Chest discomfort - lack of oxygen?

[KissKiss]

This is my first posting. I've had a look through the other postings but can't find anything that exactly matches my query.

Background is that I'm a 44 year old woman. Was diagnosed with irregular heart beat and benign murmur when I was 12 (congenital). Nothing happened until symptoms (not quite syncope but something like long blinks) worsened. I was diagnosed with Mobitz Type II blockage several years ago with bradycardia. Eventually a dual chamber pacemaker was implanted in 2002. Several bouts of tachycardia resulted in me having an SV ablation in 2004 so now I've got complete heart block and am pacemaker dependant.

Even before the ablation I was experiencing difficulty running or going up stairs or sometimes even shallow gradients. My last pacemaker checkup showed further bouts of tachycardia at 180bpm sometimes for 1 min 40 seconds. Not a huge problem but very uncomfortable. So the pacing cardiologist lowered the upper level of the pacemaker to 130bpm.

To be on the safe side, I was sent for a myocardial perfusion test. Blood volume levels were fine - no sign of narrowing of arteries but I did experience problems on the treadmill - fatigue (expected) tightness in chest, chest discomfort, discomfort between shoulderblades. All of these were about 6 on a scale of 1-10. BP afterwards was 170/90 then 164/97 then went to 135/88.  I felt these symptoms for about 15 minutes after the test ended.

The cardiologist who gave me outline results of the perfusion test said he thought that it was a problem with oxygen levels and that maybe my heart couldn't pump enough oxygen to support the exercise I was doing. I'm about 25lbs overweight (have just lost 7 lbs but walking is causing problems) and just want to be able to get down to ideal weight with higher fitness levels (any kind of fitness level would do).

I might be being premature by raising the question here but I'd really like to be able to ask my cardiologist the right questions. I sometimes get overwhelmed when he starts trying to explain things to me and I don't take everything in or ask the right questions. I also feel that he trivialises it somewhat because my condition isn't as severe as others.

Do you have any idea what could alleviate my symptoms - raising the level of the pacemaker again (used to be 180)? But will this allow the bouts of tachycardia to persist?

Thanks for your help.

[KissKiss]

Thanks for the idea kitcurious - it wasn't dopey at all. My doctors have tested this several times and it's always come back as within "normal" range. Liver function, kidney and usual blood tests have come back within normal range too. Just have to get on with it, I guess. There are much worse situations to be in anyway. Thanks for your concern.

[KissKiss]

Thanks for the posting. I have a feeling the yawning is related to oxygen problems. Don't have it when I'm tense, more when I'm sedentary and not particularly stressed, happens more often in a small room. I  know the cause might be difficult to pinpoint because my symptoms and pathology are complicated but still gives me cause for concern. Thanks anyway. I think I'll try and get an earlier appointment with my cardiologist.

[kitcurious]

Have you had  your thyroid checked? Considering your heart issues this may sound like a dopey question ( and probably is) but the fatigue and cold when others are hot, are common hypothyroid symptoms.
Doesn't mean it IS because the two symptoms are non- specific
( meaning it happens with many conditions other than thyroid) but it's worth investigating if you haven't had a TSH test.

[Michael J. McWilliams, M.D.]

I will add that yawning is often a sign of being very "vagal" which sometimes correlates with anxiety.  I have seen this before, usual in very anxious people.  I am not calling you anxious because I don't have the information to do that, but if you think you are anxious, that might be an avenue to pursue.

[Michael J. McWilliams, M.D.]

If you increase the upper tracking rate, from you describe the tachycardia rate will increase.

It sounds like you were fatigued before and after the pacemaker --if this is the case, I doubt reprogramming the pacemaker will help.

I think the question you are asking is good, but I think it is too complicated for what I can answer on the internet without seeing records.  In general, if a problem has been going on for several years and you have been seen by several doctors, it is probably a difficult problem to diagnosis and fix.

I know this doesn't help much, but thanks for posting.  Good luck.

[KissKiss]

Just needed to add that I frequently feel cold when others are warm or comfortable and I yawn (a lot!).