In Denial

I'm 52.  Bradycardia for at least 25 years.  Avid runner since 15 years old.  Diagnosed in the past with either type 1 block or type 2 / Mobitz 1 -- I can't recall b/c last time I saw cardiologist was at least 10 years ago, when I needed clearance for minor knee surgery.  I have no symptoms at all. My present resting heart rate is in the low 30s.  I was recently scheduled for minor procedure, but due to low heart rate, doc wanted cardiac clearance.  Long story short, I did the 24 hour monitor. I was first told by cardiologist that it's now Mobitz 2 and at times third degree block.  But then the cardiologist looked at the 24 hour results more carefully and saw that when running, my HR hit 140 which he said was good.  Then he said it's mostly Mobitz 1 and 2. I never heard of a hybrid Mobitz. Doctor said PM is inevitable for me and the question is when.  I'm getting a second opinion at U of Pa, where they have a cardiac sports program. I can't see the reason for a PM with no symptoms - even with a tough workout. Has anyone had a similar situation as me?  I'm admittedly somewhat in denial that I need a PM.  Thanks in advance.

4 Comments

It's perfectly normal

by jcb - 2017-03-26 09:39:30

To be in some sort of denial.

Luckily you're not in complete denial and have come here with your questions and are planning for a second opinion.

I was in a somewat similiar situation. Heartrate around 30 during the day, just turned 51, having brady for decades with no symptoms at all and a cardiologist telling me i should have a pacemaker. Main reason was that there was an ever increasing risk of bradicardia induced tachycardia. Furthertmore it was likely that at some point i would get symptomatic because they could see my baseline heart rate at night was slowly dropping  from occasionally dipping to 25 in 2010 to staying most of the night at 22-26 at the last 24hr holter and having ever increasing periods of 3rd degree  block.

In the end i decided to have one and a dual chamber medtronic was implanted  5 weeks ago. I can't feel much diiference betwen having or not having the pacemaker. But that wasn't expected anyway, because it was implanted as a sort of pre-emptive measure. Only thing it does is tracking my own rhythm and making sure the ventricle beats at that pace and doesn't drop below 40.

So, get that second opinion, ask any and all questions you have and make your decision. 

 

 

symptoms

by Tracey_E - 2017-03-26 19:04:46

It's possible to move between two types of block, that's why they'd say you have I and II. Sometimes you have I, sometimes you have II, not uncommon.

It's unusual for the rate to go up on exertion with av block, you are fortunate. However, that doesn't negate the problems having a rate of 30 can cause. As someone who put it off so long that my rate tanked one day and I ended up in emergency surgery, my advice is don't be afraid of it. A rate of 30 means your organs are getting half the oxygen they need and  your heart is doing the work of two beats with one beat. All of that takes a toll, whether you feel it or not. I found afterward that I didn't feel quite as great before as I thought I did. We get symptoms gradually, we blame it on something else, we compensate, we deny. I felt a whole lot better after- more energy, some little irregularities in my blood work went away, even my eyesight got better, my stamina skyrocketed. 

You'll probably find with pacing that your rate gets higher than 140 when you run, which means you may have more stamina. 140 on exertion is very high for heart block, but not high at all for someone with a normal heart rate. 

Heart block

by LORIAAA - 2017-03-26 20:26:29

I was diagnosed with Wencheback Mobitz I second A/V Block 10 years ago and the cardiologist wanted to install a pacemaker.  I went for a second opinion at another hospital and the cardiologist reviewed my case in detail and felt I did not need a pacemaker.  He also felt that I could need one in the future and that I should make yearly appointments.
I went bike riding at Valley Forge park then went swimming laps feeling great.  The next day I went to my yearly scheduled appointment.  I was in complete heart block.  (I am not sure how long).  The doctor wheeled me over to the hospital, and the next day I receive a pacemaker.  I never had symptoms.  I turned 65 while in the hospital.
I am glad you are going to the University of Penn for a second opinion.   One advantage of planning ahead is being able to pick your surgeon.  

MY REGRET

by BOBJ - 2017-03-29 13:40:13

If I knew now - after massive stemi - and crt-d (biventricular pacer) I wish someone would have told me

1 - at 35 years old get a cardiologist - even if you don't need them yet

2 - your heart is out of sync and you need a pacemaker

3 - you need to take statins even though your cholestrol looks great

4 - when we sy stop smoking what we really mean is lay off nicotene

5 - that goes for caffiene too

I hope you understand that what I am saying is listen to the doc.

 

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