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What Do Shortness Of Breath And Excessive Sweating After Pacemaker Placement Indicate?

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Posted on Wed, 1 Feb 2017
Question: My husband is 66 and recently had replacement pacemaker. He has heart failure and has had 3 heart attacks. He seems to carry fluid around his heart and the lower chamber of his heart doesn't function well.

He is falling asleep all the time during the day and we have a business to run. He also often has shortness of breathe and is very sweaty.

He has been to see his gp who is trying to help him shift the fluid.

His blood pressure is uncontrolled even though on medication. can get to 220-120 but mostly around 170/110.

The replacement pacemaker has made very little change to his health. before the change he couldn't walk far and felt unwell and I don't feel there has been much change at all.

don't know where to go from here. He did get an infection and is on anti biotics also.
doctor
Answered by Dr. Rishu Saxena (33 minutes later)
Brief Answer:
All symptoms are due to congestive cardiac failure!

Detailed Answer:
Hi ,
Firstly thanks for choosing health care magic for your query!
Have noted all your details,Your husband is having Congestive cardiac failure,As a result of three myocardial infarction a large part of his heart is not functioning properly.
The role of heart is to pump purified blood recieved from lungs to various parts of the body,but due to ischemia and degeneration of cardiac muscles,The pumping function of the heart are greatly reduced and blood starts to flow back and accumulate in lungs and other spaces of the body like ankles ,pleura etc.As blood supply to various organs is curtailed Fatigue,letharg,Malaise,drowsiness,sleepiness appears.
Shotness of breath is also because of accumlation of fluid in lungs due to back flow from heart.As space to be occupied by air is taken by regurgitant fluid breathlessness occurs.

Under normal circumstances, the treatment of congestive heart failure includes medicine to strengthen the heartbeat, diuretic therapy to reduce fluid volume, and the use of a variety of other medicines to enhance heart function.Medical therapy with cardioselective beta blockers like carvedilol and bisoprolol allong with ace inhibitor ,nitrates and diuretics are usually very effective .However,In some of these patients even this is not enough.

If significant electrical system disease like left bundle branch block or a conduction delay in heart is observed pacemaker therapy seems to be quite useful,Pacemaker will prevent sudden cardiac arrest due to any arryhtmia arising as a result of congestive cardiac failure,though some trial shows that it improves cardiac function in long term,Yet results vary from one person to other.Main function of pacemaker is to prevent cardiac arrest from arrythmia.Please mention if your husband has biventricular or univentricular pacemaker(attach reports).

Your patient is having severe hypertension ,Blood pressure control is must for improvement of cardiac functions!
Kindly attach copies of his 2d echo and treatment which he is taking ,so that suggestion can be given in regards to medicines.

Infection would be treated by antibiotics TLC and DLC should be done on daily basis to monitor infection.

Please attach detailed copies of all his treatment papers,Medications and investigations!
Waiting!

Thanks
Dr Rishu Saxena

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Rishu Saxena (1 hour later)
Thank you doctor
Below is a list of medications. .
I do not have the echo as the specialist has this.
My husbandhas been on blood pressure tablets for 30 years but it has always remained uncontrolled.
He had arrhythmia for years without detection and finally had renal nerve ablation and also somethinhnon the heart. I believe the pacemaker has fully taken over the heartbeat
Zircol
Zanadip
Spiractin
Candestarten
Physiotens
Frusemide
Atacand

Also my husband has pacemaker with 3 leads .
doctor
Answered by Dr. Rishu Saxena (28 minutes later)
Brief Answer:
Detalis below!

Detailed Answer:
Hi again,
2d echo reports are very important when we are dealing with a patient of congestive cardiac failure,However i can give suggestions on the basis of medications you have written down(again have not mentioned the doses).

A nitrate should be added to his regimn-
Nitrates dilate veins throughout the body so that they can hold more blood. This reduces the amount of blood going back to the heart, reducing the heart's workload.They are very strong venodialtor and can be used in resistant hypertyension to relieve the symptoms of congestive cardiac failure.
Long acting nitates like isosorbide mononitrate should be added in high dose 60mg every day.
This can be very helpful in lowering his blood pressure and relieving his symptoms.

Trimetazidine -Trimetazidine should be added in doses of 35mg twice daily.It is a cytoprotective anti-ischemic agent.
Trials done by NCBI shows- "short-term TMZ improved left ventricular systolic function and functional capacity despite no change in myocardial perfusion. These benefits were more evident in patients with more severe perfusion defects on initial evaluation.",Ask your cardiologiost to add trimetazidine in above mentioned doses.

Thirdly your husband is not prescribed any betablockers by your cardiologist, After 3 myocardial infarctions ,Beta blockers are a must and should be administered.Cardioselective betablockers like Metoprolol,Carvedilol,or bisoprolol should be added in optimal dosage.

Zircol and zinadip are both same salt calcium channel blockers,though they are used to treat hypertension,but they don't improve cardiac functions significantly.Ask your doctor to start high doses of betablockers and stop calcium channel blockers if required.

Thank you!
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Rishu Saxena (55 minutes later)
Doctor I am very appreciative of your advice.
Thank you sincerely.
Kind Regards
XXXX
doctor
Answered by Dr. Rishu Saxena (2 minutes later)
Brief Answer:
Welcome!

Detailed Answer:
Your welcome!
Please do write a review.
Wish your husband a very happy recovery.

Regards,
Dr Rishu
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
Answered by
Dr.
Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

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What Do Shortness Of Breath And Excessive Sweating After Pacemaker Placement Indicate?

Brief Answer: All symptoms are due to congestive cardiac failure! Detailed Answer: Hi , Firstly thanks for choosing health care magic for your query! Have noted all your details,Your husband is having Congestive cardiac failure,As a result of three myocardial infarction a large part of his heart is not functioning properly. The role of heart is to pump purified blood recieved from lungs to various parts of the body,but due to ischemia and degeneration of cardiac muscles,The pumping function of the heart are greatly reduced and blood starts to flow back and accumulate in lungs and other spaces of the body like ankles ,pleura etc.As blood supply to various organs is curtailed Fatigue,letharg,Malaise,drowsiness,sleepiness appears. Shotness of breath is also because of accumlation of fluid in lungs due to back flow from heart.As space to be occupied by air is taken by regurgitant fluid breathlessness occurs. Under normal circumstances, the treatment of congestive heart failure includes medicine to strengthen the heartbeat, diuretic therapy to reduce fluid volume, and the use of a variety of other medicines to enhance heart function.Medical therapy with cardioselective beta blockers like carvedilol and bisoprolol allong with ace inhibitor ,nitrates and diuretics are usually very effective .However,In some of these patients even this is not enough. If significant electrical system disease like left bundle branch block or a conduction delay in heart is observed pacemaker therapy seems to be quite useful,Pacemaker will prevent sudden cardiac arrest due to any arryhtmia arising as a result of congestive cardiac failure,though some trial shows that it improves cardiac function in long term,Yet results vary from one person to other.Main function of pacemaker is to prevent cardiac arrest from arrythmia.Please mention if your husband has biventricular or univentricular pacemaker(attach reports). Your patient is having severe hypertension ,Blood pressure control is must for improvement of cardiac functions! Kindly attach copies of his 2d echo and treatment which he is taking ,so that suggestion can be given in regards to medicines. Infection would be treated by antibiotics TLC and DLC should be done on daily basis to monitor infection. Please attach detailed copies of all his treatment papers,Medications and investigations! Waiting! Thanks Dr Rishu Saxena