Hi Everyone...should I get a PM ?

Hi Everyone....

I am 25 years old man from norway and I have today been diagnosed with second degree heart block. i dont know yet whether it is type 1 or 2. But i am hoping it is type 1 as i have read that this is the less serious one and more common. My young Doctor told me my hard had stopped about 1 second after I have been monitored in hospital four days due dizziness and slow heart beat which cause a skip. Anyways he told that this could be nothing serious and we wait for further examination.

I am caring a 7 heard monitor right now but he also told about pacemaker. I also went through stress test today with a bicycle and all went well not to my surprise as i often work out in the gym. These symptoms of slow hard I have, are really rare, and they usually appear when i have been exercising very hard or when had a hard and stressful day. I mostly only feel them at bed when im about to sleep.

Im really scared, sad and shocked today. And I hope to find some what of guide here. I feel very young at just 25 and haven't had any kids. Mostly of i have of heart rate 60-80 but that one night it dropped to 47. And it is really not that frequent this happens.

So my question is, do people here think that pacemaker right for me ? Are there any other pm people that have been to somewhat in my situation/ exact condition ? Are there any other treatments ? I have also read that type 1 usually does not need treatment, is there anyone with type 1?

I know this might be hard to answer and probably better answered by a doctor but there is nothing like talking to he PM community, who actually have a PM everyday in their lives and can tell why they have it. .I hope some of you can give some tips... :)

15 Comments

Should You get a pacemaker??

by musser75 - 2010-05-04 09:05:21

Fisrt of all, I would like to ask if You are professional athlete or do You train like a professional one? There is an entity which is called athelete's heart. It's benign ( you do not have to worry about it). In this circumtance, slowing of the herat rate can be accepted especially during sleep. It's positive sign that Your heart rate has gone up in an approciate way during exercise test. If Your 24 hour ECG recording ( Holter examination) shows no pauses greater than 3 seconds during sleep and the blocks are only 2nd degree type I, it won't be necessary to implant a pacemaker. I would request from You a tilt table test in order to exclude vaso vagal syncope.
musser75, MD

PM

by nbarton - 2010-05-04 09:05:47

I have heard that Heart Stop = Pace Maker. But I will tell you that I too was extremly scared and I have come to terms about this and I am 5 days into my PM. And another thing is, You will get a wealth of responses here and I hope everything will work out for your benefit.....

not a pro...

by Jayson20 - 2010-05-04 09:05:52

no. im not professional athlete. 2 or 3 times at gym lift weights and run a bit.
The hospital i was at probably didnt have tillt table and took only bicycle test.

So im assuming i should ask for this test, which i will. Is tillt table test more accurate ? Do all people faint there ?

Tilt Table Test

by musser75 - 2010-05-04 10:05:41

Hi Jason,
exercise test and tilt table test are different entities. Via an exercise test, your heart rate response is assessed. Tilt table test is used to diagnose "vasovagal syncope". Not everyone faints in this test, only those who have got vagal overeactivity. Dizziness in your age should be evaluted for vaso vagal syncope and tilt table test is for it. Indeed, that's my professional opinion.
It has been a tendency among medical doctors to inform their patients about every possible outcome. This is the reason for Your doctor's behavior. Don't be pessimistic, everythings will allright.

Okey

by Jayson20 - 2010-05-04 10:05:48

Thanks for you kind works Musser75 and im happy to hear your opinion.Im obviously not good at dealing with fear.

Hi Jayson!

by JessA828 - 2010-05-05 01:05:17

Hi Jayson,

I'm two weeks into my PM today. I didn't have a choice about getting mine. I just wanted to tell you that I'm 24 and also feel very young, especially to have something like this happening. I can only tell you that it's ok to be scared. I know I still am. I have to tell you I'm still learning something everyday about all of this but I've learned all of my most valued information on this site. Please keep us informed about your decisions!! I hope this finds you well.

Jessica

Reveal Device

by Genie - 2010-05-05 01:05:50

A reveal device is an implanted version of a loop recorder (a Holter device). It is implanted under your skin in your chest a bit like a PM, but there are no wires (local anaesthetic, takes about 30 minutes). It might also be called an implantable loop recorder: Reveal is the name of the Medtronic device.

It senses your heart beat and records any incidences of low heart rate and heart block. What is more important, however, is that it can be patient activated: you get a hand-held monitor that you place over the device when you have any symptoms. This allows your cardiologist to check if you symptoms (such as dizziness) are related to your heart block. Your cardiologist should be able to tell you about it.

Mobitz Type 2 is more likely to progress to complete heart block. If it was me, I'd want to be paced for this, even without symptoms. But other people will think differently, and you need to discuss it carefully with your cardiologist.

Rather not

by golden_snitch - 2010-05-05 03:05:54

Hey,

just because of a one second pause and a heart rate that dropped to 47bpm at night, there is no need for a pacer, at least not according to all the guidelines that have been published for example by the American Heart Association or the European Society of Cardiology. And since you are only 25 years old (I'm 28), if I were you I'd wait and just monitor your heart rate regularly.

When I had my very first holter monitor my heart rate dropped to 40bpm at night but there never ever was any talk about a pacer since this happened only at night. And later, after my sinus node ablations, they waited with the pacer implant until I fulfilled the guideline criteria, and those say - at least in Germany - pauses up to 4.5 seconds at night are ok, when I had 5 seconds pauses and rates as low as 18bpm at night, I got the pacer. I really appreciate that my doctors just watched me closely and waited; they made sure I really needed the pm, and not just put one in because I had once had a pause.

Best wishes
Inga

wait

by Tracey_E - 2010-05-05 06:05:56

I agree with Inga. Nothing you've mentioned is bad enough to get a pm yet. I'd watch for now. You could stay as you are for years, or there is a chance it will progress and warrant a pm at some point. Medications will slow down a fast heart, only a pm can speed up a slow heart so, no, there are no other solutions other than a pm.

I was born with complete (3rd degree) heart block and was monitored all my life. I got my first pm at 27. I am 43 now, healthy and active. It sounds scary at first, but it's not that bad! I don't even think about mine most of the time and most people never know I have it. It allows me to lead a perfectly normal life. Looking back, I wish I would have gotten mine sooner than I did. I waited too long, until I was always tired and dizzy. I spent a year feeling bad and procrastinating because I was afraid of it when I could have been feeling great and getting on with my life.

If you are getting tired/dizzy from working out, a pm will probably make that go away because it will keep your heart rate up where it should be when you exercise. A heart block is a short circuit. Our hearts are structurally healthy and our natural pacemaker- the SA node- works normally, but the signal gets blocked on the way to the ventricles. All the pm does is wire around that block and complete the circuit so our ventricles always beat when the atria do.

No, we do not all faint, and no there is no reason for everyone to have a tilt test. A tilt test is done when you pass out for no reason, it checks to see if changes in position make your heart rate or blood pressure drop. I would imagine you need a holter monitor more than a tilt test. A holter monitor records everything your heart does while you wear it so you know exactly how low your heart gets.

Having a pm will not affect your ability to have kids!!! There are several of us here who have had babies after we got our pm. I had two very easy, uneventful pregnancies with perfectly normal deliveries. It would have been much more complicated, if not impossible, without my pm. Having a baby makes your heart work harder, the pm makes sure it's working just like it should.

Good luck with your decision. If you have more questions about getting a pm or living with it, please ask!

It Depends...

by Genie - 2010-05-05 07:05:13

I have type 1, second degree heart block, and pauses of only 2.5 seconds, which caused me some dizziness and palpitations. Like you, mainly at rest, and then all through the night, when my pulse also dropped to about 40.

I had a pacemaker fitted at the end of March. I probably don't meet the criteria people have mentioned, and I had several doctors who wouldn't pace me. But I am being treated by a leading cardiologist at the Royal Brompton Hospital in London and we decided to pace me based on current research and my own feelings about the situation (including the fact I am a 31 year old woman, and would like to have a family). I had a reveal device implanted which recorded my incidences for a year before this, so I knew exactly what my situation was. Some of the current research suggests 2.1 heart block is not as benign as initially suggested.

This doesn't mean I'm saying you should have a pacemaker: everyone is different. My pacemaker surgery has brought new problems (I also have problems with tachycardia, and these have got much worse!). So it's not an easy solution. And if your slow rates are due to increased vagal tone from being an athlete (mine definitely aren't), then waiting would probably be best. So it depends how you feel. You should read this article, from The British Medical Journal, http://heart.bmj.com/content/90/2/169.abstract If you can't access it send me a private message and I'll organise to e-mail it to you.

Genie

Looks like type 2.

by Jayson20 - 2010-05-05 10:05:19

I called the doctor earlier today and he said it looks like
type 2. But he is not sure yet, since a specialist has yet to determine it. He is said to even though it appears to be type 2 it can so seldom that you need a pacemaker.

I have also read that possible underlying disease have to checked before making a decision, because if there is no underlying causes and then it is less severe and probably just have to eat food, no smocking, controlled exercise and so on. Can we say this is true?


I have been one day home and feel got dizziness and headache sometimes. But my heart rate has been fine, as far as i can tell and i have a holter monitor.


These is incidents have occurred two times this week after work out in the gym, and the last time i used feel anything like this was 2007. At that time i used work out hard and push my body to limit. And stopped that the symptoms disappeared or less frequently and minor that haven't noticed even. But now i have started working out again and taking protein, I also smocked cigarette randomly.

Suddenly all symptoms came back. And now I`m wondering if I provoke it ? Is there a link between the gym and my problem? My hear rate is fine when exercise. .
Or is it most likely something deeper?

Thanks to each of you for all supporting words , they are very encouraging and help me in this difficult time. Its good know im not alone.


@Genie: What is the reveal device implanted ? is this good option determine the problem?


jason

greedings to everyone here. :)
.

jason

by LS - 2010-05-05 11:05:06

I've also been told underlying sleep problems can contribute to different heart problems.
Has that been checked out?
Good luck to you.
BTW, I think it's great you're doing your homework before this decision is made.
Liz

gym

by Tracey_E - 2010-05-05 11:05:21

Yes, it's probably related to what you're doing at the gym. When you are exerting and your heart can't keep up, you are going to get symptoms.

Think of the atria as the brains of your heart. It senses oxygen levels and raises/lowers your hr as needed with activity. It tells the ventricles how fast to beat. Think of the ventricles as the brawn, they make the strong beat we feel as our pulse. With a block, that signal doesn't always get through, so sometimes the atria will beat but the ventricle will not get the message. If you need the higher heart rate- like when you're exercising- but the ventricles aren't getting the signal from the atria, this is when you will feel symptoms like shortness of breath and dizziness. Your heart is trying to beat faster but the ventricles aren't getting the message so your pulse is lower than it needs to be. The pacemaker works by sensing when the atria beats then watching to see if the ventricles beat. If they do, it just keeps watching. If the ventricles don't beat, it generates a pulse that causes a beat. The pm is simply completing the broken circuit and keeping the heart in sync.

What happened when you rode the bike? They should have been able to see when your atria was beating faster than your ventricles.

If your hr is naturally high enough to allow you to do what you want to do and the block is intermittent, then you can get by having a block and not need a pm. When your resting hr drops too low or the episodes are often enough/long enough to keep you from doing what you want to do, that's when it's time to get a pm.

Diet, exercise, taking care of yourself- none of these will affect an electrical problem. They all help plumbing problems- blocked arteries- but are completely unrelated to electrical problems. It can be caused by disease or the side effect of medication, sometimes it just happens, some of us are born with it. Once you have electrical damage, it is not going to go away or reverse itself. Whatever the cause, the treatment is the same.

difficult one!

by Hot Heart - 2010-05-07 10:05:35

I didnt get my pm until i was 55, but now find out that i could have keeled over at any time in my life, with 3rd degree hb. Its not known if mine was congenital, or whether i went through 1st and 2nd degree before i went into 3rd degree, will never know.

The only thing i do know is that I am now fit and healthy, can do more things than the average 56year old, can keep up with the kids no probs! lol.

My dad dropped dead age 35, heart gave up after asian flu epidemic is what my mum was told, this was over half a century ago, soooooooo, was he a victim of heart block? I will never know.

I just know that I feel safer with mine now I know i've got a problem, than I would do without.

HH

no symptoms..

by Jayson20 - 2010-05-07 12:05:25

hi Hot heart

Its hard to believe that you went through 1st and 2nd hb without any symptoms for such long time.. probably not i`d say.
I think if i can avoid Bradycardia (Slow Heart Rate) which I only get after hard training then i can avoid the blocks, thats my hope now.

Great to hear you are well.

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