SOB and general weakness

I have had my pacemaker for over seven years now. I am in generally good condition for my 66 years and swim a distance of approximately 3km  x 3-4 times a week at a relatively good clip. My little friend's performance is examined approximately every six months and apart from an episode a couple of years back where they detected arrythmia, I pass with flying colours. I see my cardiologist every 12 to 18 months and the conclusion is invariably "see you next year". I do have SSS and my physician put me on atenolol for a short while to deal with the occasional bouts of tachycardia. I stopped taking it, with his permission, because the treatment was worse than the disease.

The problem is this: I have no problem doing intensive swimming for an hour and a half several times a week. Mild effort, such as walking on the street at a regular clip, gets me winded. When that happens, the world starts closing in on me - my field of vision shrinks, my ears buzz and my extremities tingle. Duration is short - a second or two. My cardiologist has made me wear a Holter, then a cardiomemo. Both came out negative or with minor, negligeable occurences. So, I have symptoms that the machines don't pick up.

Does anyone have a thought about this?

4 Comments

Could it be rate response settings?

by LondonAndy - 2017-12-17 05:28:03

Some pacemakers have different sensitivity settings, so I wonder if your swimming is sufficiently vigorous to increase the beats per minute, but the walking is not if the sensitivity setting is "low"?  But this is just a guess.  If my theory is right they would need to increase the sensitivity settings.  Hope you will post an update if you get a diagnosis!

Another thought!

by LondonAndy - 2017-12-17 05:31:27

I have posted this separately, as I am less sure about this given that you can swim vigorously, and what I am about to describe affected all activity. 

When I had shortness of breath and dizziness, it was because of a severely restricted aortic valve.  The only test that showed this was the case was an ultrasound examination, so if you haven't had one of those might be worth it.

Thank You

by Edouard - 2017-12-17 10:47:42

Thank you all for your comments.

Robin1: I don't believe that I suffer from panic attacks. I feel no fear, panic or anxiety when this happens. I fact, I have jokingly remarked to friends that it is a cheap way of getting high without resorting to drugs (although I am not sure what getting high would actually feel like).

LondonAndy: The rate setting question is an interesting avenue to explore. I will raise it during my next pacemaker review. As for the aortic valve, I am fairly sure that the problem does not lie there. I have been submitted to an ultrasound test and no particular problem was detected.

SOB and dizziness on mild exercise.

by Selwyn - 2017-12-18 18:16:20

I would think your symptoms are due to postural hypotension- that is a transient fall in blood pressure. The old reflexes then increase the BP ( BP= heart rate x peripheral resistance)  and the dizziness is transient. [ peripheral resistance is really the ease of flow of the blood, the wider the vessel, the greater the ease of flow]

The question is why does this occur?

I get the problem after swimming, when I am hot, have sat down for a period of time, and then stand. It lasts a few seconds.  The cause is a drop in blood pressure, whilst the heart has not caught up. The rest area and me are warm- my veins are dilated ( low peripheral resistance) 

A number of things will help:

1. Fluids ( as you dehydrate swimming. Avoid diuretics)

2. Avoid drugs that slow down the heart rate ( eg. beta blockers)

3. Have a faster setting for your rate response. 

4. Increase the resting heart rate slightly ( eg. 60... to 70 bpm)

5. Make sure you are not anaemic ( or alternatively you have too many red cells) 

Get your nurse to do a lying and standing blood pressure. This should be done after a period of rest, and immediately on standing to measure the postural drop. 

Selwyn

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