Incomplete MUGA

by SMITTY
2009-02-14 02:02:38
General Posting
3794 views
8 comments

Hello Folks,

How you have had a MUGA? I had about 1/3 of one Thursday and would like to know if any of you have had anything like the experience I had.

I got the radioactive substance injection and went to the scanner. They got me all wired up with the 3 leads and she next thing I hear is "something is wrong, I'm getting a heart beat of less than 30 BPM and it must be above 30 to do the scan." Over the next 30 minutes, or so, they replaced the electrode pads, repositioned the pads, sand papered (literally) the spots where the electrodes were to be attached, all to no avail. Finally, one of the nurses said they were going to ask the doctor what they should do now and the next thing I'm told is "the doctor said we can't finish the test and he will contact your cardiologist and tell him what happened."

What makes this especially aggravating is that while I have a pacemaker with a low set point of 70, I've been complaining for two years that I have a low heart rate from time to time. But never, to my knowledge, has it been less than 30 BPM.

So how about it, have any of you experienced anything of this nature with a MUGA, or do any of you have any suggestion as to what may have occurred? I certainly don't know and the puzzled look on the faces of nurses that were involved tells me they don't know either.

I'll see the cardiologist next week but I am not expecting much from him. Because to tell the truth, the more I see these people the bigger joke Scott & While Health Care Systems in Temple, Texas becomes.

Thanks,

Smitty

PS, The only fun part was when one of the nurses told me since we couldnt complete the test you will not be charged. My comment was, Im sure Medicare and the insurance company will appreciate that.

8 Comments

Weird

by candi51 - 2009-02-14 07:02:30

Wow- that is really strange!!
I wonder what the device rep would say about that. Do you think the rep would have any input on the low bpm?
Have they ever noticed these low bpm periods on your interrogations?
Can you go see another cardio or EP?
I hope you get some answers soon!
Best Wishes-
Candi

interrogation

by Tracey_E - 2009-02-14 09:02:35

Can you get them to do an interrogation right away before the incident gets overwritten?

Very generous of them not to charge you (heavy sarcasm intended)

Heart Wall Motion Study

by Pookie - 2009-02-14 10:02:25

and a MUGA....are they the same test? If so, I'm having one this coming Wednesday to get my ejection fraction tested. This will be my 4th one. the dye that they inject always make me feel weird and I feel like I'm going to faint....once I actually did.!!! but I need to know what my EF % is.

Smitty, have you ever requested a Holter Monitor or an Event Recorder? would that even help them see that your rate is going below your lowest setting?

Gosh...there has to be an answer.

Good luck & keep us posted.

Pookie

Checking the problem

by ElectricFrank - 2009-02-14 11:02:51

This should have been very easy to check. The ECG waveform would have shown whether the pacer was failing to provide the stimulation to assure a lower limit of 70 ,or if your heart was not responding to the pacer (failure to capture). If the latter is the problem you may need the pacing voltage turned up. A third possibility is that the 3 lead monitor was unable to interpret the paced heart signals at the location they were using.

The problem is that the people running the tests are only trained in the particular area and don't understand the implications of a pacemaker on their equipment.

Tracey's idea of a pacer interrogation is also a good one.

frank

MUGA Results

by SMITTY - 2009-02-15 11:02:42

Hello Folks,

This will be long and probably not very interesting. I tell you that so that you don't get involved reading and think "will this nut ever shut up?" But you see I'm not going anywhere for the next few hours because I'm tied to an oxygen concentrator for my daily O2 therapy. I've read all of the today's newspapers so I'll now start on another of my favorite pass times.

I do thank all of you for your input. Some of the suggestions have been done and I'll be asking for most of the others during my upcoming visits with the cardiologist.

Specifically, Candi, I had planned to ask for a rep to take a look at the PM. Of course that means I'll be walking all over the toes of the doctors and nurses in the Pacemaker Clinic at S&W, so my request will not be greeted with open arms. As for seeing another Dr. I'm on my third or fourth one in the last 5 years. They have all been with S&W which means they all use the same recipe book for determining treatment. The current cardiologist is not involved in the PM Clinic and all he can do is refer patients to them.

Tracey, as I told Candi, I'll be asking for a PM interrogation by a rep. I've had no telling how many PM interrogations during the last couple of years and all the reports were that the PM was working fine.

Pookie, I can't answer your question about a wall study and MUGA being the same, but I do know that both are used to determine ejection fraction. I had an echo a couple of weeks before this excursion and the results were so incomplete a good estimate of the EF could not be made and the MUGA was ordered. Also the echo showed a heart rate of 81 BPM, but the doctor said this included the PVCs I was having and these were a major factor in the inconclusive results. Shortly after the echo I had an ECG which showed a heart rate of 48 BPM. It's the same old stuff; I can pick almost any number between 45 and 72 and say this is what my HR is now, or was few minutes ago. I haven't been on a Holter in a number of months but did have an Event Recorder about 6 months ago. The EP said the results of that showed that my "events were unremarkable." (I'm not a fan of that doctor term because it does not tell me anything.)

Frank, The EKG tracing was a good one, according to what I over heard from the Einsteins conducting the scan. The only problem is it too showed a HR of less than 30. I did question the location of the pads. My only first hand experience with locating the pads is with the ones I put on for my PM telephone checkup. I put one just below the clavicle, midway between the shoulder and neck on the right side and one about 3" or 4" below the nipple on the left side. The location of the three they used was the same as I used on the right side but the one on the left was about 6" to 8" below the nipple and the other one was with in one inch of the PM. I tried discussing with a couple of the nurses about location about being different from where I put them, and in reality I guess they were very considerate of my thoughts because neither of them told me to shut up.

I'll agree very much with your last statement about "the implications of a pacemaker on their equipment." I say this because one of them asked about the age of my PM and I told them about 8 1/2 years old. The reply was "you are about ready for a new battery since those things never last over 10 years and you may as well get a new pacemaker because the entire pacemaker is less trouble to put in than it is to change out a battery." I just grunted in agreement.

As for increasing the voltage, I have wondered about that and will ask a rep, if I can see one. Also, I have a question for you. Does a PM have a sensitivity adjustment? What I'm thinking of is a setting where the PM can be biased to ignore a weak natural pacemaker impulse and go ahead and send an impulse to make the heart beat. I ask that and all the time I'm sitting here thinking that I bet it will really be hell if they don't get such setting exactly right. I could see where it may be possible to have natural PM and manmade PM trying to send impulses at the same time.

Again thanks to all of you and I will keep you updated. I do want to say one more thing. Any of you that may think I'm concerned about all this, forget that. I find it almost comical. I do get aggravated, but concerned, never. You see I've already lived at least 20 years longer than the best estimate I have gotten in the last 25+ years. So, everyday is a bonus. I guess if the feds can prevent bonuses for the top dogs in our financial institutions, then I'm sure The Almighty can stop my bonus days whenever he thinks it is time and all I can say is thank you.

Bella,I just saw your comment. Thank you. It could very well have been equipment failure, but trying to get anyone to admit that is pretty near impossible.

See you down the road,

Smitty

PM

by SMITTY - 2009-02-16 10:02:54

Thank you Frank.

To my surprise I actually think I understand what you are saying. I'll see the cardiologist later this week and will hit him with the question about their ECG being able to show the PM output. I will be pleasantly surprised if his answer is more than "duh." Although in his defense (I guess) he is just a cardiologist and not an EP.

I don't pay any mind to the my life expectancy estimates. I would have died from worry long ago as the first one I got in 1983 and that clown said I had about 2 more years. I have now outlived him..

I do have one big goal and that is to be here 4-17-09. My wife and I will celebrate our 60th anniversary on that day and that will set a record for longest marriage in either of our families.

Again, thanks for your help in my trying to understand what is going on with my little toy.

Smitty

Just a thought from Blighty

by Molley - 2012-05-01 09:05:17

Hi, I am a Cardiac Physiologist in the UK and my thoughts on this on a simple level are that the operators doing the MUGA basically have not hooked up the ECG correctly. The waveform needs to be of an optimum size to be recognised, in simple terms the machine measures the gap between each peak or R wave. In a paced beat hte waveform is not usually large and is biphasic. Most devices are programmed bipolar so the preceeding paced spike will not register either on the monitor. It is therefore down to the size of the paced ECG signal to trigger the RR. If small it does not trigger and on some monitors will default to 30bpm or others zero- hence nothing and the cheese and pickle sandwich comment!. What the tech needs to do is select another 'lead' on the monitor or incerase the size of the ECG until the rate is recognised. So in answer to the question it is not the device, they are pretty much bullet proof, don't really have much in the way of grey areas. Hope this helps. Loving your site by the way xxxx

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