Pounding in chest, thumping feeling

Hello

Recently I had an emergency aortic aneurysm repair and aortic valve replacemetn surgery. I went in to complete heart block post surgery so they decided to implant a pacemaker. During the implant, looks like atrium signal came back and so my ventricles were set to pace according to atrium. All this was done in july (July 17th). Its been little over a month and I was feeling fine. I went to visit an Arrythmia clinic last week to see if I can use them (they are lot closer than the team which did the surgery ). They used the biotronik device to interrogate and test my pacemaker. I repeatedly told them that I do not want the logs to be deleted and no reprogramming since the original team is still remotely monitoring me.  They assured me that everything was safe. 

So they interrogated the device and performed the test. They told me I have 2-1 AV block.  They assured me no settings were changed. However, since that evening every time my heat beats its very pronounced - almost its a thump or beating out of chest.   I called them again and verified that nothing was changed. I called my device clinic from original surgical team and they also told me they do not see any change in settings. 

Does anyone have any idea if this is pacemaker related or just coincidence ? I read various blogs from people who have received articial heart valve and lot of them have the "thumping/ loud heart beat" issue . Some got it 2 weeks after surgery and some after a month. For me, it seems odd that I would get it just after pacemaker test and interrogation. Also, i dont know if i ts anxiety - my blood pressure is running higher than usual although I am on metoprolol and its keeping it under check. 

Can this happen if voltage settings somehow got changed? Hate to think I have to live with this for rest of my life

 

Update: My model is Edora 8 DR-T


9 Comments

AVR

by USMC-Pacer - 2023-08-27 02:00:43

I've also had an AVR, 2 actually. I've also had the pounding that resolved a week a two after the surgeries. Doctor's said that my heart was probably annoyed from the surgery. Also, after both AVRs, my blood pressure went way up probably because of improved heart function. In my case, it was a stenotic valve holding blood back and causing an enlarged ventrical. Once they fixed the valve, that all changed causing increased blood pressure. I'm not sure about your device issues as I got my device 5 years after my AVR due to scar tissue, or so they say. 

Pounding, thumping feeling, I know it well

by Gemita - 2023-08-27 05:34:45

Hello Chandler,

It sounds very much to me from the pounding, thumping sensation description, that you are experiencing an arrhythmia either due to pacing, to the stress from your recent two procedures, or to your heart block condition.  Your body has clearly been traumatised and will take time to heal.

I would like to believe that your settings have not been adjusted since you specifically asked that nothing be changed.  However, it could be that because you are developing some issues now, your Settings may need to be finely tuned or your rhythm disturbances better controlled.  The first thing I would do perhaps, is to ask for extra monitoring, like a Holter monitor or a Zio Patch, to try to see what rhythm disturbances you might be getting?  High blood pressure won’t be helping and needs controlling, since in my experience it is one important cause for heart rhythm changes.  

An irregular heartbeat can be a common finding following an aortic valve replacement but it usually passes with time.  It may need treating however until things settle down for you.

My feeling is that your heart rhythm has not settled and it will take a little while to adjust to pacing and for the right pacemaker settings to be found for you.  Sometimes changes to settings are not made immediately however since they usually like to wait to see how well our hearts respond to pacing first which is much kinder than rushing in too quickly to change settings, settings that may not need drastically changing.   It took my heart for example, 3 months to settle down and to get used to pacing.

If present, I would get any rhythm disturbances identified, to help your doctors treat and effectively alleviate your symptoms.  It could be that your doctors will adjust your dose of Metoprolol which will help to calm any arrhythmia seen as well as control higher than normal blood pressure.  Try to stay calm, breathe slowly, rest well and keep well hydrated.  You have been through a lot.  If your symptoms do not improve quickly, please consider seeing your general doctor for some checks, like electrolytes or other blood checks. I hope you recover quickly

Hi 🧡

by Lavender - 2023-08-27 11:29:08

My heart goes out to you. You've been through a lot of trauma and scary stuff so recently. You would naturally have lingering anxiety and "flight or fight" sort of emotions. 
 

It shows how strong you are-your underlying intellect and survival skills-in that you went online and are seeking support and input from others. 

I do not believe that you have to live like this for the rest of your life❤️‍🩹 It won't always be this way.

I believe that you will recover and things will calm down. It's so early in the healing process...both mentally and physically. May God shower you with renewed energy and hope. 🪷🌷🪻

Pounding , thumping - follow up

by chandler_vt - 2023-08-27 11:29:56

@usmc-pacer, 

My pounding started a month later and that is what is concerning. Immediately after procedures I didn't feel anything . In fact up until last week, I felt I was recovering well. 

@Gemita

They said they will adjust settings at 3 months mark. So I am looking at October. My pacing is atrium driven. So I am assuming only thing they can adjust is delay and voltage. I read somewhere on this forum that higher voltage should not cause pounding, and certainly not suddenly - unless something has changed in my heart. The arrhythmia is there - I am getting an extra beat randomly. it's not Afib and when I take.metoprolol it goes away. So being on a higher dose might help. I switched from metoprolol ER to regular tartrate yesterday and it helped. I can control blood pressure more and heart rate as well.

Will talk to the pacemaker team and see what dosage of metoprolol works for me. I was also talk to them about holter monitor, my regular cardiologist didn't think it was necessary.  They keep saying pacemaker will pick up but pacemaker only picks up events like Afib . If it's just rhythm issue then it doesn't fire any event. That's my understanding. I hope you are right that heart is adjusting and so is my body.  Funny thing is when I wake up after a good sleep , I can barely feel the pounding . Once I start walking it is emphasized. So if it was pure voltage issue , i should feel it all the time. Also , it's more pronounced if I am sitting with back rest. Standing I can feel it but not as loud.

Seems like it's going to be one of those weeks where I have to make multiple calls and see what works for me. Glad I found this forum. definitely helps to know others who have been through similar experience 

Forgot to footnote..

by USMC-Pacer - 2023-08-27 13:49:30

I meant to add a link about high BP after AVR.. it's a good read:

https://www.ahajournals.org/doi/10.1161/JAHA.119.014631

In a similar situation

by susiebear - 2023-08-27 17:55:28

I feel for you with this. My PM team did make a change for me recently and I've felt lots of problems since and they are totally denying that the change they have made could cause any issues and it's something I won't feel.
I would say something has changed since your PM check perhaps they have increased voltage. Perhaps same thing as me? they have turned on my auto threshold test. Ask them about that? As they feel certain patient won't feel it. I don't see how we wouldn't feel it. I certainly feel the threshold test in clinic that they do. My bet is it's related to that! 
My history is very much the same as yours I had a sudden aneurysm of the sinus of valsalvar I to was meant to have my valve replaced but they managed to repair my own. Total heart block like yourself due to surgery. I was 24 at the time. 47 now. 
i do get your symptoms but not all the time. I have episodes of thumping in my chest. Feeling every pace. But then at other times I don't. Never fathomed that out. 
I hope you get to the bottom of it 

sue x 

Update

by chandler_vt - 2023-08-27 20:02:30

After switching to metoprolol tartrate, I have control of Arrhythmia. When metoprolol starts wearing off, my heart struggles between the natural rate, which is around 112 and medication induced one. With the extended release it was hard to say when the concentration reduced in blood stream , so I was getting at random times. So now the issue is only about thumping /pounding of heart beat. 

@uwmc-pacer. 

Thank you for the link. It seemsike higher blood pressure is associated with better outcome, which makes sense. I had mild stenosis though. So my blood pressure , which used to run high sometimes , is at the same level if effect of metoprolol wears off. 

@lavender

Thank you for the kind words. I am 45 and I have a 3 yr old.  Our whole world has turned upside down but I am lucky to survive. So counting my blessings. 

@susiebear

They said they just ran the test and interrogated to see the settings . They don't make any change in first 90 days anyway, according to them. They told me my ventricle voltage is 4.2 and atrium is 3.  I have to check with my surgical team about original settings. I think it could be just a big coincidence. I started rehab this past week,. Clearly it had an impact on my metabolism of medication. So something changed in me. I will update once I hear my surgical team. I am.hoping nothing was changed. It will totally destroy my trust in local.clinic. they have been really nice about it and have been reassuring all the time. I am hoping my heart is adjusting increased activity. There are times I can barely hear the beat.- like if I am talking to someone and just stop talkijg then for couple of minutes I don't feel the thumping. And there are times it's just pounding. Heart has gone through a lot. One more thing is they told me my bicuspid valve was really small. So they had a hard time putting in mechanical valve. The whole surgery took about 8-10 hours. I hope heart continues to heal and just like you I am ok with occasional episodes . 

 

 

 

Update # 2

by chandler_vt - 2023-08-30 18:03:20

So I verified the pacemaker settings and they have not changed. The only explanation is I am eliminating metoprolol from my system faster than before. If I can maintain a constant level of metoprolol like 25 mg in my system, I would feel fine. Currently I am taking metoprolol ER 37.5 mg twice a day. I need to probably up it to 50 mg twice a day if symptoms don't improve or switch to different medication

I have pounding on paced beats - I think i know what it is

by quikjraw - 2023-09-06 09:29:21

Hi - I do not know if this will help you but I also have pounding on paced beats. 

How do I know they are paced beats? Well I have AV heart block and my pacemaker is set to only pace when my ventricles beat at less than 40 bpm (VVI 40) So I can actually feel in my wrist pulse the longer gaps.

My pacemaker will only throw in a beat if my ventricles have not done their own thing in 60/40 = 1.5 seconds. 

My opinon no facts to back this up.......on those paced beats my ventricles have higher blood volume and as such the eventual beat is more powerful due to the higher blood volume.

Would you say your settings can allow situations were the delay before pacing is longer than normal?

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