the GP first would be best.  I see you are in the UK.  Good luck


by Astolat - 2023-03-07 18:35:14

Thanks Gemita, that's very helpful. I think I'll go back to the pacing clinic first now because I think I'll get a faster answer from them, but I will get back to both in the next few days. The point about a potential fall is a good one to make to them.

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