dizziness and fatigue

I am a 28 year old with an AAIR pacemaker implanted for three sinus node ablations for IST that left me with a junctional rhythm.Pacemaker has been functioning very well and have been feeling great since it was implanted in Nov. 2004.Over the passt 3-4 weeks I have had a lot of fatigue, weakness and a lot of lightheadedness.I occasionally feel short of breath at times.My cardiologist checked the pacemaker and said everything was functioning fine and also check an echo(was normal) and all basic labwork(all normal).My pacemaker check did reveal that my heart rate was not getting past 90, so they made some adjustments to the rate respone feature.I am very, very active and run and do cardiovascular exercise 3-5 times/week for an hour.I am just very, very exhausted now and feel so much different than I did.BP's have been normal.I feel absolutley wiped out after my workouts now, instead of good after them like I used to.I am going to a pulmonary dr. to rule anything with my lungs out.Cardiologist thought maybe my BP was low.  Checked it at home and readings were lying-109/69, hr-79, sitting 117/75, hr-75, standing 134/78, hr-74.Shouldn't my HR go up as I stand up?Do you think this is pacemaker related?  Should I have them try to reprogram my pacemaker on a treadmill or check it further?  Does this sound like a pacemaker syndrome, or would that show up on an EKG?Cardiologist had me increase my salt intake with thought that BP was low, but it appears normal?Should I just ignore my symptoms and move on?I feel bad to keep pestering my dr.No other medical problems in my history.Thanks

[CCF-M.D.-MJM]

Hello KAD,

This can be a very difficult problem.  IST has a lot of overlap with several other medical conditions like postural orthostatic hypotension (POTS) and fibromyalgia type syndromes.  These are conditions that we as physician don't understand and have grave difficult treating.  Patients feel very bad and we can't tell them why or fix.  It is frustrating for both parties.

Shouldn't my HR go up as I stand up?

There is usually a slight increase in heart when people stand, but I don't think this can account for your symptoms.

Do you think this is pacemaker related?

It could be.  It depends on what you heart rate increases to with exercise.  Twenty eight year olds should be able to increase their heart rate to 180 with significant work loads.  If your pacemaker sensor is set too low, it may account for this.  This is the first thing an EP doc. would check.  An exercise stress test would answer this questions easily.

Does this sound like a pacemaker syndrome, or would that show up on an EKG?

Pacemaker syndromes occur with ventricular pacing, not atrial pacing. I do not think this is a pacemaker syndrome.

Cardiologist had me increase my salt intake with thought that BP was low, but it appears normal.  Should I just ignore my symptoms and move on?

I would do the exercise stress test first.  If it is revealing your problem is solved.  If the pacemaker is working, I do not think this is a heart related problem but may be in the spectrum of IST related illnesses.  I don't want to say your shoud ignore symptoms, but if you have several doctors that say they can find nothing wrong, it might be the best thing to do.  Is there a chance something is being overlooked -- yes.  But there is much greater chance that nothing is wrong and I have seen problems like this drive people crazy.

I hope this helps and thanks for posting.  Good luck.

[KAD]

Pulmonary evalution was normal.  CXR, pulse ox and incentive spirometry all normal.  I forgot to mention that my hands and feet are always very cold to the touch.  Thanks for your time.

[madgeOwens]

I was driving down a very busy highway this afternoon when I got so dizzy that my eyes were jerking back and forth and my head began to feel like an anvil it was getting that heavy. I pulled off the road and waited for about 5 minutes before feeling I could drive again.
I am being treated with the equivalent to Inderol xl, I cant think of its name now.  
Also my ears have been bothering me and so I thought I may have a middle ear thing. I was wondering if anyone gets this dizzy from these meds?  Also my neck is stiff and I am worried about that connection. Geeze I sound like a hipochondriac....any input out there?

[upbeat63]

middle ear infections, or debris in your semi-circular canals can definitely cause dizziness like you described, and if your balance is thrown off because of it, your neck muscles might tighten in response (as in, your body ((head)) can't figure out where you are in space, upright or not, therefore your neck muscles might go into spasm). Just a thought, you should talk with your doctor and get examined. BB can cause dizziness, but I think it is in the beginning when you are first trying to get used to a new medication and the side effect should wear off over time. Did you increase the dose of BBs?

By the way, how have the PVCs been? I hope the fatigue and sob are better too.

[madgeOwens]

Hi. Yes I have been really good, thanks.  I was to see the doctor, and should have saved the money for all the good she was.  I am on Innopran XL 80 mg(Inderol)...I still get break through pvc occasionally, but they don't cause the symptoms so far, that I was having before.  I think too that its my ears, today they were whistling like an old radiator, it was driving me crazy...it quit after about half an hour  thank God. They gave me some dumb exercises to do for my balance.....like throw a ball under your knees.......yeah ok.....Im  thinking I couldnt do that EVER haha....or walk up an incline with my eyes closed hahaha I guess they want me to break a hip next........oh well....nice to hear from you.....take care

[ladyann1]

I'm on atenolol and have been for a month. I still have lightheadedness/dizzy and the feeling that my feet are cold. I also have trouble with blurred vision or at least thinking it isn't doing what it should. I also feel a bit shaky from time to time. I don't know what the heck it is. I take a very low dose of Atenolol and wish I could stop it all together as my border line hypertension at times isn't that bad but the PVC's are better since I went on it. I am so tired all the time, no energy. I wonder how long these symptoms last when you start on atenolol. Does anyone else have anything simular.