problem with exercise tolerance

I am pacemaker dependent following successful AV node ablation for sick sinus syndrome.  Heart is structurally normal on echo but I am finding exercise increasingly difficult (central chest discomfort and breathlessness, particularly bad on stairs or walking up even moderate slopes, though I am told symptoms not typical of angina). Have also had pneumonectomy. I gather that exercise test cannot be done because of the pacemaker.  Do you have any suggestions?

[CCF-M.D.-RCJ]

irene,

Thanks for your question.

Your symptoms could be from many things but the three most likely are

(1) pacemaker syndrome -- a feeling of fatigue or light-headedness sometimes seen in patients with pacemakers

(2) Coronary artery disease -- patients often have shortness of breath as an "angina equivalent".  This can be tested with a pharmacologic stress test, heart catheterization, or by a pacemaker stress test where your heart rate is made to rise by adjusting the pacemaker settings.  An echo will not show coronary obstructions.

(3) Pulmonary insufficiency -- this could be tested by pulmonary function tests.

Certainly numerous other possibilities exist.  You need to see your doctor soon to be evaluated.

Hope that helps.