Heart muscle aches after moderate activity

I've had those strange feelings...

by USMC-Pacer - 2024-03-30 00:00:05

and it's usually on the left side of what I would say is my heart. Lots of times, I'll move around and stretch, or breathe deeply (ribs) and see if I can recreate it. Most of the time I can and then assume it's a musculoskeletal strain of some sorts. For me however a strain wouldn't be unusual as I also lift weights. If you can't move around and feel it, I'd get it checked out especially if it's related to shortness of breath or any type of dizziness - as you well know. 

Just my two cents and probably not very helpful. 

I am so pleased you had a better day yesterday

by Gemita - 2024-03-30 02:42:34

Janene, I wonder if we can define heart ache a bit better, please?  What sort of pain are you experiencing?   Dull, pressure, tightness of your heart muscle, for example?  Where exactly is the pain and does it spread, or is it mainly located in the heart?   I am thinking too we can suffer from emotional or physical heart ache and both can cause problems if we push ourselves too hard, too quickly.  

Having experienced a number of chronic illnesses over the years, one thing I have learnt is that if we do too much today (when we are feeling well), we may not be able to do anything tomorrow.  It is all about learning to pace ourselves, even when we are feeling well, so that we will be able to make steady, consistent progress rather than doing too much today and then having to rest all day tomorrow.

I am experiencing some chest pain which is currently being investigated.  I cannot always pinpoint the exact position I feel my chest pain since at times it can move around (upper back, upper left arm, even appear to be coming from my epigastric area).  It is usually associated with frequent ectopic beats or arrhythmias like Atrial Fibrillation and the chest pain may disappear when the rhythm disturbances stop.  My chest pain is quickly triggered by exertion as my heart rate increases, like walking uphill, but it can also appear when I am at rest so a complex picture which is why I am asking you these questions.  I am waiting for a stress echocardiogram to look for coronary artery disease.  I had an angiogram a few years ago and my arteries were totally clear.

Your comments:  “The day following my unusual activity, my heart actually is sore, like any other muscle would be if you worked it out more than usual” tells me that you probably overdid it.  So yes, I have experienced this too, but I think we have to accept that chest pain can have many different causes and your sore heart may not be coming from a heart problem alone.  The pain/discomfort however is a clear indication perhaps of the need to find a safe level of exercise for you where you will not suffer these setbacks.  Cardiac Rehab might be a good place to start where you can work with a therapist to find a safe level of exercise/activity for you, or at least provide some reassurance that what you are doing will do no harm?   I would ask your cardiologist for a referral because of your continuing difficulties as you try to exercise. 

As USMC-Pacer wisely states if you are getting other symptoms with chest pain, like dizziness and breathlessness it needs to be assessed.  

As always, I wish you well Janene

More likely diaphragm

by crustyg - 2024-03-30 06:33:17

I'm not at all sure that most of us can feel our heart muscle except in extremis.  Classic symptoms of MI are tightness across the chest, or crushing central chest pain +/- radiation down left arm.  And there's quite a lot of research that shows that many women feel heart muscle ischaemia less well than men, or describe it differently.  Heart muscle doesn't fatigue in the same way as skeletal muscle does.

I talked to one of the most experienced EP-techs in my local centre, and in 20+years in the role, he'd seen one patient who could feel a loose lead inside the heart.  Internal RF ablation - that feels like an MI so a cycling chum told me.  He only had the one burst before asking for sedation!

It's not common but it's possible to 'strain' the diaphragm, and that produces a deep ache *inside* the chest, quite different to strained lats or intercostals.  Usually much worse with deep inspiration.

But that's just my opinion.  Not fun whatever the cause, and a powerful avoidance conditioner which is a shame.  BF Skinner's work showed that extinguishing a conditioned avoidance response is extremely difficult, so once your brain associates 'exercise' with this pain, it's easy to avoid the 'exercise', which is a problem.

More clearly...

by R2D2 - 2024-03-30 19:26:13

What I realized is that while I'm being paced a high percentage of the time, I only feel certain pacing which is during any form of prolonged activity. But that day, I was moving a lot and could feel the pacing more on the top left side, all day for the most part. When we are being paced, we are being "shocked" a tiny bit each time. And my thoughts were, since my heart ached like this for days after my defibrillator went off and technically I wasn't supposed to feel that... so maybe my heart was sore from all the extra "therapy". I know,  that probably sounds strange to everyone else. But I feel things most people don't.  I felt my baby move at 2 months pregnant. 

Can we actually "feel" being paced?

by Gemita - 2024-03-31 07:57:38

Janene, good morning and happy Easter.  How you describe your symptoms and heart ache makes a lot of sense.  We will all feel pacing and any natural heart rhythm disturbances in our own unique way.  I tend not to feel my pacing in general particularly when I am not exerting myself or having rhythm disturbances.  I can certainly feel symptoms when my pacemaker is working according to its programmed settings, to intervene when it encounters an atrial or ventricular high rate episode and mode switches or overdrive paces me.  I certainly feel these sudden changes in pacing rates and mode switches which can leave me feeling quite unstable until my heart returns to normal sinus rhythm and to my usual atrial (AAI) pacing mode.

Your statement, "I only feel certain pacing during any form of prolonged activity" resonates with me too since the harder we push during periods of rhyhm disturbances, particularly with a weakened heart, the more likely we are to need pacing support and to feel symptoms from this.  I am not though able to pinpoint the exact position where I am being paced although I certainly always feel a sinking sensation in the epigastric area at the start of a rhythm disturbance whether the rhythm disturbance is caused by a pacing change or a change in my own heart rhythm.  It is so complex, so individual, isn’t it.

I am not sure that I agree with your statement “when we are being paced, we are being shocked a tiny bit each time” although I think I know what you mean.  The pacemaker is watching to see if our own heart will beat on its own and if it doesn’t do this within a specific time frame, the pacemaker will kick in and pace us so that our heart rate will not fall below the set lower rate limit.  That is the theory at least, although some settings and rhythm disturbances like ectopic beats, may cause timing issues for some of us, which is why pacing adjustments may sometimes need to be made.

Your statement “since my heart ached like this for days after my defibrillator went off and technically I wasn't supposed to feel that... so maybe my heart was sore from all the extra "therapy".  I know,  that probably sounds strange to everyone else . . .”  I would say it would be perfectly normal to feel sore following a defibrillator shock so your statement is not strange at all, but you should not be feeling the same level of “soreness” after exerting yourself during your daily activities as you felt at the time of your defibrillator shock, unless you perhaps received anti tachycardia pacing therapies while you were active the other day?   You could always send a transmission in and ask them to look to see what your heart was doing when you felt your discomfort?  I know you are still getting some tachy arrhythmias coming from both the upper and lower heart chambers and also frequent PVCs (premature ventricular contractions) so these might be more active during periods of exertion.  Mine certainly are and this can be a frequent cause of chest discomfort/pain

Gem

by R2D2 - 2024-03-31 11:21:29

Explaining further... Each lead placed in the heart has a tiny wire screw at the tip which is twisted into the heart muscle, and when therapy is needed or our heart rate needs to advance because we are being more active, a tiny electrical shock happens. That is the therapy delivered. Unlike the defibrillator wire which zaps big, the other micro shocks are what we sometimes feel. I wasn't having PVC's or arythmia's that day, but my heart doesn't beat fast enough when I move around, so my device kicks in more frequently,  raising my heart rate to match my level of activity. I feel this every time, it's the strange tapping or "heart flicking" sensation. It doesn't hurt, it just feels weird. 

I noticed that my pacemaker was kicking in off and on all day, doing it's job, making me wonder if all of that therapy was somehow responsible for the ache. Like I said, there were no other troubling symptoms, the mild pain eased by late afternoon the following day as long as I rested, which I decided to do. 

Can we (HSP individuals) actually FEEL any sort of trauma to the heart muscle? Or is it something else? OR... is it psychological? I mean... I'm being honest, my brain is a sneaky thing. 

We need to explore further

by Gemita - 2024-03-31 14:52:55

Hello Janene, I see you have been busy.  I will break down your message into two parts: (1)  What we might feel from pacing and (2) What we might feel immediately following fixation of leads and placement of leads into delicate blood vessels.  

(1) We shouldn’t feel pacing as you have described, although some members can be extremely sensitive to pacing or to their own natural heart beat, especially when it is irregular.  Your description of a strange tapping or heart flicking sensation isn’t a part of normal pacing, particularly if you have a well adjusted pacemaker with good lead and battery function.  I think you should mention your symptoms as expressed here to your EP or technicians and ask them to check your device.  You shouldn’t be feeling those symptoms so acutely.  I see you are pacing to a high degree in both ventricles with CRT pacing and also in your right atrium as well.  CRT pacing should help you to feel more comfortable in any event and not to feel the difficult symptoms associated with right ventricular pacing alone.

With my dual chamber pacemaker, I am pacing 100% in my right atrium because my own natural (intrinsic) heart rate is now in the 30 bpm range.  I am paced at 70 bpm.  However I do not feel my atrium being stimulated or as you call it receiving micro shock therapy, and nor should you feel your heart chambers being stimulated with every heart or paced beat.  I believe with the exception of a small minority of members who have also told a similar story, most members do not feel their heart being paced.  If that were the case we would all be extremely symptomatic and be asking for some fine tuning.  Something clearly is not working properly if you feel this with every paced beat?  

(2) Yes the trauma to the heart muscle following implant of leads can be fairly significant and can result in a heart which throws out lots of ectopic beats or other arrhythmias as a result.  For me it was the physical aspects of healing that were the hardest to overcome.  My heart went into overdrive following my pacemaker implant.  I was kept in hospital overnight and my heart monitor alarm went off all night long waking other patients when my heart rate and rhythm went from one extreme to another.  I was very symptomatic and throwing out wild episodes of Atrial Flutter, Fibrillation, multi focal atrial tachycardia and non sustained Ventricular Tachycardia.  I felt close to collapse.

No I don’t believe it is the therapy, as in normal pacing therapy, that is causing you to feel heart discomfort, ache, or whatever we should call it, but if you were getting episodes of anti tachycardia pacing therapy, this could trigger more in the way of symptoms.  You might still be experiencing lead tip trauma or another trauma from your implant procedure itself.  There are risks that can occur during implantation:  see under Learn, FAQs, Implantation, Are there risks associated with implanting a device?

This is such an interesting subject and we should explore it further:  Why do some members feel their pacing so acutely while others clearly do not?  Thank you for the link

What I know... Gem

by R2D2 - 2024-03-31 18:44:49

I have felt it from day one. In the same areas, the same sensation. While I know that there is some of the therapy happening regularly daily, I only feel certain things at certain times like when I'm starting to move more. If I begin a walk, and speed up a bit, it kicks in. Like clockwork. I feel it on the upper left (my perspective) the most, and a bit on the lower left. It will bring my heart rate up because it senses I need it to go faster. Then, after a couple minutes of resting, it stops. My doctors all have told me that most people don't feel the therapy, or pacing, or whatever. Most. But some do. And I am one of those people. If it's going on in my body, I FEEL IT. 

In order to test that theory, my pacemaker settings guy ( can't spell the other word) had me tap his knee whenever I felt something, so I did. And wouldn't you know... I got 100% of the feelings correct as for where they were felt and also when. He was shocked. But that's me. No one has ever questioned that I actually felt it since then. And there's nothing wrong with how it is performing. Everything is perfect. So I just keep going day by day, hoping that eventually it will get to a point where I don't feel it as much, but they told me that may never happen. As for being sore? Well... that's just basic common sense. I was electrocuted as a teenager, so bad that it shot me across the room about 8 feet. And let me tell you... even though the doctor said I wouldn't feel any weird sensations afterward, I DID. My body hurt in a weird way for days and my heart actually felt sore. That was 40 years ago. 

I think it's a mystery why some feel things and others don't. But I won't go have them messing around with my settings because the last time they did that, it took over a week to feel somewhat normal again and I don't think that's the issue. 

Rate Response function?

by Gemita - 2024-04-01 04:49:45

Janene, it appears you are perhaps describing your response to the specific setting "Rate Response" kicking in as you start to move.  Many of us feel the result of this setting, particularly when it is set too sensitively at the start or finish of therapy.  I realise however from your comments that your sensitivity to pacing overall is extremely high.  I can understand that you don't want any settings changed in case it makes the situation worse but sometimes working with a caring Electrophysiologist or technician who will at least try to help or to restore it back to where the setting was in the first place if it doesn't help should not be absolutely rejected.

Going back to the link you provided, it seems you have made up your mind what the problem is and have given yourself a firm diagnosis “heightened cardiac pain sensitivity” based on your own research and extensive knowledge of your body.  There is a lot of truth and good information in the link you provided and it has been very helpful for me too.  I hope you downloaded and read the whole PDF to get a balanced view because there were some limitations in the study as is often the case. 

I think we have all self diagnosed at times but I hope that other possibilities for chest pain when they present themselves in the future will not be rejected out of hand as always being caused by a "heightened cardiac pain sensitivity".   Other triggers according to the link for chest pain might include changes in loading conditions, heart rate, contractility or ectopic beats. 

There were some limitations in the Study, one important one, in my opinion, is that not all patients underwent tests on oesophageal function/sensitivity as a contributory cause for their abnormal cardiac sensory function.  As a patient with oesophageal problems I know only too well that the close proximity of the oesophagus to the heart, sharing the same nerve pathways (vagus nerve) may result in many difficult symptoms.

There are so many potential or contributory causes of chest pain, so it is important to keep an open mind Janene