Complications, Possible Pacemaker, Extended Stay

[WATD]

I'm the spouse of a recent aortic valve replacement and aortic root anuerysm surgery. So recent, in fact, that we're still in the hospital. The patient - incredibly healthy, elite athlete throughout lifetime, 42 years old. Just recently found out about BAV disease by way of strange circumstances that are too lengthy to list. Needless to say - it's all been a huge shock. He chose a mechanical valve and surgery went well, or seemingly so. But after a rough bout with afib and ameodarone treatment, it appeared he went into heart block. Doctors weren't certain if heart block was due to ameo, or due to surgery. And so, because of his age and other lifestyle factors (he's an avid weightlifter), they have taken great care to take time to observe his heart's conduction system post surgery. We've been here for nearly 2 weeks. We're told tomorrow we should have a decision about a permanent pacemaker. It's been a rollercoaster and we know the time spent observing has been taken to try to do what's in his best interest. We're in a place of acceptance for whatever way this goes, but still holding out hope. Any younger pacemaker patients who can share experiences - very much interested. In fact, any and all experience welcome, regardless of age. If anyone is a weightlifter and has a pacemaker, what have been your limitations and what has been your experience?

BTW- this site is amazing. I've read so many of the posts to my husband. He's not much for forums, but the information and shared experiences have helped both of us so much throughout this process.

 

[epstns]

I had all sorts of rate and rhythm issues post-op for implantation of a tissue aortic valve. Prior to surgery, I had brady/tachycardia -- my resting heart rate was quite low (mid-to high 40's), but under exercise load (runner), it would go up to near 170. At the time of valve implant, I was 63. Years before that, I had done lighter weights (less than body weight), but as my valve worsened, my cardio warned me off the moderate weights and told me to lift light weights at high reps.

Immediately after surgery, my heart tried any and every sort of rate and rhythm anyone could think of -- bradycardia (slow), tachycardia (fast), atrial fibrillation, and even looong pauses between beats (many times up to 20 seconds between beats). They tried amioderone and various other meds to no avail. Finally after 5 wild days of this, they said ". . . we may need to implant a pacemaker. What do you think about that?" My answer was "What are you waiting for?" I now have a Boston Scientific pacemaker, which is now 3 years old.

I have found that the pacemaker manages fairly well to adjust to most exercise and athletic activity. I've had problems with 2 activities. First, I'll mention mountain biking (yeah, I know I'm 66 now, but I don't feel that old). When sprinting up a steep hill, I quickly out-distanced my pacemaker's rate response and had to get off and walk the bike up to the crest of the hill. I couldn't catch my breath, as the pacer did not raise my heart rate enough to compensate for the workload. Finished the rest of the ride with the younger folks, but on that one hill, once I got ahead of the pacer, there was no catching up.

The other activity where I have to be careful is lifting heavier than "light" weights. I don't lift in the gym any more, but for example, if I am unloading bags of rock from our truck, it is a lot like lifting weights. I find that when I do "high-dynamic" activities like intermittent heavy weight lifting, my pacemaker cannot sense anything to make my heart rate elevate. My particular pacemaker raises my heart rate in response to either body motion (running, walking, etc.) or breathing rate (bicycle on smooth road, etc.). Unless my lifting causes me to breathe faster, there is nothing to raise my heart rate, and I quickly go into "oxygen starvation" and feel bad. I recover quickly, but I think it would keep me out of the weight room at the gym.

That said, I would NOT allow a passion for lifting to cause your husband to decline a permanent pacemaker. I would, however, advise him to speak openly with the doctors about his favorite activities and ask their input as to which pacemaker would be best for him. It is entirely possible that there are devices that are better for lifters than the one I have. I discussed endurance and cardio gym activities with my docs, and they used that discussion along with my need for a small device (I'm a smaller guy) to help select the best device.

I hope I'm not putting too much of a damper on your husband's dreams of his future, but it is probably better that he have an idea of what he may be up against so that he can properly discuss and plan with his doctors.

 

[ottagal]

I had all sorts of rate and rhythm issues post-op for implantation of a tissue aortic valve. Prior to surgery, I had brady/tachycardia -- my resting heart rate was quite low (mid-to high 40's), but under exercise load (runner), it would go up to near 170. At the time of valve implant, I was 63. Years before that, I had done lighter weights (less than body weight), but as my valve worsened, my cardio warned me off the moderate weights and told me to lift light weights at high reps.

Immediately after surgery, my heart tried any and every sort of rate and rhythm anyone could think of -- bradycardia (slow), tachycardia (fast), atrial fibrillation, and even looong pauses between beats (many times up to 20 seconds between beats). They tried amioderone and various other meds to no avail. Finally after 5 wild days of this, they said ". . . we may need to implant a pacemaker. What do you think about that?" My answer was "What are you waiting for?" I now have a Boston Scientific pacemaker, which is now 3 years old.

I have found that the pacemaker manages fairly well to adjust to most exercise and athletic activity. I've had problems with 2 activities. First, I'll mention mountain biking (yeah, I know I'm 66 now, but I don't feel that old). When sprinting up a steep hill, I quickly out-distanced my pacemaker's rate response and had to get off and walk the bike up to the crest of the hill. I couldn't catch my breath, as the pacer did not raise my heart rate enough to compensate for the workload. Finished the rest of the ride with the younger folks, but on that one hill, once I got ahead of the pacer, there was no catching up.

The other activity where I have to be careful is lifting heavier than "light" weights. I don't lift in the gym any more, but for example, if I am unloading bags of rock from our truck, it is a lot like lifting weights. I find that when I do "high-dynamic" activities like intermittent heavy weight lifting, my pacemaker cannot sense anything to make my heart rate elevate. My particular pacemaker raises my heart rate in response to either body motion (running, walking, etc.) or breathing rate (bicycle on smooth road, etc.). Unless my lifting causes me to breathe faster, there is nothing to raise my heart rate, and I quickly go into "oxygen starvation" and feel bad. I recover quickly, but I think it would keep me out of the weight room at the gym.

That said, I would NOT allow a passion for lifting to cause your husband to decline a permanent pacemaker. I would, however, advise him to speak openly with the doctors about his favorite activities and ask their input as to which pacemaker would be best for him. It is entirely possible that there are devices that are better for lifters than the one I have. I discussed endurance and cardio gym activities with my docs, and they used that discussion along with my need for a small device (I'm a smaller guy) to help select the best device.

I hope I'm not putting too much of a damper on your husband's dreams of his future, but it is probably better that he have an idea of what he may be up against so that he can properly discuss and plan with his doctors.

Steve is able to speak from personal experience and has provided you with some excellent advice and insight. I just wanted to add that I am thinking of you and your husband and hope that he is able to resolve the post-op issues and make peace with his decisions.
All the very best,

 

[WATD]

Thanks so much. We're still in waiting mode. They put a temporary pacer on him for last 5 days. He hasn't used it - but they paced it at 30. He feels a bit like he's in a fishbowl, but they (the electrophysiologists) are spending a lot of time looking at his rhythms. We are prepared to have the surgery, but, they are suggesting he may not need it. It seems his pauses are for less than 3 seconds and that is not indicative of need for a permanent pacemaker, right now. We shall see. It seems they are going to interrogate the temporary pacer he has and see what they can learn outside of what they've been studying from monitor strips, and then make a final, final decision - at least for today. This is the third time we've been NPO as they make assessments day by day. Either way, we'll be following up with electrophysiologists for quite some time, and if he doesn't need one now, he may very well need one in the future as he gets older, if the conduction system deteriorates. Your feedback is so very helpful. We can learn so much from research AND experience.

 

[WATD]

And I say "we" as if I am the patient. It's all his body - I'm just along for the ride, every step of the way.

 

[Paleowoman]

The other activity where I have to be careful is lifting heavier than "light" weights. I don't lift in the gym any more, but for example, if I am unloading bags of rock from our truck, it is a lot like lifting weights. I find that when I do "high-dynamic" activities like intermittent heavy weight lifting, my pacemaker cannot sense anything to make my heart rate elevate. My particular pacemaker raises my heart rate in response to either body motion (running, walking, etc.) or breathing rate (bicycle on smooth road, etc.). Unless my lifting causes me to breathe faster, there is nothing to raise my heart rate, and I quickly go into "oxygen starvation" and feel bad. I recover quickly, but I think it would keep me out of the weight room at the gym.

With the weight lifting I do (SuperSlow) you purposefully do fast breathing like panting. If you watch some guys lifting really heavy weights SuperSlow they pant very fast straight away ( http://www.youtube.com/watch?v=efTXh5OQg5U ). Could you make the pacemaker respond by doing fast breathing on purpose like that ? Sorry, I don't have a pacemaker but I picked up on that aspect of the post.

 

[epstns]

Anne - Maybe SuperSlow would get it pumping, but I'm a bit reluctant to do heavier than I now do, just in case there is any weakness of my aorta. (Don't forget that I had a BAV, and no aortic repairs at valve time.)

Maybe I'll remember to try it the next time I'm unloading the truck or mountain biking.:biggrin2:

 

[bluefields409]

Although so many get through surgery and deal with the "bumps" as necessary, not everyone's journey is straightforward. Thinking about you and your loved one as you are dealing with everything and may you be comforted. encouraged and strengthened by those close and far and the myriad of dedicated medical professionals .

Helen