Post PM implant

Nine days ago had PM implanted for heart block. It was done at my HMO and am not pleased with the post implant care. Never saw the doc post surgery, attending cardiologist came by and said he would see about getting me realeased and never showed up again. One week later to HMO for check up on PM, attended by a young tech with less than a year experience and briefly seen a cardiologist at the clinic who was surprised that I since had two near faint episodes. She suggested it may have been vasovagal related, then disappeared. Tech went to show her the test printouts and then said I could leave. Asked for the cardi as I had questions. She was occupied with another patient. Have had 3 incidents since the install and find it difficult to sleep as I feel that i cannot catch a breath. Pacing is set at 60, my normal pulse was 48-52 and as low as 44 when at complete rest and ready to sleep. I am obviously pacing most all the time. I suspect the problem is that the paced rate of 60 requires more oxygen and thus I must breath deeped to provide it. If so its tough to do when trying to sleep. Is this a normal aftermath? Got the Medtronic manual I ordered and also find the AV voltage set at 5 v which depletes the battery. Is this common practice i.e to set it high in the post operative period?
Thanks for your replies--much appreciated.


6 Comments

hang in there!

by CathrynB - 2007-08-10 02:08:17

Hi brbpdb, Welcome to Pacemaker Club!
I agree with ela-girl and brokenheart that not everything you're experiencing is unusual, though the quality of care and attention you're getting does not sound good! It's definitely normal to have your voltage set high initially, and they will most likely turn it down from 5v to 2 v or 2.5 v after a few weeks or 2-3 months. That's commonl. Mine was set that way, and I'm projected to have 9-11 years on my pacemaker (I'm only paced about 4% of the time). It's also common to come out of the hospital with "factory settings" and those should be adjusted over the first several visits with your cardiologist to best meet your needs. I started off with 60 beats per minute lower setting and the rate response mode turned on, sleep mode turned off. After several visits I have 2.5v, 50 bpm during daytime hours and 45 bpm in the sleep mode from 11pm to 6am, and the interval between the time sensing and generating a pulse was shortened for the ventricle because I continued to have mild dizzy spells occasionally, and rate response mode turned off. Now I never even know I have a pacemaker as far as cardiac symptoms are concerned, but it took about 3 months to get to that point.
It's very important that you be assertive in advocating for information, answers to your questions, and attention to any symptoms you're experiencing. If you're not getting that, either push harder, get someone to go to appointments with you to help advocate, or change doctors. You're going through a LOT right now with a new foreign device in your body, several months of healing ahead of you, and some adjustments, hopefully small, to a few changes in your life. You deserve to receive good care. Please keep us posted on how you're doing, and know this site is full of caring knowledgeable people who are happy to share their stories and offer you support. Take care, Cathryn

VVS

by bini - 2007-08-10 07:08:19

I also know all about VVS, I have a condition called posteral othostatic tachycardia. This condition has led me to faint almost daily for three years. In fact, I had to get my PM for this reason.
VVS can be treated by many things, meds, more exercise, sometimes PM implantation when needed, and many more.
I would talk to your Cardio about this and see what he recommends for you to do.

Christine

dont be discouraged...

by brokenheart - 2007-08-10 12:08:05

hi...i am sorry to hear that u are not having a great experience with your docs and that is not okay. You only have one heart and you deserve the best care for it possible. Is a second opinion an option for u? for myself i can say i did seek a second opinion because my first cardiologist did not seem to know what he was doing and he was not very experienced. I also have the vasovagal disease and for me medication has helped so that i dont pass out the way that i used to. I believe that the voltage was set high for me in the beginning but this is something that can be changed later on during your check ups. Now my voltage is set at lower and my battery life still has 5 years left. About the sleep...i was having trouble sleeping and having chest pain and palpitations a lot at night to the point that i was not gettin any sleep...so a rep suggested that i get a night mode...this is when they adjust your settings differently only at night during sleep because you may not need your hear to beat so fast. Mine is set at 55 beats at night between the hours of 10pm to 8 am and when i wake up it goes back to the 70-160 beats. I hope this helps but i know there are lots of more people here who can give you wonderful advice and more details. Take care and God bless you.

VVS setting

by bowlrbob - 2007-08-10 12:08:34

I know how you feel. My pacer surgery was done on an emergency basis. I was on vacation at the time. After i was released and went home. No one where i lived seem to give a RIP if I was seen or not. I couldn't get an EP though we have them here. The heart Dr. i saw said you don't have heart trouble and just told me to get my 6 month tech. readings. I had no where to go for answers. Then i found this site it has been a great help. Because of this site i sought answers and called the EP that did the surgery. he said I could come back to him for my adjustments. He is 5 hours away but that's nothing to fix the problems I was having. He reset my pacer from 50bpm to 70 bpm. He then turned on the rate drop response and this took care of the blackout problems caused by the VVS. So ask about the rate drop response if you ever get to the EP again. Keep calling them until they see you the squeaky wheel gets the grease. Bowlrbob

Hope I can help some!

by ela-girl - 2007-08-10 12:08:55

HI, brbpdb!

By no means am I a doctor nor a pm tech, but from my experience, yes, it is common to have the pm set at a higher voltage at first post surgery. Most times, the voltage will be checked and reset as necessary at your check-ups. My EP told me that this is done mostly to ensure that the pm is working properly. While having the voltage set higher does deplete the battery quicker, if you only have it set high for the 6 week recovery period or so, it doesn't overly kill the battery and it's life. I know mine was set at 5 v then reduced over the next few months as my pacer was checked and operating ok. It also depends on how much voltage you need (I can't remember the specs here, but something about how much v it takes to get the pm to capture...). I know there are others on this site who can probably explain it better....people like Smitty...and hopefully, they will come to your aid!

I'm so sorry to hear that you've had a rough time with all this. I know getting a pm in and of itself is stressful enough. I have a great EP, so I don't have these complaints. Is seeking out another doctor an option for you? You should feel comfortable with who you are seeing--you two are a team working together for YOU.

I also can relate to the vasovagal stuff. There are many of us here with VVS/NCS. If you have specific questions on that, I know many will respond.

As far as sleeping, I know that I had a heck of a time with it for the first 3-4 weeks. I couldn't get comfortable, my mind was so focused on the pm going off at times, and ugh. I use my pm a lot when I sleep, and now I sleep much better. A lot of pacers will probably say the same... I would say talk to your doc about the problem, but it seems you are not getting much help in that department. Again, you might seek another opinion?

Hope it gets better for you...you've found a great support network.

Happy pacing-
ela-girl

Thanks

by brbpdb - 2007-08-14 10:08:59

Your comments very much appreciated. Between your input and receipt of the manual ordered from Medtronic (free) I think I am developing a level of understanding of the PM and it's capabilities and how they apply to my condition. Am now awaiting a copy of my doctor and hospital records to confirm the diagnois made and go at it from there. Have made an appointment at the clinic and one with the assignedd cardiologist. Will also attempt to get the Medtronic rep to attend my clinic appointment,

I have not had any additional incident since those reoprted in my first posting and definitely feel better than prior to my implant. I suspect I had a period of skipped beats that finally were long enough to cause syncope.
Again, thank you for your input and the good feeling of knowing others care enough to take the time to do so.

You know you're wired when...

You participate in the Pacer Olympics.

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