Light headed and dizzy

I just had a Medtronics dual chamber pacemaker installed for second degree Mobitz 2 heart block 10 days ago . I am a 55 year old male. 

The pacemaker has gotten rid of the skipped  beats and the Terrible palpitations I was having at night as well as keeping my heart rate very stable while sleeping . This is a big relief  

On my checkup a few days ago the doctor said everything is normal and he was happy with the settings despite my complaint that I was experiencing feelings of light headedness and disorientation. Also my pulse rate is elevated at rest from my normal of about 65 to 75 or higher. He cleared me to exercise on the stationary bike and when I did so my pulse went up immediately to 135, which normally takes a good long session to achieve. This concerned me  

My pacemaker is only pacing the lower chamber but he said it was doing it about 60% of the time. 

I realise it is very recent after my surgery and don’t want to be expecting too much, but these feelings of dizziness are really bothering me. From what I have been reading there are a multitude of settings to adjust and while my EP may be happy with the settings, they still may not be right for me. At what point should I push him to try some options ? It seems that the only one he has played with is the delay in the ventricular pacing. 

Thanks and it’s great to have such a supportive forum to turn to. 

4 Comments

Lightheadedness after pacemaker implant

by Heart-Rhythm-Center.com - 2018-07-22 15:33:50

DCS:

Any new symptoms after device implantation should be relayed to the implanting physician. Many pacemakers are set to have rate-response to activity. Activity is usually sensed by movement which may not be adequately sensed if you are on a bike; sometimes devices can sense respirations which would be sensed while on a stationary bike (or swimming). Your pulse increasing to 135 beats per minute may be normal response but could also suggest Pacemaker Mediated Tachycardia (PMT). PMT is nonfatal but can cause symptoms; it is easily fixed by programming changes. There are a myriad of possible causes to your new symptoms after device implantation so again, relay any worrisome symptoms to your doctor. 

Hope this helps.

Thanks for your response.

by DCS - 2018-07-22 20:59:01

Rate response is turned off so this is not the cause. Is it possible that over pacing the ventricle could cause these kinds of issues? He said that my ventricle was paced 60 percent of the time which seemed very high considering I only had skipped heartbeats at night..

my concern is that the doctor was completely dismissive and told me to come back in three months. Seemed he was not willing to adjust the settings at all. Said they were fine and that he had not heard of any case like mine  

 

Give it some time

by Gotrhythm - 2018-07-23 15:37:10

Two things to consider:

(1) Your heart has only been paced for 10 days. You are sitll healing and your heart is still getting used to being paced. It might be wise to wait a few weeks and give things a chance to settle down before making any settings changes. After all, although a resting heart rate of 75 might be new to you, it isn't outside the normal range. The same is true of 135 when exercising. Worrying about these changes is premature.

(2) I absolutely understand how the doctor's dismissal of your symptoms would be hard to take. It sounds like intolerable arrogance. However, the problem might be less his unwillingness to take your desires into consideration, and more that he is unable to explain why he thinks everything is okay in lay terms.

Forgive me if I'm making assumptions I shouldn't, but your questions make me think you would be more at ease if you had a more complete understanding of heart block and what your pacemaker is supposed to do. Reading descriptions is good, but the heart can only be understood in motion. On Youtube you can find wonderful animations of the workings of the heart.

Here's my favorite. It shows heart block and also explains what it looks like on ECG ( Not a live link. You will have to copy and paste)

 

https://www.youtube.com/watch?v=sg9l2O6MDc0

Thank you for the link.

by DCS - 2018-07-23 21:44:43

I had watched s few of these videos. Yours was instructive and I appreciate the effort in responding and posting. 

I realise it has not been long but I am having a hard time coming to grips with pretty much constant low level of dizziness and light headaches. Occasionally I feel tightness in my chest and during exercise my heart rate elevates vastly quicker than it used to before the operation. Before the operation I was in excellent cardio shape, rowing 50000m per week, swimming and walking at least 3 miles per day. During my walks my heart rate was usually around 90-95. Now the same walk my pulse is 115-120 and I don’t feel good.  

What is strange is that when I left the hospital I felt great. This started about 5 days after the operation. 

Anyway im currently waiting to see my EP. I need to make a transpacific trip for a major family event quite soon and want to get to the bottom of this. 

I appreciate your thoughtful response. 

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