PM Hematoma? And ?nerve pain in left arm

I am 1 week post PM implantation, and just now realizing that this big bulge at the site is not normal.  

I have a bulge that is about 2.5 inches wide by 5.5 inches long, and when I get up from lying down there is an uncomfortable sensation of thick liquid settling. The size seems to go up and down, and when it's up the pain in my arm is amplified.

I had this at the hospital before discharge, and a nurse casually referred to a hematoma in passing. I was not on my game, and I thought she was referring to little spots of blood under the see-through bandage.

Now that I've googled it, I'm concerned.  I understand that they can go down, but that there is an increased risk of infection.

I'm a bit miffed that nobody advised me about this complication at the hospital.  I have had to take old Vicodin to manage the pain since they did not send me home with any pain medication.   I am mostly concerned about the increased risk of infection and really do not want to take an antibiotic prophylactically that could cause C-diff, since I have first hand knowledge of how sick that can make me.

I am contacting my doctor's office for guidance, but in the meantime I do wonder if heat helps or ice helps or what others' experiences are.  I have been puzzled by my pain level given what I've read and heard, and am having an ah-ha moment.  Thanks for any responses.



by AgentX86 - 2020-07-22 21:44:32

A hematoma isn't fun, to be sure, but it's not all that uncommon and not usually serious.  That's probably why the nurse brushed it off.  She should have explained it more, however.  She should have given you more information and warned you what to watch for. Pain meds are a real problem.  Many doctors are extremely hesitant to prescribe serious pain killers fearing the feds will come down on them for dealing drugs.  Some doctors don't care - "let 'em talk to my patients about pain".

Ice is a good idea. Ice reduces bleeding and numbs the nerves.  Heat can make it worse on both accounts.  The hematoma will get reabsorbed into the body soon enough but in the meantime ice it and take whatever works for you. Ibuprofen is a no-no for heart patients but it works for me and my cardiologist and EP, both, have said that it's OK to take for occaisional pain. Your doctors should be able to give you advice too.


by Tracey_E - 2020-07-22 22:04:59

Some doctors give pain meds, some make us ask for it. If tylenol isn't cutting it, it's ok to ask for more but after a week you really shouldn't need it except maybe at night to sleep.

I would get them to at least look at the hematoma.

Ice is good for pain well. 

Bruising or something else ??

by Gemita - 2020-07-23 04:29:49

Hello Twodrifters,

So sorry to hear of your difficulties and hope your doctors will find the solution quickly for you.

Yes hematomas can look very sinister and are often painful as they drain and they can drain extensively down the body or a limb and turn a variety of deep colours.  What to do about them has to be based on the patient’s symptoms and appearance of the bruising and whether any swelling/infection is present but our doctors recommended stopping anticoagulants for a period during the initial acute phase to help prevent further extensive bleeding.

In my case, it was unclear whether a pseudo aneurysm or true aneurysm may have formed in a blood vessel/artery. An ultrasound confirmed a pseudo aneurysm.  Of course there is also the risk that your symptoms are caused by something more serious like a DVT and/or an infection which would require additional measures.  

My advice is to keep asking your doctors for guidance.  A special ultrasound test may rule in or out a DVT or true aneurysm.

Both hubby and I developed severe bruising following different cardiac procedures.  We were both hospitalised while tests were carried out.  It was a difficult decision for our doctors but eventually anticoagulation was withheld for several days during the acute phase.  Since we both have AF, this was extremely risky but necessary at the time.  Icing did not help either of us, only withdrawal of anticoagulation helped with our symptoms

About that nerve pain

by Aztraildude - 2020-07-23 10:55:26

Your headline mentioned nerve pain in the left arm. I am a week ahead of you, and had pretty severe nerve pain in my left arm. At the one-week consult with the pacer clinic Monday, the nurse said it should go away by the end of the week, and it has gone down considerably. Doing absolutely nothing with the left arm was the only thing I could do to ease the pain. Opioids typically don't help with nerve pain, and because it's transient there's not much point in seeking other treatments. Had it lasted longer I'd have seen my acupuncturist, because I've had good luck with that in the past for sciatic nerve pain.

Thanks/Improvement at 10 days post implant

by twodrifters - 2020-07-25 17:47:11

Thanks for your helpful comments.  At the wound check appointment yesterday the nurse reassured me that this healing process is normal.  Good to know. She advised alternating heat and cold. The Dermabond bandage is slow to start coming off, so I'm supposed to start peeling at the edges.

The nerve pain in my left arm has definitely improved.  So perhaps the bruising down my left arm/underarm is not just from the procedure but also from the hematoma draining?  

The nurse said I'm using the PM 30% of the time in the atrium and 1% in the ventrical.  That is higher than I would have expected in the atrium, which tells me that I did indeed need the PM.  It's interesting to note that I can get used to managing and trying to push through not feeling well, only to find out that there really was a problem.  I'm so glad I went ahead and got it done, and I thank those of you who helped me move forward.


by Gemita - 2020-07-26 18:49:35

Yes the hematoma can travel far as it drains and turn up in really unexpected places !!  

I am paced close to 100% in my right atrium mainly because my minimum heart rate is set quite high day and night (70 bpm).  What are you paced at?  If mine was set lower, say at 60 bpm, I expect my pacing percentage would be lower also.

Hope you continue to recover well

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