Pacemaker?

I am scheduled for a dual chamber pacemaker Tuesday. I'm a little nervous...and I just haven't been able to comprehend that I actually need this! I was wondering if there is anyone out there that has experienced some of the same symptoms I have.

This is my story:
Two years ago I was feeling a little strange one night (it came on suddenly). I took my blood pressure and it was 52/36 and I thought "Wow, that is low."......then I woke up. My first thought was "gosh..I fainted." Then I noticed that I had thrown up too. I wasn't sick or anything. And I never felt it coming. I've fainted a few times in my life...but I could always tell when it was going to happen.

Now, I'm going to go back a to six months earlier. Six months before this happened I felt like I was going to pass out one night and when I looked in the mirror I was very very pale. I sat down and drank some orange juice and felt better in a little while. Two days later the same thing happened and I thought it might be low blood sugar, but I tested my blood sugar and it was normal. (I am not diabetic). I had an EKG done and it was normal. The next month my doctor did an EKG and said I had left bundle branch block.

Back to 6 months later: After I fainted I went to the emergency room and the doctor on call said I had had a seizure. I told him I didn't think that was it because I wasn't confused at all when I woke up. He sent me for tests and they were normal. I was then sent to a cardiologist. He did the tilt table test (normal)...a stress test (normal)...then implanted a loop recorder.

I went back every month for 10 months and there were no episodes. Then, at the 11 month check it showed 4 episodes all on the same day. The first one lasted 14 minutes and my heart rate was 158 bpm. The others were anywhere from 7 seconds to 45 seconds long. He said I should have felt them, but I never felt anything.

Now, for the past 8 months I have had several episodes every time, (except for one month - which was episode free!). They usually last a few seconds to a minute and a half. Mostly 154 bpm or 158 bpm. Twice it was 240 bpm and ONLY once it was 40 bpm.

I had an EKG that was normal....and the last one showed right bundle branch block. I am so confused with all this! My doctor insists that I need a pacemaker. He said he thinks my heart stopped when I fainted and that it could stop again and might not start back next time.. I am 55 years old and basically healthy.....



11 Comments

Don't let anyone push you

by golden_snitch - 2010-01-15 01:01:34

Totally agree with Tracey: one incident of a heart rate of 40 is absolutely no problem, especially not if it happened at night. If this was your average 24/7, this would be a different story. When I had my first holter done I was anywhere between 40bpm and 190bpm, and the doctor never mentioned needing a pacer, and the cardio I was referred to neither.

And then, there is not really a need to treat your fast episodes (is your doctor even sure those happened when you were at rest?), if you are not symptomatic at all. Supraventricular tachycardia - I suppose that's what those fast episodes are - is not life threatening, not dangerous. If people are not symptomatic, nothing needs to be done. If they are, then nowadays lots of cardios would say that an ablation should be tried and not meds. So, if there is no need for meds, then there is no need for a pacer, from your cardios perspective.

So again, please, please, please, don't let anyone push you - not your family and not your doctor. Get that second opinion. As Tracey said, so much time has passed that a few more weeks won't be a problem.

Best wishes
Inga

Wait till...

by golden_snitch - 2010-01-15 04:01:16

Hi there,

from everything you are writing here, I would say: don't get the implant done until the indication is clear and you have understood why you need the pacer. Sounds to me, again from what you are telling us, that chances are high that the pacer won't change anything and will not make you feel any better.

The pacer won't do anything about the fast rates, what could be done for those is either meds or an ablation if they really bother you. Have you been symptomatic or is this just what the loop recorder recorded?

The pacer indication is clear when a pause in your heart beat has been documented. If you read the guidelines about pacer implants, you'll see that there is not one sentence on implanting a pacer just because the doctor FEELS that what you experienced was a pause.

You should get a second opinion. I mean, it's your decision in the end, but if the indication for the pacer is neither documented nor you have understood it, then please don't let the doctor talk you into getting one.

Best wishes
Inga

puzzled

by dw5281 - 2010-01-15 04:01:38

I'm not going to pretend to be a fountain of knowledge about pacemakers but I am puzzled by your situation. I had a loop recorder implanted. I had it for about a year before anything happened - I blacked out & set it to record. It recorded a 26 sec pause hence the pacemaker. I was diagnosed with SSS. I dont understand how they can decide that you also have same/similar condition when if your loop recorder didnt record such an event?? I would definately ask more questions of your dr/cardiologist. I'm so very very glad for my pacemaker but its a big thing to happen to you & I think that you need to make sure that the decision is right for you - it all seems a bit vague for you at the moment. Whenever you think of something you want to ask write it down because its so easy to forget before an appointment. I really wish you lots & lots of luck

debs

second opinion

by Tracey_E - 2010-01-15 07:01:43

I'm with Inga, you need a second opinion. IF your heart is pausing, then yes you need one, but it sounds like tachycardia (fast rate) is your problem rather than a slow rate. As Inga explained, a pm can't do anything for a fast rate, it can only speed up a slow rate. Something is definitely going on but I'd wait on the surgery until you get fresh eyes to look at your records.

It's normal for a BBB to come and go so it's not surprising it's not always present on the EKG.

Good luck!

20 months loop recorder with no pauses?

by golden_snitch - 2010-01-15 07:01:52

Hey again,

I read your post again, and just wanted to add: if you had this loop recorder for around 20 months, and not a single pause showed up, it's really highly unlikely that this is your problem. Did you ever faint in these 20 months?

You should in my opinion really cancel this surgery.

Best wishes
Inga

Pacemaker

by cfritza - 2010-01-15 10:01:00

Hi DJS,
getting a pacemaker is a pretty serious thing so I would want to be sure I needed it before I allowed them to put it in, just because one Doctor says to do it is not to me the final say. I fainted also (never had in my life) went to ER had a holter monitor for 24hrs it caught a 4.4 sec pause the Cardiologist wanted to put a pacemaker in, but since I had been on a beta blocker we were not sure if that could have made my heart slow way down and then pause, I also have a RBBB but was told that isn't always a bad sign. Anyways I allowed a loop recorder to be put in and a 18months later had another episode this time 8 second pause, so even though I was sad about needing it I did get my proof that I should get it. The loop recorders can last up to 5 years so maybe they can just keep chekcing you- I would want to know I really needed it before I let them put it in,

Thanks for the response

by djs - 2010-01-15 11:01:36

I really don't know what to do. My family is pushing for the pacemaker....and I still want to be sure before I let him put the pm in. My doctor has been telling me I need it for the past 8 months. I have been putting it off, but he has never mentioned a pause. He told me that he can treat the fast heart rate with medication once the pacemaker is installed. But, because of the slow rate (40 bpm), he does not want to put me on medication until I have the pacemaker. He first said I have tachybrady syndrome....now he is calling it sick sinus syndrome. He said it is an electrical problem. He also said that is why the EKG will show LBBB one time....nothing the next....and then RBBB. I appreciate all of your comments.

diagnoses

by Tracey_E - 2010-01-15 12:01:58

BBB's are often intermittent, so it's not at all surprising they'd see it one time but not the next. It does indicate an electrical problem, but not all electrical problems need treated and there's (to me) no evidence it's what's causing your fainting.

SSS is when your hr drops off but picks up again with activity. I'm no doctor, but one incident of 40 bpm is not SSS. What is your resting rate? 40 slow but it's not dangerously low. A resting rate of 40 is a different story.

I don't know your whole story and again, I'm no doctor, but it seems to me he doesn't have a clue what's wrong with you and he's guessing. If the main reason he wants it is so he can give you beta blockers to stop the tachycardia, an easier way to do that is hospitalize you for a few days while you start it so they can keep a close eye on your hr, that's not at all uncommon. If it stops the tachy but drops your resting rate too much, then you can make a decision where to go next.

If he's wanted you to have the pm for 8 mos, another week or two while you get a second opinion is not a big deal. And always be wary of a dr who has reservations when you say you want a second opinion. Your family is just worried about you and that's totally understandable but you need to be reasonably sure this is going to fix your problems.

emiller95251

by emiller95251 - 2010-01-16 02:01:10

After a kidney stone was removed and meds given, i died of a blocked main LAD, got stint then three strokes the following 30 days after 6 months of cumadin the seizure/blackouts started a few at first then alot, then gone, in and out 3 times to get pacemaker then they changed their minds, after a 8 month stint on every seziure med and prozac and etc. I stopped taking everything for 90 days seizure/blackouts did not get worse or better, went to every different kind of doctor several different neurologists and always the same confused and dazed looks of we do not know what to do, then they found my stint blocked 65% from scar tissue on cath table to repair it i had 3 seizure/blackouts. I have worn recorders 10 times they do not show anything. only on the heart cath table did they record them, then they put me on amiodorne and they stopped they immediately went in to fix stint and had to put in 3 new ones, then blackouts/seizures returned with no warning still on amiordorone, again heart doctor was perplexed and confused after three times in for pacemaker 16 months earlier I decided to get 2nd opinion and new heart doctor said you should have had pacemaker 16 months ago after he reviewed all records. He had to wait till stint surgery healed but the blackout/seizures became so bad the 3rd time in er they admitted me to neurology floor and hooked 100 leads up to my head the doctor at er said you are going to stay on this monitor until we record a seizure/blackout 4 hours later it hit me in my sleep. They recorded my heart stopped 7.5 seconds and rushed me to heart floor and on to pacemaker schedual.. Have had pacemaker/defib two chambers for nearly 90 days seizure/blackouts returned thanksgiving day while on floor playing with grandson. I am really confused as now they say nothing wrong with heart or pacemaker and we are still on the amiororone and coreg and plavix and lycentipril, I am back to square one only this time with the pacemaker/defib and a new heart doctor. Whatever is causing mine it is very hard to record them. 35 recordings on one monitor i wore AND NOT ONE RECORDING SHOWED A PROBLEM/BLACKOUT/SEIZURE.; I am confused and not sure where to go. Really am tired and wore out all the time heart function at 29% with all the damage before pacemaker now around 35%, not sure where to go from here. I thought pacemaker/defib would solve the problems but no such luck, good thing is Doctor said with the implant it will not let my heart stop and I die, it will keep me going if it is needed, that is great comfort for my family and their piece of mind but it really has not helped me. keep searching for answers and second opinions, i wish i would have went for a 3rd and 4th.

A pain though they may be. A pacemaker can save your life.

by chippy22 - 2010-01-17 12:01:38

Hi,
I was very sceptical of having my pacemaker implanted....even a little belidgerant. Two years later and it has saved my life a number of times.
I think for me and my family, after many years of collapsing and being passed between neurologists and cardiologists with no answers i had got to the point where i was totally fed up. When cadiologists eventually said 'pacemaker ' i did initially say no....But then i took stock and realised that it was in a way a full stop, an answer, to all the years of worrying- for not just me -but those around me.. and at the end of the day the pacemaker is a remedy for those of us whos hearts will slow or potentially stop.
charlotte intermittant total heart block 2008
Take care. Change is never easy,but you will adapt.

walesridge

by walesridge - 2010-02-01 10:02:53

I certainly did not want to put in an ICD. However, the medical evaluation indicated that medications alone would not solve the problem. As far as second opinions go, that depends on your confidence with your doctor(s).
I think the best advice is to go with your gut feeling. Easy to say, but hard to do. It is an emotional thing from the git go.

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