questions
Hello, I am writing for my mom who is 81 and has dementia. She can't remember what she did today, but still enjoys seeing family and going to church. She lives in an assisted living apartment. She has been very short of breathe so doesn't walk very far and sleeps a lot. She has CHF and braidal branch something. After tests her cardiologist said her heart is weaker and recommended a BV ICD. We just went to the consult appointment last Monday. My mom says she is scared of having any kind of surgery, but will have it if I think she should. I'm trying to gather information to help us make that decision. If anyone has had a similar situation or has suggestions for me, please let me know. Thanks!
7 Comments
bv icd
by Tracey_E - 2010-05-28 04:05:39
bundle branch block
http://www.mayoclinic.com/health/bundle-branch-block/ds00693
It's a blocked electrical signal within the heart between the atria and the ventricles. By itself, it's not usually treated. When it causes symptoms or is part of other problems, a pacemaker will fix it by completing the broken circuit and making sure the atria and ventricles beat in sync.
chf is when the heart isn't able to pump enough blood
http://www.mayoclinic.com/health/heart-failure/DS00061
This is why they would recommend a biventricular pm instead of a more standard two lead pm. A two lead pm will synchronize the atria and ventricles fixing the bbb. The third lead synchronizes the ventricles, making sure the left and right ventricles beat in sync, which can improve ejection fraction (the percentage of blood that the heart pumps out) and help blood flow.
icd is a defibrillator. A defibrillator will jump start a heart that stops or restart a heart that gets into a very fast rhythm. While the pm paces all the time (or as needed), the icd is an emergency back up plan, it would only fire in the instance of a dangerously fast rhythm or stopping. She may or may not need this but it's fairly standard with a bi-v pm, that's how most of the manufacturers make them.
How low is her EF and how is her health other than her heart? CHF has no cure but the device can help symptoms by increasing EF. This may help her dementia a bit by getting her better circulation. It's not a cure-all or a magic fix, but it can help increase blood flow significantly which might make her less tired and short of breath.
Have you asked your family dr about the challenges of dealing with recovery when she won't remember things from day to day? Recovery from a biventricular pm is longer than recovery from a traditional two lead pm. It's not long or awful, but if the dementia is bad she will need supervision for at least a week or two.
If it were my mom, I don't know what I'd do. It would depend on how much improvement she could expect and if she has other health problems which would hinder recovery. If she's otherwise healthy and has a good chance of seeing improvement in quality of life, I'd go for it. If the CHF is advanced and they aren't reasonably sure we can expect significant improvement, and/or she has other problems which would keep her from bouncing back easily, I'd probably not put her through it. Your answer is most likely somewhere in the middle, it's not cut and dried.
A crystal ball would be handy, huh? There have been other discussions here about how people have fared with their bi-v icd's. A search for CHF or bi-ventricular may get you some of the experience you're looking for if no one with personal experience sees this and posts. Good luck!
hi cat
by Hot Heart - 2010-05-28 07:05:29
What a very difficult decison you have to make.
There are lots of very elderly people with pms at my hospital, but you know your mum best.
I cannot advise you on this, but pray that with the help of the more knowledgeable people on here and the info that the doctors give you, you will be able to come to a decision.
Love HH x
Difficult Decision
by cruz - 2010-05-28 09:05:37
This is a tough call, and I'm sorry you are faced with a decision like this. Also, at 81, if she says she doesn't want it done, and she's capable of making a decision about her health, you may just have to respect her decision if she understands everything. Prayers and good thoughts being sent your way.Also ask the doctor about the side effects of the medications I would think she will be on. Some of us have experienced dizziness, drowsiness, fatigue with the medications. This might be difficult for someone who is 81 to handle. We had major problems with my Dad (at 79) when he started experiencing dizziness. He just wasn't "aware" enough to do things to prevent himself from getting hurt and wound up with a broken leg. I know you have a difficult time ahead of you and my prayers are with you.
Tough Situation
by dparker329 - 2010-06-10 09:06:28
Went through the same thing with my Mom... and she was lucid. Here was the deal from her perspective.... she had a DNR and figured that having an ICD implanted would negate the DNR.
At 70 (not all that old) she elected to not have the surgery and died 4 years later of VT. She had a a great life and lived it the way she wanted.
Unfortunately, your circumstances are different. I will pray that whatever decision you make is the right one.
David
Thanks
by mvmomcat - 2010-06-11 12:06:43
I appreciate all the thoughts, comments, and prayers on the situation with my mom. We'll be seeing her dr. the first of July and you have given me some more good quesitons to ask and information to gather. We are off to my youngest sons college graduation tomorrow night and she is looking forward to that!
Please be sure to update
by cruz - 2010-06-16 10:06:04
Just saw that your appt is first week in July. Please be sure to update us. I've thought of your situation many times.
Cruz
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Hi and Welcome
by tcrabtree85 - 2010-05-28 03:05:06
Hi and welcome! I think that if the Drs think that your mom can handle the surgery then I don't see it being a issue. Though on another note if she doesn't want one I could respect that also.
I'm 24 and have had a pacer for 3 years now. Getting a ICD or Pacer placed is not as horrific as it sounds. Depending on the Dr it could be done in less than 3hrs.
I am hopeful that more people will respond with better answers for you. I can just tell you from my experience I have had 3 pacers placed and it wasn't the worse part of everything I have had done.
Blessings,
Tammy