deciding if pacemaker is necessary

I joined your club even though I do not have a pacemaker yet--hoping someone could provide some insight. I have PVC's often and low heart rate often and my cardiologist keeps talking about a pacemaker. I don't often feel the PVC's anymore and my only symptom is fatigue. He infers that I will know when I need one although he originally brought up the topic a year ago when my heart rate was 37. I always thought the doctor would tell me when it was necessary. i certainly don't want to jump into having a pacemaker any sooner than necessary. Any comments will be welcomed.

8 Comments

timing

by Tracey_E - 2010-07-04 02:07:05

A pm will probably have no effect on pvc's. A pvc is an extra partial beat, the pm can only add beats. What a pm WILL do is get your hr up to a normal level which will give you more energy. With your rate as low as 37, I'm surprised they're letting you choose when to get it.

I also knew for years before I got mine that one day I'd need it. My rate was 44, always, no matter what I did it never went up. I procrastinated and stalled and one day it dropped to the mid 20's and I almost died and ended up in emergency surgery. Not the easiest way to do it! In hindsight, I wish the dr had pushed me to do it sooner. I spent two years feeling tired when I could have been full of energy. Also, it's hard on our organs when we have a low hr. A lot of small health problems went away and my mind was more clear after I got my pm. I'm on my 4th now and still feel terrific.

I don't agree that you'll know when you need it. The symptoms can come on so gradually that you don't realize how bad you feel until after you feel better. And when your rate drops very low, it's like being drunk and we don't have good judgment. The day I got my pm, my fingernails were blue- I was merely amused when I should have been alarmed. It never occurred to me to check my pulse or be worried, or that driving myself to the hospital when my doc said to get there asap was really stupid. We've had other members that waited and they passed out. You don't want that to happen, you could be behind the wheel or at the top of stairs and really hurt yourself.

50's and upper 40's you can get by without a pm. In my opinion, anything lower than that is too low and a pm is beneficial. It may not be necessary for you yet, but it is probably wise.

Wake-up call

by Edouard - 2010-07-04 03:07:07

Hi Jorie
I got my pacemaker on May 25th of this year. I'd been followed by a cardiologist for +/- 3 years for bradycardia & a minor heart block. I did not react well when he first mentionned that I might EVENTUALLY need a PM. I'd had some dizzy spells and a few fainting episodes. I always attributed my slow heart beat to my intensive swimming regimen. In fact, my family doctor had even referred to my condition as "Athlete's heart". As a result, I never considered my situation as serious.
It caught up with me on May 21st, the Friday of a long weekend in Canada. I had cut down a tree and spent the afternoon chopping it up and cleaning the yard. That evening, while watching TV, I went up the stairs. The next thing I know, my wife is screaming something about blood and I'm wondering why I'm there, kissing the floor. Anyway, at the hospital they put 4 stiches in my chin, 4 in my lip and cleaned out the blood from my nose. Not much to do about my busted rib, though.
Overnight, my heart rate went down to 31. The EP on duty came to visit and basically told me I had no choice. Of course, it being a long weekend and the nurses fearing that I'd pass out again, I was confined to my bed for 4 days (5 including post-op recovery). Not fun.
My advice, be proactive and discuss it fully with your doctor before your situation catches up with you.
Best regards and good luck.
Édouard

thanks

by jorie - 2010-07-04 04:07:18

Thanks so much for the immediate input. Both posts are filled with such good info. I see my cardiologist this week and will be ready to discuss things with him. I have also seen an EP at a university hospital--maybe it is time to see him again. Thanks again.

Do You Need A pacemaker

by SMITTY - 2010-07-04 04:07:55


Hello Jorie,

You already have some info about pacemakers and PVCs and low heart rates. Now I have a couple of questions.

You say a year ago your heart rate was 37. Are you on any medications, such as beta blockers, calcium channel blockers or any other kind of heart mediations? When your heart rate was in the 30s range did you ever feel dizzy or feel like you were going to pass out? Are you into an intensive exercise program such as long distance running?

Now the reasons for my questions.

Medications - Some heart medications are prescribed for people experiencing PVCs. These medications can also lower the heart rate to levels like you experienced.

Feeling dizzy or passing out - Low heart rates cause these symptoms for some people. Passing out can be very dangerous as you have no control over when one of these episodes may happen and if say you are driving--- well you get the picture.

Intensive or strenuous exercise programs can cause some people's heart rate to be in the mid-30s to the low 50s range, because the exercise can will make the heart larger and stronger. These can give the heart the capability to pump much more blood with each beat than that of a person on a normal exercise program. Volume of blood pumped by the heart with each beat is what it is all about to start with.

I agree your doctor should be the one to tell you if and when you need a pacemaker. Maybe you should talk to him about his thoughts on why you had a heart rate in the 30s and if he thinks it is an on going thing that may be a problem for you.

I also agree that you do not want to get a pacemaker any sooner than you need one, but on the other hand you don't want until well after you need one to get it. Depending on the reason for your needing a pacemaker, it may be better for it to be sooner than later.

Good luck,

Smitty

meds

by jorie - 2010-07-04 05:07:14

I have been taking metaprolol for several years for the pvcs and hypertension..When the low heart rate started showing up they continued to decrease this med. It has been a balancing act between controlling the pvcs and keeping the heart rate at acceptable levels. I also take an ace inhibitor.

I am not a big exercise person so that is not an issue in this case. I should probably exercise more.

I cannot say I get dizzy other than a very occasional feeling when I first stand up. Fatigue is my main problem and of course that is a very subjective feeling.

I have been through many many surgeries over the past 12 years--mostly orthopedic. I recently had to go in unexpectedly for a total hip revision after a failed prosthesis broke. Following surgery I was put in the telemetry unit because I had some chest pain and the EKG showed trigeminy----well anyway, I won't go on, but this recent episode has brought everything to the forefront again.

If I have a PM I won't be able to have any more MRI's--is that right? What happens also for a PM wearer when surgery is needed?

Thanks so much for your input.

surgery

by Tracey_E - 2010-07-04 08:07:22

We cannot have mri's with a pm. There are some new pm's that are mri compatible but I don't think they're common yet.

We are monitored during surgery.

To or not too.. my two cents...

by harley63 - 2010-07-04 10:07:32

Jorie,

Welcome! Your in good company here and should find great support, insight and encouragement.

Now.. the question of to or not to get a pacemaker... hhmm.. wow.. that is really a personal decision and between you and your MD's. My pacer decision was made without any hesitation when I was asked. Of course being in and out of 3rd degree AV block, HR in 20's and hearing all the limitations on daily living...all happened suddenly after living with chronic fatigue for 3+ years... I had no problem saying yes to give me some internal bling bling!

Here I am.. 4.5 yrs later and I feel like a million bucks! Oh I have days that I'm playing alligator, but mostly I'm giving the energizer bunny a run for his money. Whatever choice you make I wish you the very very best. Keep in touch and let us know how your doing.

Take care....
Harley63

Pacemaker

by SMITTY - 2010-07-04 10:07:50


Jorie,

I'll try to comment a little more after getting more information on your problems. Of course I'm no doctor, which means anything I say here has to be taken with a grain of salt. But I feel comfortable talking about some of your problems because I have traveled a lot of the same road you are on, except I've not had any orthopedic surgeries, thank God.

As you know Metoprolol is one of the beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. It also can cause fatigue. The fatigue is the main reason I cannot take any beta blocker. Ace inhibitor can also cause low heart rate and tiredness, but my reason for not taking ace inhibitors is they cause me to cough very frequently. But on the surface it looks like your slow heart beat MAY BE caused by the medications you are taking.

From what I see members talk about here, as will my personal experience, a pacemaker is often the solution to offset the side effects of these medications. I don't know what options a doctor has for treatment for people that need these medications to treat their problems. I was having PVCs but I convicted I could live with them better than I could the fatigue and just generally feeling miserable all the time, he decided to treat my hypertension with a calcium channel blocker and not try to treat the PVCs. I think that decision was mainly done to get me to shut up.

While I still have an occasional PVC, the reduction was because I persuaded the doctors to make some setting changes on my pacemaker that reduced them by more than 90%.

As for a MRI, it is true I cannot have one because of my pacemaker, but I keep reading article about pacemakers that can tolerate a MRI are on the market or close to being there. As for other surgeries, about the only thing of concern is any electrical device, such as a cauterizer, that develops an electromagnetic field can be a problem. But they are no problem if kept at least six inches to a foot from your pacemaker. Again, for me a MRI is a no-no, but other surgeries I have were not a problem.

If at all possible I suggest you consider having a discussion with your doctor.

Good luck,

Smitty

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