Question about Pacer checks and pain

  1. As you all know, I'm a tele nurse. I don't claim to know everything, and I don't know much about pacers.

    So I have a question for any of you who do pacemaker checks.

    Or any of you who might know the answer.

    My husband's mom called me this afternoon. She had a pacer put in last year. She went for her pacer checkup today. She states that she noticed a few palpitations while she was having it checked, but that the nurse said that she might feel something, and that would be normal. Her pacer check was normal.

    Driving home, she noticed a squeezing, intermittant pain under her left posterior scapula that radiated around to the left rib and up under the shoulder blade.

    When I asked her to describe the pain, she would say "now" every time she had it. It appeared she was having brief pains lasting about a second apiece as often as 50 times a minute. She insisted that the pain was not constant, and that she could move her arm and breathe without increasing the intensity of the pain.

    She said that after she got home, she realized that the pains started while she was having the pacer check.

    So I had her take an aspirin, a nitro (which did no good), and a couple of tylenol. She called the doc's office back but the staff left for the day. I told her to go to the ER and she refused.

    (How did I know THAT would happen. :stone )


    So she just called me back and told me she's still having the pains. I almost hung up on her, I was so ticked off that she wouldn't go to the ER. Because of course, all this stuff makes me nervous and I'm too far away to go babysit her.

    Now my question is: vasospasm or muscle spasm? heart or something else?
    Any ideas on how to convince her to call 911 and get her butt to the ER tonight? She's very sweet but very stubborn. This is horribly frustrating for me of course, but only because I'm worried about her. Oh, and she says she hadn't eaten anything since an early breakfast before she went to her late afternoon appointment.

    Then she told me she was going to order Chinese!

    I think I'll go back to bed with an ice pack and some Valium.....
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  2. 2 Comments

  3. by   begalli
    Angie,

    The only way to know vasospasm or muscle spasm is going to the ED.

    I wonder if her pacer is also an AICD (is it firing?)? I don't know much about interrogation of pacers but maybe something triggered some ventricular irritability leading to some ectopy that's possibly causing her some ischemia/pain?

    Did the nurse tell her that she would "feel something" even when the check-up was over and she was home? Poor teaching on that nurses part if she didn't address this.

    We all know that cardiac problems can present atypically, especially in older women.

    Maybe your husband can convince her to go? Remind her that when someone walks into the ED with chest pain, they go back right away. They don't sit around in the waiting room. She's sounds like she's in denial.

    Be blunt. Remind her that pain equals tissue damage. The tissue that's possibly being damaged here is her heart. Tissue damage in the heart is frequently incompatible with life.
    Last edit by begalli on Mar 7, '05
  4. by   Pill Hoarding Hussy
    Quote from Angie O'Plasty, RN
    As you all know, I'm a tele nurse. I don't claim to know everything, and I don't know much about pacers.

    So I have a question for any of you who do pacemaker checks.

    Or any of you who might know the answer.

    My husband's mom called me this afternoon. She had a pacer put in last year. She went for her pacer checkup today. She states that she noticed a few palpitations while she was having it checked, but that the nurse said that she might feel something, and that would be normal. Her pacer check was normal.

    Driving home, she noticed a squeezing, intermittant pain under her left posterior scapula that radiated around to the left rib and up under the shoulder blade.

    When I asked her to describe the pain, she would say "now" every time she had it. It appeared she was having brief pains lasting about a second apiece as often as 50 times a minute. She insisted that the pain was not constant, and that she could move her arm and breathe without increasing the intensity of the pain.

    She said that after she got home, she realized that the pains started while she was having the pacer check.

    So I had her take an aspirin, a nitro (which did no good), and a couple of tylenol. She called the doc's office back but the staff left for the day. I told her to go to the ER and she refused.

    (How did I know THAT would happen. :stone )


    So she just called me back and told me she's still having the pains. I almost hung up on her, I was so ticked off that she wouldn't go to the ER. Because of course, all this stuff makes me nervous and I'm too far away to go babysit her.

    Now my question is: vasospasm or muscle spasm? heart or something else?
    Any ideas on how to convince her to call 911 and get her butt to the ER tonight? She's very sweet but very stubborn. This is horribly frustrating for me of course, but only because I'm worried about her. Oh, and she says she hadn't eaten anything since an early breakfast before she went to her late afternoon appointment.

    Then she told me she was going to order Chinese!

    I think I'll go back to bed with an ice pack and some Valium.....

    totally a valium-worthy situation. the only ones worse about not seeking med attention than our famiy members are nurses! i wonder if she ate something would she feel better? a year is well beyond the healing time so that probably rules out lead migration and shocking of muscle tissue. vasospasm? maybe. muscle pain? maybe. does she have the pgr # of the md who placed the device? or could she call the hospital and talk to the on call ep fellow? it is hard to say what's up when cards pts have vague symptoms. i think that if there is any question though, she should be evaluated by a cardiologist. esp.since the pains started during the pcm interrogation.

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