Pacemaker-Mediated Tachycardia

You are slowly making progress

by Gemita - 2022-09-30 07:56:37

Benedeni,

Whatever is causing your heart rhythm disturbances and sudden rate changes is clearly making you extremely symptomatic which you are finding difficult to tolerate.  Your symptoms therefore need treating.  The problem is pinpointing the "exact" cause of your disturbances.  I had hoped they had finally found the problem from your last message.    

Sudden heart rhythm changes (from a regular heart beat to an irregular one) and swings in heart rate (increasing, slowing) can really affect the way we feel.  Medication, pacing itself, especially when the settings are not well adjusted to suit us, any acute illness (like gastric and I see they want to check for any potential difficulties here), lifestyle changes, lack of sleep and the list goes on, can all clearly affect our heart rate and rhythm.  I would continue to work with your pacemaker clinic/technician since clearly a problem has been identified and your settings may still need adjusting? 

I don't know what the problem is with getting an endoscopy.  I have had many without the need for clearance from my EP/cardiologist.  A gastric/cardiac connection for your symptoms is very possible too and should be ruled out.  It is often a cause for heart rhythm problems for many of us because of the proximity of the oesophagus to the heart and because digestive disorders, like reflux, can be a major cause of palpitations and chest pain, often mimicking heart problems/angina.

Never stop believing that this will get better.  I have just had the most awful time with my palpitations, imagining all sorts of things and for the last two days my heart has been quiet again.  We are such complex creatures.  Be kind to yourself and to your doctors, keep an open mind as to the cause and above all, allow yourself “time” to get better.  It seems your higher than normal heart rates have at least stabilised?

Thanks, Gemita

by benedeni - 2022-09-30 08:49:19

Your response was so helpful.  I have had esophageal spasms for 30 years however they have been fairly well controlled with Pantaprazole regularly and a GI Cocktail infrequently.  Recently they have started up again and that was the reason for all the doctor visits.  My gastro/surgeon had to have clearance from cardio before doing the procedure.  Not so much for him but for the anesthesiologist.  It's such a short time you're "kinda out" that I wondered myself what the big deal was.  At any rate now it's Time as it's adding to my stress, which as you agree, causes so many issues.  By the way, and this may be helpful to someone else, I've had 5 major esophageal spasms where the ER was involved.  It Does feel exactly the way I envision a heart attack to feel but once that GI Cocktail takes affect, it calms right down.  Not fun for sure.  I am sorry you have these issues as well, adding to all your problems.  Take care of yourself and hubby as well.  Thank you. 

Nutcracker oesophagus patient here

by Gemita - 2022-09-30 11:17:02

Benedeni, never under estimate the ability of the oesophagus to trigger heart rhythm problems and chest pain.  I frequently have swallowing difficulties even with liquids, often triggering a racing heart and have passed out briefly with them too. Oesophageal dysmotility is very frightening when it occurs and there are meds that can help but some of them can affect heart rhythm.  Good links below on oesophageal motility

https://pmj.bmj.com/content/81/958/515

https://ctsurgerypatients.org/lung-esophageal-and-other-chest-diseases/achalasia-and-esophageal-motility-disorders

oesophageal spasms and other gastro problems

by _Claire_ - 2022-09-30 18:07:29

Hi Benedeni

I see you have had excellent advice from the lovely Gemita (who has helped me immensely with excellent advice). I just wanted to say that I too seem to have some gastro problems, I thought maybe reflux and esophageal spasms have been suggested as a potential cause of my unexplained angina type pain. My barium swallow test was unremarkable though for reflux. Cardiologist also mentioned Coronary Artery Spasm (but I'll save that for a separarte post as I have many questions). Do either of you know how esophageal spasms are diagnosed? Is this through an endoscopy? Could I also ask, Benedeni why are you getting put under for the endoscopy? It seems here when I've asked, they seem to do them without any anaesthesia. Just asking out of curiosity. 

I really hope a solution can be found to ease your symptoms as it sounds really tough. I wish you the very best. 

Claire - Tests for oesophageal dysmotility

by Gemita - 2022-09-30 20:00:02

Tests useful in diagnosing motility disorders include high-resolution esophageal manometry, barium swallow and endoscopy.  The first named (oesophageal manometry) was the test which successfully found my nutcracker high pressure contractions. although it was also partially seen on barium swallow and during several endoscopies.  I was challenged with a piece of bread during manometry.  Of course as with all tests, I got lucky and had the swallowing problem at the exact time of my test.  Now how often does that happen?  Since so many conditions are intermittent in nature - like with arrhythmias - it can be difficult to detect oesophageal dysmotility.

Claire, like Benedeni I often get a heavy dose of anaesthesia during an endoscopy otherwise I would fight them all the way.  I think I just get heavy sedation.  They had to abandon an endoscopy on several occasions because I tried to prevent them from scoping me.  The doctor in charge placed on my file the need for a "GA for this patient".  

Endoscope Procedure

by benedeni - 2022-09-30 22:34:49

Claire, I am sorry you are having these gastric issues.  These spasms are intense and a bit scary as can easily be mistaken for heart attack.  Gemita covered things far better than I could but I do want to add that for the endoscopy procedure I have always been given the heavy sedation.  I don't think I could handle having my esophagus scoped without. 

I was diagnosed after my second trip to the ER in about 1993 when my heart checked out ok after testing.  Also the fact that a hefty dose of G.I. cocktail took care of the problem.  It's prescribed under the name of Magic Mouthwash but of course you drink it, not swish it.  I never go far from home without it.  During that time period I also had an esophageal manometry test.  Now that's a test I'll never forget.  Not pleasant, for sure.

At any rate, I wish you well and hope that you find solutions for your issues as well.