First of all you need a cardiac work up checking for coronary artery disease; this work-up consists of ECG and Echocardiography tests, like stress ECG and stress Echo.
So first, you need a cardiac work-up; the type of pain you describe can also be generated by other organs like gastric inflammation or spinal causes.
This sound like a venous obstruction of the vena cava superior as a response to pacemaker lead implantation. This is a significant and difficult situation as far as vena cava is affected and not only peripheral veins. Two things have to be discussed: Either wait and watch hoping that collateral pathways are formed over time; in case of high degree stenosis of the vena cava, lead explantation migth be an option. You need a trained EP and device specialist to discuss thise traetment modalities.
Bisoprolol is a beta blocker used to treat fast heart rythms. You would need further investigations with 24 hour heart rythm monitoring to diagnose your rythm abnormality.
From what you describe it is possible that you are experiencing ventricular ectopic beats (extra beats originating from lower chambers of the heart) or your heart rates are on the slower side. However definitive diagnosis can only be made by reviewing the holter monitor recordings.
You need further investigations with exercise testing and echocardiogram in the first instance. If your symptoms are very infrequent but distressing you could discuss with your cardiologist about implantable loop recorder implantation. This device would aid in the diagnosis of your heart rythm abnormality.
Your doctor would carry out a detailed history taking followed by clinical examination. You will need further investigations such as EKG/ Holter monitoring/ Echocardiogram etc. You would also need some blood tests.
You are probably implanted with a rate responsive pacemaker because both your minimum and maximum heart rates are paced rhythms. Discuss with your cardiologist about decreasing rate responsiveness of the pacemaker.
Atrial fibrillation ablation is a complex procedure. It carries a 1-3% risk of cardiac complications such as cardiac perforation/ stroke/ bleeding/ heart attack and extremely rarely (probably less than 1 in 1000) risk of death.
You need some urgent investigations with ECG/echocardiogram (ultrasound scan of the heart) and coronary angiogram (although other causes such as cervical spine disease need to be ruled out).
Your father needs thorough clinical evaluation. His symptoms are unlikely to be due to pulmonary embolism. His symptoms are likely to be due to partial venous obstruction.
This is not a life threatening condition. Venous congestion can be relieved by venoplasty if deemed necessary.
Dr. Andrea Natale
Dr. Andrea Natale is a board certified electrophysiology expert and practices at executive medical director of the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, Texas. Dr. Natale also is the Senior Medical Director at Pacific Atrial Fib and Arrhythmia Center in San Francisco. He visits MetroHealth in Cleveland, and Akron General, Ohio. He has pioneered a new circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world's first five patients. For further details Please visit :Link
Dr. Dhanunjaya Lakkireddy
Dr. Dhanunjaya Lakkireddy, MD, F.A.C.C, FHRS. is a board certified electrophysiology expert and practices at Mid-America Cardiology and The University of Kansas Hospital Clinics in Kansas City, KS, USA. He has several distinctions in clinical and research career to his credit and serves as an associate editor for Journal of Atrial Fibrillation.For further details Please visit :Link
Dr. Dhanunjay Lakkireddy, MD, F.A.C.C, FHRS, The Kansas City Heart Rhythm Institute (KCHRI), KS, USA.
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