New PM

My husband recieved his PM on 4/20. He passed out and was flown to nearest major hospital with a HR of 30-33. He recieved a 3 wire Medtronic CRT Percepta. He is a 77yro with a 32 yro mechanical aoric valve. His heart could not sustain a HR beyond 33BPM without a PM. This was a sudden onset and the EP said it was an electrical bundle failure. Prior to his PM his HR usually ran around 60 BPM. His situation is muddled with orthostatic hypotension from Parkinson's, causing his blood pressure to fall to 48/34(in the extreme), but usually 80/55, causing dizziness. His cardiologist diagnosised his OR as being Parkinson's related. It could be that we had issues from his heart that were being assumed to be Parkinson's. Since he got the PM, he has pretty much been either in bed or in the recliner due to frequent dizziness and fatigue. Now his BP has been running any where from 80/60 to 139/74 with our monitor saying his HR is 50 BPM (though the doctor said the monitors were not good at measuring HR). He is sleeping about 12 hrs a day and laying down for naps and obviously is sore from the surgery.

I would be interested in how anyone thinks the PM will impact his situation and what type of issues we need to be aware of, since he is a complicated case. We will go to the Device Clinic this next week. We are hoping for improvement after adjustments. 

Prior to this he was doing yard work, taking walks and able to function pretty well with resting as needed or when his BP fell.

Thanks for any input.


3 Comments

Others will have more experienced-based information

by crustyg - 2021-04-30 07:27:45

There is no doubt that for some folk, a PM *can* produce an increase in BP, although this is very variable.

It may well be that with a suitably high minimum HR (perhaps as high as 70BPM, possibly a little lower at night to aid getting off to sleep) your hubby gets *some* improvement in the low BP that's not great for the brain and can easily lead to falls and all of their consequences.

There are several contributors here who have had major improvement from having their minimum HR increased at the PM.

However I wouldn't want you to get your hopes up too high: a PM isn't often a miraculous cure, although for some it really can be life-transforming.  I suspect that once suitably adjusted it will be just another complicating factor, but one that guarantees that a low HR is no longer a risk  - which is one small worry taken away.

Best wishes.

Input

by AgentX86 - 2021-04-30 14:12:52

Just as a guess, I'd say that he should fully recover to his previous activity, once everything settles down.  From your description ("electrical bundle failure"), leads me to believe that your husband had what is called a complete heart block (likely caused by a "bundle of His" failure).  It doesn't really matter why but pacemakers are very good at "fixing" this problem.  Obviously a pacemaker can't help with his other problems but should bring him back to where he was before this latest problem. 

No, these sortts of BP monitors aren't all that accurate in measuring heart rate, particularly if something else is going on.  Often, after a pacemaker is implanted, it takes the heart a while to settle down and get used to being paced.  During this time several sorts of arrhythmias may develop that, along with your husbands other problems, can cause the symptoms you describe.  These usually go away after a short time but his case is more complicated than most.  The best course of action is to make sure his cardiologist (he really needs an elecrophysiologist, at least for a time) knows all about his symptoms.  He may want to do more tests to get to the bottom of this.

 

My experience

by Gemita - 2021-04-30 15:08:37

Sharron, despite your husband’s complex medical history, I would not expect him to be worse off following a pacemaker implant than before his implant, since I note in your final paragraph, prior to his syncope event due you say to an electrical bundle failure, he was doing yard work, taking walks and able to function pretty well with resting as needed or when his BP fell.  I do not see why he cannot return to this level of activity and stability once he has healed and things have settled down following implant.  Of course I am assuming that nothing else has changed in his overall medical condition?  If his medical condition has changed more widely, then the pacemaker is not going to be able to fix everything but it should help stabilise your husband and help him to return to his former self.

How specifically will the pacemaker impact your husband’s situation?   I believe by keeping a steady, higher heart rate it will help to maintain blood flow to his body since a falling heart rate can cause many unwanted symptoms from extreme fatigue, to dizziness, weakness, breathlessness, cold extremities and brain fog.   Unfortunately though a pacemaker is unable to prevent our blood pressure from falling as it can with our heart rate.  Blood pressure may continue intermittently to suddenly fall due Orthostatic Hypotension or other reasons, even with the pacemaker, so he could still suffer a pre or actual syncopal event.   I suffer from sudden falls in blood pressure which can occur at any time due to situational (swallow) syncope (part of Vasovagal Syncope), or due to my arrhythmias. 

My heart rate is set at 70 bpm night and day and I am so much better.  My heart is steadier.  I feel stronger, less cold, less tired, clearer in the head.  My dizziness/presyncope episodes continue periodically when I will need to lie down, or sit down to prevent a faint, but not frequently any more with a steady, strong heart beat which has made an enormous difference to my quality of life.

My blood pressure can dip to 80/47 before recovering, although my blood pressure is always on the low side and has been all my life, so I really needed a higher heart rate to keep things flowing.  Looking at your husband’s BP figures, these would appear unstable.  Does he have arrhythmias, since my arrhythmias certainly trigger frequent, sudden blood pressure changes as well as heart rate changes?  It is true home monitors aren’t always reliable when measuring heart rate, especially if your husband has an irregular heart rhythm.  I would ask your clinic whether a higher minimum heart rate setting could be given to your husband to see whether this might help with his symptoms.

I wish you both well and hope that the Device Clinic and your doctors can help provide a better pacing experience for your husband

 

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