Pacemaker or not

Hi

I have intermittent bradycardia <45.  First ECG noted it at 44 and a 24 tape recorded 38 overnight.  It is normally around the low 50s.  

I feel fine most of the time but very occasionally have an overwhelming sense of fatigue and this is always accompanied by pauses and a silly cough that I've been told is a vagal response? 

The 'pauses' have been felt by a nurse but never captured on ECG and are assumed to be PVC. .

I've now managed to get a referral to a cardiologist and am wondering what to expect. I'm assuming a longer tape and only if they find something would they act.  Since the above scenario isn't permanent and I can go days without a problem if they were to suggest a pacemaker I'm not sure I should accept (GP has already mentioned it, am awaiting cardiologist who may not consider it necessary especially if tape doesn't detect anything!) 

Any thoughts?  

6 Comments

Diagnosis of infrequent arrhythmias

by Selwyn - 2017-03-04 18:53:32

You can have a 48 hour ECG  recording - this is  the usual ( the device is about the size of a little camera and straps onto your belt)

You can be given an event recorder ( this is carried in the pocket and you put in onto your chest when you feel something happening, press the button and it records the event ECG)

You can have an implanted recorder for the very rare, and not felt problems.

- first things first, find out what is going on before jumping the gun about possible treatments.

 

Selwyn

symptoms

by Tracey_E - 2017-03-04 21:49:00

It sounds like you've already had a Holter? Under 60 is the definition of bradycardia, so you don't have occasional brady, you have brady. In the 50's is rarely treated, as long as it goes up normally on exertion and you feel ok. Once the rate is dipping to the 40's or lower, it's time to fix it. Have you had a stress test? Under 50, you may or may not feel it, especially if it is at night, but it is having an effect on your body. If your pulse is a little over half of what it should be, then your organs are only getting half the oxygen they need, and the heart working harder, doing the work of two beats with one beat. Do you know how much time you spend in the 30's? A few seconds is very different from most of the night. 

A pvc is a small half beat between the full beats. That's not the same as a pause. With a pause, there is no beat. However, unless a pause is more than 5-6 seconds or causing you to pass out, it's not considered problematic. PVC would show up on an ECG, but are usually ignored because they are harmless and most people have them at least occasionally. 

It sounds like you fall in the gray area, no clear immediate need but certainly cause for concern and will likely need one at some point. What that point is is subjective. Usually you can go by symptoms. When you are at risk of passing out, when you don't have the energy to do what you want to do, if you are tired all the time, then get it. However, the 38 at night would tend to sway me to sooner rather than later regardless of symptoms, esp if it's prolonged periods. When the rate drops at night, the effects on the body are less obvious. Reality is, these things don't get better on their own. They stay the same or get worse so most of us end up paced eventually. Odds are you'll be surprised how much energy you have after. We are good at compensating and making do and coming up with other reasons why we are tired! 

In my case, it got worse so gradually that I compensated and didn't realize how bad I truly felt until I was paced and had a normal heart beat again. It was like night and day, and I resented that my doctor never pushed me to get it sooner. He didn't want to give one to someone so young (mid 20's), so I said no (out of fear) and he let it go. My rate went from the 40's to the 30's then tanked to 22 when I was admitted for emergency surgery. If I'd known then what i know now, I would have done it several years sooner. Planning it is for sure easier than emergency surgery, definitely not the easy way to do it! Not to mention dangerous. 

decision time

by zawodniak2 - 2017-03-04 23:11:10

I had similar symptons and passed it off as just getting older  (65 years old).  Then I passed out and decided to take an ambulance ride to the hospital.  Observations showed bradycardia and left bundle branch block with indication for a  pace maker. Suprised, to say the least, so I put it off, but became more aware of my symptoms of dizzy-light-headedness and occasional fatigue. I finally went to an electrophysiologist for a tilt table test and he confirmed that  I was a candidate for a pace maker..  He indicated that if I did not get a pace maker then---I would be needing one in the future.  So I made the decision to get it.  That was 10 years ago and I have enjoyed quality of life, since.  No more episodes of dizziness and fatigue. The electrophysiologist was right in that over the last 7 or 8 years my interrogation tests show I am 100% dependent on the pacemaker to keep my heart rate over 60 bpm and to increase my heart rate as needed when exercising.  I am glad I made the right decision before having a potentially serious accident and I have never looked back.  The added bonus of getting a pace maker these days are that they are MRI compatible. Good luck on your decision.

                                          Rodger

 

Thank you

by Pig - 2017-03-05 04:09:11

(I'm in the UK) Yes I've had a Holter but HR didn't do the pausing thing when I wore it. Pauses are also very short, just a missed beat.  I have no idea what it was doing most of the day or how long the 38 was. The symptoms of overwhelming fatigue are rare which is I suppose what formed my question...the infrequency of it.

I am generally tired a lot but then I'm a busy single mum working 40 hours a week. I think that is normal. 

I will await the appt and see what testing shows. I like Tracey's gray area comment. I think that covers it and thanks for so much info

write down your questions

by Tracey_E - 2017-03-05 10:02:57

Make a list of questions for your next appointment. Nothing like sitting in a doctor's office to get amnesia and forget everything you wanted to ask. Good luck!!!!

HI Pig...........................

by Tattoo Man1 - 2017-03-08 15:46:42

...................In my view ,..even occasional Bradychardia needs to be taken seriously....a bit of .."Oooh I need a lie down"....when translated to passing out while driving..means that you really need to get the help that you need..

Pig..this is the picture..1 you are driving along a road

                                    2 the person heading towards you is having a Bradychardic episode...

                                   3 none of you need this

Tattoo Man..been there

You know you're wired when...

Your pacemaker interferes with your electronic scale.

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