HF ongoing issues

[Nomis21]

Hi, Had a 2 lead pacemaker fitted cpl of years ago after pace n ablate, have total heart block so paced 100% since then I have been diagnosed with heart failure with echo showing left ventricular dysfunction and a EF of <40% I'm also in AF.

HF nurse has prescribed meds and currently on Bisoprolol 1.25mg, dapagliflozin 10mg and 7.5mg ramipril.

Ongoing symptoms of tiredness, breathless, no energy, dizziness, lightheaded and chest discomfort, I struggle walking especially up an incline and stairs are my enemy!

I had a Cpex test in Feb and last week received the outcome which says my pacemaker shows no rate response, I have currently been attending cardio rehab and now I'm wondering if I should be exercising and putting exertion on my heart when there is a issue with my pacemaker?

Always been told to keep active which I do but finding it more difficult.

When I had the Cpex test the consultant stated my heart rate didn't increase and was constant around 75bpm.

Just wondering if I should be doing anything physical like cardio rehab while my pacemaker obviously isn't providing the rate response?

Pacing clinic notified but told it can take up to two weeks to get an appointment even though the request was sent urgent.

Any thoughts?

[CDreamer]

Hi and that is a lot to cope with. If you have had Pace and Ablate the fact you are in AF shouldn’t be making that much difference to your symptoms as your pulse is steady rather than irregular but the pacemaker not responding to exercise is going to be the main issue. I think you need to wait for the pacemaker clinic follow up. If your HR is not adjusting when you exercise then you will have symptoms of fatigue and breathlessness on exertion so do what you can movement but take your time. Unfortunately the meds will also contribute to your symptoms and I might query that prescription with a doctor if you HR is steady.

Do you know what sort of Pacemaker you have - 2 or 3 leads? Have you any sort of pacemaker monitor?

It’s really good that the Cpex has identified the problem, now it is up to the Cardio Physiologists to see what the PM is doing and hopefully it can be adjusted accordingly. An EF of 40% is not ideal but neither is it into heart failure terrritory unless you have HF with a preserved EF.

I think it’s a case for patience.

[Nomis21 in reply to CDreamer]

Thanks for your reply, I have a 2 lead, it's been mentioned of potentially having a 3 lead in the future but il find out more when I go for my appointment with the cardiologist in July.No monitor.

Feels like my heart pumps hard upon the simplest exertion and with the meds it's draining.

[BobD Volunteer]

Most important that any exercise you not push too hard. For example you must be able to walk and talk at the same time.

[Ppiman]

I was reading a study only recently that showed how certain uses of PMs could increase EF significantly, essentially taking the heart out of HF. Obviously each heart has individual aspects that affect it but I would be asking my cardiologist for where to go next.

Steve

[Nomis21 in reply to Ppiman]

Hi Ppiman, thanks for your input. It's been suggested by my cardiologist that a 3 lead pacemaker may be the way forward.No expert but I've been told my two lead PM pacing the right hand side may not be in sync with the left hand side ventricle which may be causing additional strain hence the HF, a 3 lead would pace both ventricles in rhythm?

In addition to that i have been informed in the last cpl of days from cardiology that my pacing has little/no rate response and from what I understand my PM isn't responding to any physical exertion, my heart rate doesn't increase, I've checked this over the last few months and it doesn't increase regardless of any physical activity, just stays around 70bpm

Awaiting a urgent pacing check but told it could take 2 weeks!

[Ppiman in reply to Nomis21]

Well - you've had bad luck but it seems as if that's about to change and all will be well. You'll be very relieved indeed, I should think. What a worrying time you've been through.

Steve

[Nomis21]

Thanks Steve, it been a journey!

[Beastiebob]

Hi Nomis. I can't coment on the pacemaker issue, but I can identify with the, lack of energy, breathless and general exertion scenario. When I was eventually diagnosed with AF. I was put on Apixaban and Calcium chanel blockers, with no discernible side affects. It never was explained properly to me, how the CCB's were supposed to help, just that they should! When it was realised there was no change in my condition, the CCB's were stopped and I was put on Bisoprolol. This did have side affects. It had the affect of dropping my pulse rate to the point that any physical activity was draining. I've read on here that a lot of people have changed the bisoprolol with more tolerant results. I, on the other hand, chose to abstain from the Biso and so far my bp is still in the, goldilocks zone and strangely, my episodes have decreased. We're all different, but there are some consistancies. I would bring up the biso thing with your specialist to see if a change would be of benefit. Good luck and best wishes.