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Shortness of Breath after Pacemaker placement
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Shortness of Breath after Pacemaker placement

My Mother had a 2 lead pacemaker placed in one month ago and is experiencing shortness of breath with mild activity.  She is currently on Metoprolol (Lopresser) 50 mg BID (recently changed due to simular symptoms from another simular cardiac med).  Prior to the pacemaker placement the only symptom she had was tiredness with a heat rate of 30 (amazingly no SOB or dizziness, but did see her physcian for right shoulder pain);  this is when it was discovered that she had a heartrate in the 30's. She was then sent to the hopspital and pacemaker was placed in the next day.
My Mother wants to wait and see if her current symptom of SOB subsides after the recent change in her med to Lopresser.  I think she should see her Dr. right away with these symptoms.  What would you advise.


This discussion is related to After pacemaker implanted, still having shortness of breath.
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976897_tn?1379171202
I would have the pacemaker checked immediately in case it needs to be reprogrammed.
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367994_tn?1304957193
If I understand your mother's condition, she had a low heart rate of 30 bpm and a pacemaker was implanted, but now she has SOB that is being treated with a change of medication?

When taking metoprolol, side effects may occur, such as nausea, tiredness, shortness of breath, or slow heart rate...metoprolol may not correct SOB!  The pacemaker has corrected bradycardia!? The pacemaker will override any disruptions of the normal electrical impulses controlling the rate of your heart's pumping action.

SOB is almost always a serious symptom...it was the only symptom for the admitting personal to put me in an emergency status, but I had other symptoms, dry cough, hyperventilating when laying down, etc .  She said that is all that is needed is SOB.  so it is a difficult call for your mother and may depend on any other symptoms!
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976897_tn?1379171202
It is not unknown for pacemakers to develop faults because they are man made and produced by the cheapest bidder. How much time would it take to have this checked just to be on the safe side, and gain peace of mind. When in CCU, a man was admitted who had sudden shortness of breath at my local train station and was 100s of miles from home. They discovered his pacemaker was not only faulty, but it had been incorrectly callibrated. This is not the only case I have witnessed over the last two years and all I can do is offer my opinion on the matter. Everything electronic can develop faults as we all know. I'm certainly not saying it is faulty, but I know I would feel much happier knowing it isn't.
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367994_tn?1304957193
Manufacturers of those sensitive medical devices have very strict guidelines for quality control.  The devices have to go through a burnin phase of several days and very few if any get through that will malfunction...a malfunction or incorrectly programmed pacemaker at inception would place a heavy liability on the manufacturer or whomever, but anything is possible just not very probable and shouldn't be any cause for concern unless one paranoid or have an obsessive/compulsion disorder...but those individuals my want to have the unit checked daily.:)
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63984_tn?1385441539
A blockage in a heart artery will result in SOB, so will medications, so will pacemaker malfunction.  It sounds to me that she should contact her doctor right away.  I'm not a health professional, but have had shortness of breath because of blockages, medications, and pacemaker that needed to be adjusted, so know this is an issue that needs to be addressed.  I hope you let us know what the doctor says.
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976897_tn?1379171202
"Manufacturers of those sensitive medical devices have very strict guidelines for quality control"

Well, one would seriously hope so, however, what is actually claimed is hardly ever reality. Here is something announced in May 2009 which is just one example to prove my point.

"Approximately 37,000 Medtronic pacemakers that are implanted in patients may contain a wiring defect that could cause them to malfunction and fail. Approximately 2% of all Medtronic Kappa 600, 7000 and 900 series pacemakers and Medtronic Sigma 100, 200 and 300 series pacemakers could be defective and experience a problem with the internal circuitry. Wires that connect the electronic circuit to other components in the pacemaker, such as the battery or connector, could separate resulting in potential loss of rate response, premature battery failure, loss of telemetry or no output. This could cause return of bradycardia symptoms or potentially result in death or serious injury.
Medtronic has notified doctors that there is no testing that can predict whether one of their pacemakers may fail and no device re-programming can reduce the risk.
Symptoms of lightheadedness or fainting could be potential signs of a Medtronic pacemaker malfunction, and patients have been urged to seek immediate medical attention if they experience any problems."

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159619_tn?1318997813
Ed, what you don't mention is that's 37,000 out of 1.7 million sold of those models or about 2%. Not exactly the horrendous problem you suggested. In the future it would be helpful to post all information, not just the numbers that back you point.
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159619_tn?1318997813
Sorry, got interrupted before I could finish the story. You also neglected to pint out the following;

"Medtronic says it has received two reports of patient deaths where the pacemakers may have played a role." They have not even identified an actual defect yet.

Again, that's a terrible thing to have happen, but not nearly indicative of an industry that has these units "built by the cheapest builder". This sounds like a very responsible company taking all the steps possible to inform their customers of a very, very slight risk.

All information should be included when posting from news articles, not just those that back you position. Picking and choosing thefacts is very misleading.
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159619_tn?1318997813
Sorry, yes you did mention the 2%, missed it the first time I read your post.............
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976897_tn?1379171202
yes, and 2% doesn't sound much does it when you are speaking of 10 people or 100. When however you relate this to millions, it certainly begins to reflect a rather large number. Instead of just 2 if it were 100 people we are looking at 20,000 per million which is a huge number. Enough to disturb me anyway.
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159619_tn?1318997813
But we're not talking about 2%, only the possibility. According to the press release you quoted there are only 2 POSSIBLE units that MAY have been associated with a patients death. No defective units have yet to be discovered but they are recalling the entire production run to be safe. The recall is only a precaution which is the responsible thing for the company to do. You can't make the assumption from what I read that all 37,000 units are bad, they don't know in any are, they are just being careful.

But yes, if 37,000 turned out to be bad it would be alarming, but that's not the case.
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367994_tn?1304957193
Jon is correct.  You can't judge the complete population of pacemaker devices on the probability of run of specific models that may have had a manufacturing problem.  It appears to be a recall or heads up for any probable problems.... A malfunction of a device is 1.4 per 1000.  One out every 50 devices manufactured is defective is ridiculous...should be ashamed to post the comment.:)  

The pacemaker should not even be an issue.  The OP's mother had bradycardia (heart rate of 30) so a pacemaker was implanted. The pacemaker would be an asynchronous device that sets a fixed rate higher than the low level being experienced. Now, how would that cause shortness of breath?  Before there can be shortness of breath the hempdynamic system needs to be compromised...What mechanism or etiogenical significance is being relied on to produce SOB with a normal generated pulse from a pacemaker?  If mother's pulse wasn't normal, then there could be pacemaker problem.  




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976897_tn?1379171202
No but this as usual has been blown all out of proportion by Jon. I post something and it always has to end up as a problem and be debated. We are entitled to our opinions. Having worked in the electonics industry for 20 years making patient monitoring equipment, I am very aware of electronic faults which develop. Each individual component can fail at any time, and invariably does. I even used to witness defribillators exploding in the test department because the huge capacitors had a fault. You would be surprised at the problems that have to be overcome. Now, back to the original post. I suggested having the pacemaker checked because this is a logical common sense thing to do. Why try different drugs etc, when all the time it's a simple reprogramming task. Like I said before, there is no harm in checking to be SAFE.
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976897_tn?1379171202
Oh and before Jon questions me regarding the electronics company, It was a subsiduary of Roche. The actual name was Kontron Instruments and we had companies based all over Europe as well as the UK. Patient heart monitoring/defibs were the main products made in the UK along with accessories such as balloons etc. I left the company in 1999 and I believe it went into liquidation soon after due to high competition from HP.
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367994_tn?1304957193
QUOTE:
"My Mother had a 2 lead pacemaker placed in one month ago and is experiencing shortness of breath with mild activity.  She is currently on Metoprolol (Lopresser) 50 mg BID (recently changed due to simular symptoms from another simular cardiac med).  Prior to the pacemaker placement the only symptom she had was tiredness with a heat rate of 30 (amazingly no SOB or dizziness, but did see her physcian for right shoulder pain);  this is when it was discovered that she had a heartrate in the 30's. She was then sent to the hopspital and pacemaker was placed in the next day.
My Mother wants to wait and see if her current symptom of SOB subsides after the recent change in her med to Lopresser.  I think she should see her Dr. right away with these symptoms.  What would you advise".
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I understand what you had in mind, but if you analyze the original post it states a slow regular beat (30 bpm) and tiredness (the only symptom) and that symptom would be the result of the <bpm.

For a slow regular heart rate, the appropriate unit to install would be an asynchronous pacemaker that fires at a fixed rate regardless of the heart's ability to generate impulses (it replaces the heart's natural pacemaker (sinus node).  It is a relatively simple device when compared to the demand pacemaker that sense's the heart's own electrical activity and delievers beats when need. This type of pacemaker has stimulating and sensitivity threshholds and should be checked daily if in the demand mode.  This is unnecessary with asynchronous mode!

If the asynchronous pacemaker was malfunctioning, a slow pulse would easily be detected by taking one's own pulse and the tiredness symptom would still be present.  But the symptom is now SOB?!  So my question was/is how does an asynchronous pacemaker malfunction go undetected by the patient, and what is the mechanism (pathologically) where a slow heart rate compromises hemodynamically the circulatory system enough to cause SOB?

SOB is known side effect of the medication taken by OP's mother,  and I don't see any
causal connection to a pacemaker whether it is the demand type or the simple pacemaker as a cause for shortness of breath!  I also have electronic experience and some knowledge as well, but that is irrelevant as I don't see any malfunction that would cause SOB.

For awhile I was a computer specialist in a manufacturing environment, I would ask you to relate to the quality control procedures with the company you were associated.  Computer systems are put into a burnin phase prior to shipment, it is a well known fact that electronic components fail within a few days and after that are very reliable, and I would expect no less for manufacturers of a device that has a burden to cause no physical harm.  Also, there are very tight random sampling of any mass produced components, and I doubt very much if quality control passes any batch that has a 2% probability of failure, however, there are runs that may have missed something.  The manu. isn't aware until there are a number of unusual failures cited, the manu. will then go back and correct a problem, if known, and possibly recall the batch associated with the failed devices....it happens with almost all manufactured goods.  
etermine
random samples
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367994_tn?1304957193
Sorry, I just reread your orginal answer and you indicate a possible programming problem.  I believe it is the damand type that requires sensing and pacing parameters for irregular heartbeats and daily monitoring.  The asynchronous pacemaker is adjusted to the EKG, and the patient would know if there is rate problem and almost always no problem unless there is a malfunction!
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