Pacemaker
My Heart Works at 20%. Here’s What Waiting for a Pacemaker Feels Like.
Notes from the in-between: after the diagnosis, before the device
I wake up most mornings with the same question in my head: Am I going to die today?
It isn’t dramatic. It’s quiet. It sits next to me while I make coffee. I wake up already tired, the way most people feel at the end of a long day. Then I get up anyway, because that’s what you do.
I’m writing this because I’m in the middle of something. My doctor told me I need a pacemaker. I don’t have a date yet, but it’s going to happen. When I went looking for stories from people in my situation, I found plenty of medical pages and very few honest accounts of what the waiting feels like. So here’s mine.
The number I didn’t know I should care about
Until recently, I had no idea what “EF” meant.
EF stands for ejection fraction. It’s the percentage of blood your heart’s main pumping chamber pushes out with each beat. A healthy heart usually sits somewhere around 55–70%. Below 40% means the heart is struggling. Below 35% is when doctors start talking about devices.
Mine was 20%…
The part that still stings is that this wasn’t new. I’ve had bypass surgery and an angiogram. My EF has been low since 2020. In 2024, a test showed it had dropped to 20%, and somehow we skipped right past it. It seemed unimportant. Nobody raised an alarm, including me.
I’m not writing this to blame anyone. I’m writing it because I suspect I’m not the only one. If you’ve had heart surgery, if you get tired easily, if you have a report with “EF” on it, ask what your number is and what it means. Ask again if the answer is vague. That one number turned out to explain years of how I’d been feeling.
What 20% feels like
People picture heart trouble as chest pain and a sudden collapse. For me it has mostly been exhaustion.
I get tired very fast. Things that used to be automatic, like walking somewhere, carrying groceries, or climbing stairs, now take planning. I measure my energy like money in a wallet and decide what’s worth spending it on.
The physical part is only half of it. The other half is mental. When your heart isn’t working well, every flutter, every breathless moment, every unusually heavy morning feels like a warning. You start listening to your own body like a nervous stranger.
And some days I feel completely alone in it. It’s not that people don’t care. It’s that nobody else can feel what’s happening inside your chest. You can explain it, and they can nod, but at 3 a.m. it’s just you and your heartbeat.
If you’re reading this from that same place: I see you. That feeling is real, and it’s common in people with heart failure. It’s worth telling your doctor about, the same way you’d mention a symptom.
Medication helped more than I expected
Here’s the hopeful part, and I want to say it clearly: my EF went from 20% to 30% with medication.
Ten points may not sound like much, but for a heart like mine it means a lot. Modern heart failure medicines can genuinely help the heart muscle recover some of its function, or at least protect what’s left. It took patience and consistency, which meant taking the pills every day, even on days when I felt fine and on days when I felt they weren’t doing anything.
If you’ve just been diagnosed with a low EF, don’t assume your number is fixed forever. Ask your cardiologist about your medication plan and stick to it.
So why the device?
Even at 30%, my heart is still well below normal. When the heart is this weak, two risks matter most: it can beat too slowly or out of sync, and it can fall into a dangerous rhythm.
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For people with a low EF, doctors often recommend one of these:
- A pacemaker, which keeps the heart from beating too slowly.
- An ICD (implantable cardioverter-defibrillator), which watches for dangerous rhythms and can deliver a shock to reset the heart.
- A CRT device, which coordinates the left and right sides of the heart so they pump together more efficiently. Some CRT devices also include a defibrillator.
I don’t know yet exactly which one I’m getting. That’s on my list of questions for my next appointment, and I’ll update this post when I know. What I do know is this: the device is not a sign that things are hopeless. It’s a safety net. It’s something that will watch my heart while I sleep, so maybe I’ll stop waking up afraid.
My list of questions (feel free to steal it)
If you’re waiting for a device too, here’s what I’m planning to ask:
- Which type of device am I getting, and why that one?
- How long is the procedure, and will I be awake?
- How many nights will I stay in hospital?
- What can’t I do with my arm, and for how long?
- When can I drive, shower, and go back to work?
- Will phones, headphones, or airport security affect it?
- How is the device checked, and can it be monitored remotely?
- Is cardiac rehabilitation an option for me?
- Who can I call if I feel anxious or something feels wrong?
What I’d tell someone one step behind me
Know your numbers. Your EF, your medications, your diagnosis. Write them down.
Don’t ignore “unimportant” results. If something on a report sounds off, ask about it. I wish I had in 2024.
Take the meds. They moved my heart from 20% to 30%. That’s not nothing.
Say the scary part out loud. Tell your doctor, a friend, or anyone. Fear grows when it stays quiet.
You’re not as alone as it feels. Thousands of people are living full lives with these devices. I plan to be one of them.
What comes next
I’m waiting for a date. When it comes, I’ll write about the procedure, the recovery, and what life looks like with a small piece of technology keeping watch over my heart.
Until then, I’m still here: tired, sometimes scared, but here. And every morning I get up anyway.
If you’re going through something similar, leave a comment. I’d really like to hear your story. Maybe we can feel a little less alone together.
I’m not a doctor, and this is my personal experience. Every heart is different. Please talk to your own cardiologist about your situation.
