Will heart block second degree get worse?

Being a cardiac...

by donr - 2018-08-11 20:57:15

...nurse, I'd expect you to know the answers - unless you never had anythig to do w/ PM's.  That sounds like the case. 

I'd say it's wishful thinking to expect the situation to get better.  How often do you see your TV set fix itself?    It would take a miracle to repair itself, and we cannot lead our lives on miracles! 

We have in excesss of 30,000 people in here - There have been 2 miracles occur that I can remember.  You could win, but you could win the PowerBall Lottery, also.  You could also die while awaiting the winning ball on this lottery of life to be drawn.  The smart money is all on the losing ball being drawn first.

Donr

Getting a pacemaker while you have a choice

by Gotrhythm - 2018-08-11 21:01:07

You said, "Will it get worse if I don’t get a pacemaker?" 

The pacemaker won't keep it from getting worse. The arrythmia condition will continue, and will most likely get worse over time. Without a pacemaker, if it gets worse, at some point the arrythmia will become life threatening. With a pacemaker, the condition getting worse might neccessitate a change in the pacemaker settings--very easy to do--or it might not. Either way, getting worse won't cause you a problem.

Nobody here is going to talk you into a pacemaker, that's your decision, but I certainly understand your anxiety. I also understand thinking "oh, it's not so bad, maybe I can live with it." Then my condition which had slowly worsened over several years, got a lot worse suddenly over a couple of weeks. My heartrate plummeted. My blood pressure, too. I had six second pauses. And there I was, needing an emergency pacemaker. Not an approach that I would recommend. 

I know it feels like you are staring into the abyss, but it's important not to build up the dangers in your head. Millions of people all over the world, on every continent, have pacemakers. Medically speaking, it can't be that hard to do.

Donr your right

by PacedNRunning - 2018-08-11 21:05:04

I was a post CABG nurse. I dealt with the plumbing side of things. So think coronary artery bypass, stents etc. never worked on the electrical side. I know it won’t get better but is it practical to just tailor my lifestyle to this problem and not need a pacemaker. A full recovery would be awesome but I know it’s not likey

Never

by AgentX86 - 2018-08-11 21:09:16

Unless it's caused by an acute condition that will resolve itself[*], it won't get better and there is a 99.9% chance it'll get worse (I'll leave the 0.1% for you getting run over by a bus tomorrow).  This problem is easily fixed with a pacemaker and you can then continue a normal life. Really, your electrophysiologist (you are seeing an EP, right?) doesn't need your surgery to buy is wife a new BMW.

[*] There are infections that will cause a heart block - resolve that the block may go away but that doesn't sound like the case here.

AgentX86

by PacedNRunning - 2018-08-11 21:29:22

Yes I’m seeing an EP doctor and I’m sure he makes plenty of $$$! He straight told me it won’t get worse. But I’m with you. I think it will but it’s hard to challenge his answer. He’s a smart doc. I read your Bio. Yikes. You’ve been through it. See I was a post CABG nurse. Years ago tho! But I had my fair share of codes and crazy rhythms but not really any heart block patients. Thanks for your answer 

Gotrhythm

by PacedNRunning - 2018-08-11 21:33:23

thanks for your reply. You make a good point. I’m only 46 so I feel like I’m too young but age is just a number. Just not something I thought I would be dealing with at this age. I certainly don’t want this to be a stat placement. I surely don’t want to wait until its bad.  These are things I need to hear despite the fact my doctor said it won’t get worse. Maybe because it’s 2:1. Not sure why 

What scares you about the pacemaker?

by LondonAndy - 2018-08-12 00:02:43

I think you are right that those of us who do not have a choice have it easier in so far as there is no time to think about It, we just have to get on and do it. In my case it was a surgical complication when they fitted a replacement aortic valve, so no pacemaker and I die, means an easy decision! I genuinely think having a pacemaker has made no difference to what I can do. Yes, there are issues such as needing a new one every 10 years or So, and new wires every 20 to 30 years I think. It may also help that I like gadgets, and so my pacemaker is just another gadget.

So may I suggest the issue for you is to work out what is stopping you from WANTING one now, and weigh up the risks of having one versus the risk of not? Since it doesn't sound like you would be 100% paced your life is not completely dependent on the device working, so maybe think of it as a safety net? The pacemaker stepping in when you are doing what you enjoy (exercising And keeping fit) to help you keep doing It, not hold you back?

LondonAndy

by PacedNRunning - 2018-08-12 00:24:12

first want to make a point that I never asked if it would get better. I know it won’t. I’ve had it since last October and if it were transient, it would be gone by now. 

I don’t know why I don’t want it now. It just doesn’t feel right. I think because my doctor has presented as an optional solution. Just feels like I’m opting for something major. I’m just may need more time before I get one. I’m just curious if other people have avoided one or Have just lived with what I have. 

Did he REALLY tell you it won't...

by donr - 2018-08-12 02:38:30

...Get worse?  REALLY!!!!!?

Sprint, don't even think of running, that's too slow, to some schlock EP who drives a beat up 1950 Ford & wears patches on his elbows!

That "Smart" guy is DUMB, DUMB, DUMB.  If he is so smart he can predict the future, he should retire & play the stocks.  No one can predict what a heart's electrical system will do or when it will do it. 

In your plumbing ward did you ever see a patient's situation change suddenly when no one was expedting it & "Code"?  Same thing can happen to you.

Sept, last year, suddenly, one Sat PM, I felt "something" happen - similar to the feeling I had when my first PM went belly up & into EOL mode.  #2 Daughter, an MD, took me to her clinic & ran a quick ECG on me.  HR was normal, even saw pacing spikes, but I was having  PVC's out the wazoo!   It was downhill till Jan, when I started a heart attack while in the ER.   Treatment w/i 5 min of initial symptom saved me from really bad results. 

I am a prime example of sudden, unexpected changes.

Dpnr

Dpnr he sure did say it won’t get worse

by PacedNRunning - 2018-08-12 15:45:20

that was one of my questions to him when we sat down and talked about my EP study. I think he’s saying this because the problem is in my AV Node and not below it. I have read from research articles that it’s very unlikely mine will progress unless it’s below the AV Node. Yes, I know it’s not predictible but I have a good chance it won’t get worse. But then again part of me doesn’t want to take that risk. It’s just a lot to think about. 

You def had an unpredictable event. Yikes. I do encounter them quite frequently in my day to day job. 

Overall, I’m very healthy with no other problems. :) 

Maybe your doc ain't so dumb

by AgentX86 - 2018-08-12 16:08:07

I did some more reading on second degree  heart block.  Apparently type-1 second degree heart block is stable, though it seems it's often misdiagnosed. From your description, this sounds like your diagnosis.

A 2:1 conduction ratio has to suck, though. You didn't say what your heart rate is or other symptoms. I think it's rather like Afib,  in that your path forward is more of a quality of life than medical emergency. I don't believe such things stay static, though. The pacemaker is the only thing that's made my life better.

I am also a bit different than most, here. My EP was suggesting (strongly) that I get a pacemaker but, because it would leave me dependent, was willing to try other solutions first. Those options ran out and the pauses closed other options. However, he had me thinking that way for almost a year.

BTW, cardiac nurses are the best.

Dpnr Thanks!

by PacedNRunning - 2018-08-12 16:32:58

Thanks for that compliment! :) I do love my job. 

He’s never said if it’s type 1 or 2. I’m guessing 2 because type 1 can resolve and it’s benign. Type 1 usually doesn’t require a PM. I use to think it was Vagal but it’s not. 

My symptoms suck! I will be running or really any exertion. My heart rate drops exactly in half. So I can go from a heart rate of 160 down to 80 abruptly. The first sensation I get is like something punched me in my upper gut. Then they just keep pounding on me until it goes away. Usually 1 1/2 to 2 mins long. I start breathing very hard and sometimes I get lightheaded. I stop when the first symptom starts bc my doc told me too because I could pass out if I continue. It’s hard to continue anyway! It feels awful. . I’ve continued a few times and my legs and Arms start feeling cold. :/ lack of blood flow and O2. The body will shunt to vital organs. I only continued bc I was too embarrassed to stop. 

When I got the first symptom almost a year ago it just felt like continuous palpitations and no other symptoms at that time. Just a weird flutter in my chest with exercise. 

Appreciate you reading about my condition. What I gather from all this is, I’m not the first person who has tried other methods first before committing to a PM. BUT it seems most end up getting one eventually. I just need to wrap my head around this and realize I’m just delaying the unenviable. 

Your third para...

by donr - 2018-08-12 17:44:28

...says it all.  Your symptoms suck.  And you want to live with that?  Suppose they plant a PM & your symptoms go away.  Turn it off & just carry it around like an implanted brick.  Until that day comes you can enjoy life - you have no idea how long that day may wait to come, either.  Meanwhile, the rest of you may deteriorate due to lack of activity. 

I was curious about your age - went back & read your Bio - then the long exchange w/ Tracey.  You've been going through this for nearly a year, now.  Surely by now you'd know if you were recovering from Lyme or any other malady that is reversible.  And you said it hit you suddenly while running one day ast Oct.  Do you think that this protects you against any other sudden occurrences?  Mine all started w/ one single PVC at 9:20 PM on 15 March 1977.  I was all of 41 yrs old! 

Tracey was correct when she wrote about the dangers of "Watchfull Waiting."  If you are wrong, you cannot re-set time & live it over. 

I'm not Superman, but my Cardio once told me when I was about to do something he thought was crazy that no way was he about to tell me "No."  I'd go do it anyway.  And he was right. 

Donr

Type-1 or tupe-2

by AgentX86 - 2018-08-12 18:46:02

Not that it matters but the way I read things, type-1 doesn't tend to degrade further but type-2 will develop into third degree block. The reason the PM is needed is to get your life back on track.  It's about quality of life.  If I had your symptoms, I'd be camped out in my EP's office until he could stick the PM in me.

In your business, you see a lot of people come out of the OR in pretty tough shape.  PM surgery isn't anyting like that at all.  It's a walk in the park, comparitively. Mine was done, along with the AV ablation, with only local anasthetic.  I also didn't have any significant pain after (didn't take any of the Percs they gave me).

I agree with donr.  Why in hell would you put yourself through this when you don't have to?

Donr,

by PacedNRunning - 2018-08-12 19:24:16

Donr- all very good points. I do look back at the first time I felt the symptoms and think...wow look how far it’s come.  My doc first thought it was SVT and scheduled me for an ablation. Only to find out it was a block all along and not SVT. I was even nervous about the EP study but was also ready to be “cured”. I’ve got a lot of thinking to do the next 9 days. All of this chatter has helped me realize I’m just a big chicken lol and need to just think about how it will be to be normal again. Swangirl said it right. I wont have to worry about my heart eventually. It does suck to worry about how it handles different situations. 

AgentX and Swangirl

by PacedNRunning - 2018-08-12 19:31:47

AgentX I don’t have the type 2 that can progress to 3rd because mine is in the AV node itself and not below. That’s why the hesitation. It’s not the surgery so much that makes me nervous. It’s the thought of having this thing in me forever. Those wires in your heart attached. 🤮. Silly I know thinking too much. I’m getting there. All this talk with :DonR has helped. 

Swangirl- I did wear the Zio Patch twice. The first time it missed my block. I think they thought it was sinus rhythm because 2:1 can look like that. But when your running with a heart rate of 70-80 they should have clued them in something is wrong. Especially when my max HR was 172 bpm. The second time I wore it, it only stayed on 9 days. I worked out 4 days. I had 40 events and 30 were heart block during exercise. Even after that my doctor said I’m glad your scheduled for your PM but still didn’t say you need one. 

Tiff,

by AgentX86 - 2018-08-12 20:29:26

Right, I meant that it was Type-1, thus wouldn't progress into a complete heart block (if that diagnosis is correct). 

<https://en.wikipedia.org/wiki/Second-degree_atrioventricular_block#Type_1_(Mobitz_I/Wenckebach)>

Because it won't progress into third degree block, it's a quality of life issue.  However, your QOL sucks, IMO.  I wouldn't put up with that.  Really, I don't understand your reluctance to get on with a normal life.

It's aminor procedure.....

by donr - 2018-08-12 20:43:36

...just ask your EP.  He'll tell you that.  No sweat at all!  FOR HIM!

He's not the one lying there, semi grogged out, while some dork w/ sharp objects grubs around in your one & only heart that has to last you another 40 plus years.  We will also tell you it's a minor procedure - but we have all been there at least once! 

I can see it now - They wheel you into the OR on the gurney, scared to death, thinking all the horible events that can happen.  Then one of your buddies walks over, slaps you on the butt & says "Hey there, Nurse Ratchette, you ready for this?  You do know that Dr. Pillpusher was last man in his med school class, don't you?  He's only been sued 6 times - Lawyer Shyster won every case, so you are in good hands - he says to call him Allstate."  

First time I went in I was petrified. I introduced myself to everyone in the room & chatted them up.  About halfway through, I felt the sheet over my head lift & a masked face looks at me & says "Just checking to see if you were still here - how's it goin'?"  Six weeks later i was at a formal banquet  & a strange woman walks over to me & introduces herself - turned out she was the OR nurse who checked up on me - wife of a friend.

Last time I met three Army Vets in the OR.  After a bit of chatting I learned that the big bruiser in the crowd had been a tank engine mechanic in the Army.  Got out & became an OR nurse.  Never did see my EP in the room - for all I know the tank engine mechanic did the job. 

You will be in good hands, trust me.

Donr

Lol. Tank engine

by PacedNRunning - 2018-08-12 21:14:59

Thanks for all that. lol. The PA gave me a script for Xanax to take a couple of nights before the procedure.  Lol. I made need More after because it’s the thought of having that thing that bugs me  

AgentX I don’t think they can tell if it’s thoe 1 or 2 because 2:1 it’s hard to see blocked P waves. It depends on the PR interval before and after the drop and when it’s 2:1 you can’t tell because it’s abruptly drops and ends. I’ve never really asked. I just know it’s not below where it is more likely to progress. 

AgentX

by PacedNRunning - 2018-08-12 21:18:29

Yes my QOL does suck for exercise. ://. Just don’t want that thing living in me. I just need to get past that. Mind over matter but dam it sucks! 

Aha!!! The truth.....

by donr - 2018-08-12 23:47:15

...comes out!    The old "I can't stand the thoughts of that thing living inside me!"  issue.  I remember from a very long time ago one of our female members saying that it felt like half a brick had been left inside her.  Eventually she got over it, but it was a struggle.  It is not necessarily a vanity thing, but more of a female thing.  Ask yourself if you would feel less aware of it if planted sub-pecvtorally so it cannot be seen or felt.  That is an option.  The recovery is a bit slower & more painful, since it requires that muscle be cut to make access to the pocket, but it can be done. 

How would you feel if you had a heart attack & required stents?  How about requiring rods in your back?  A plate in the wrist?  Have you ever thought about those issues?  Ever consider a "Stim" in the buttocks (for bladder incontinence); it's the exact same physical container as a PM.   Then there's the "Stim" in the abdomen for stomach gastroparesis.  How about the artificial valve - mechanical or porcine insideyour heart?  And the beat goes on.....

I'm not trying to belittle you, but to point out the number of implants it is possible to face.  I think it's more of a "Heart" thing - recall that I talked about men grubbing around in your one & only heart w/ sharp instruments.   You mentioned you were a CABG nurse - then you are familiar w/ the term "Pumphead."  THere are many psycho problems that bypass patients face, after all they face truly MAJOR heart intervention.  PM hosts face those same psycho issues.  Stop & think how your current mental state parallels that of your former patients. 

Hope I have been able to shine a bit of light on your darkness.

Donr

Donr This is different

by PacedNRunning - 2018-08-13 03:08:05

You got it! Having Someone all up in my heart attaching things and then they stay forever!!! I think pins and stents are different. At least for me. I wasn’t too crazy about the EP study because they fish wires into your heart. That freaked me out too but I did it. I had a lot of ppl tell me it was minor and no big deal. lol. Same as this procedure. You said it all right above. I am always the one trying to keep my patients calm and distracted and I’m the one that needs it this time. Lol. For the EP study the gave me versed as soon as I laid down. Felt weird and all I remember is them telling me to put my leg down. Lol. Woke up and they said we didn’t do the ablation. I said why? They said because you have a heart block. Next thing I knew I was in the recovery room with my doctor and husband staring at me in disbelief that I had a heart block all this time. Hope the same thing happens this time except I hope they don’t wake me up and saying they couldn’t put the PM in. We shall see. Still debating.  But at this point I may just keep telling myself it’s time and keep making plans like I’m doing it. 

It's beyond time!

by donr - 2018-08-13 08:31:11

Good grief!  Can't sleep, eh?  3 AM & tyou are writing away!

Nah, stents aren't different - they go in & stay in!  I dodged that bullet last Jan when I had that heart attack that wasn't.  Had the event on Sat AM; Mon AM I had a cath.  Came out w/o a stent because it was a blocckage on a "Tributary" of my LCA, about halfway down the artery.  Talk about miracles - My previous cath was in Sept, 2002 & they found 70% blockage in same LCA.  16 yrs later it's not significantly worse! BTW: I'm nearly 82.

I think that he haS it right this time.  Electrical block, NOT whatever he predicted last time leading to the aborted ablation.  Personally, I prefer propofol! 

I had your experience w/ a radioactive seed implant for prostate cancer back in Jan, 2004.  Went to the OR, freaked out of my skull & everything south thereof.  (WAY freaked out - believe me!)  Woke up, I have no idea when, to my oncologist staring down at me, accompanied by wife & MD Daughter.  Oncologist was apologizing to me because he could NOT plant any seeds - prostate was too large to get seeds into the margins.  It was back to IMRT for me for another 23 sessions w/ Enola Gay, who was going to nuke my worthless butt 23 more times! 

I did the calming & cheerleading things in the waiting room then.  Titrating liquid Immodium was my specialty.  I came out of the vault one early session to be greeted by a strange woman (about 46 ish) accompanied by a daughter, son-in-law & new baby.  Please explain - the staff says you are the expert.  So I did.  Family never came back, they were mortified.   

Speaking of cheerleading, are you ready for this?  Rah!   Rah!  'Ray!   Rah!   Rah!  'Ray!   I'm GONNA GET A PACER  HOOOORAY!

It's time for you to pull your BAT ACT - you know, just Hang in there, you WILL make it.

Donr

Pacing indications ( USA guidelines)

by Selwyn - 2018-08-13 13:37:06

Type I second-degree AV block is unlikely to progress to advanced AV block when the delay is within the AV node. Consequently, pacing is not usually indicated in this situation. However, in patients with type II second-degree AV block (either intra- or infra-His), symptoms are frequent, prognosis is compromised, and progression to third-degree AV block is common.

Best to go with the herd instinct rather than individual experience. Safety in numbers!

Selwyn 

Donr

by PacedNRunning - 2018-08-13 13:51:07

Donr- I had a dream last night I woke up after having my PM implanted and took a walk up a hill. It felt great! No shortness of breath or symptoms. I felt like I could breath easy and it was a piece of cake. In my dream I thought to myself, I never realized how much this affected my day to day life. I had brushed off a lot of symptoms as normal. Then as I was walking i ran into an older man and his wife and he was telling me how he has a pacemaker and how it has changed his life. Interesting. I’m sure all the babble back and forth between us brought on that dream. :). 

You my friend have been through a lot! Man oh man! Thanks for hanging out with us here! All of your info and insight has been tremendously helpful. :). 

Selwyn

by PacedNRunning - 2018-08-13 14:00:12

Unfortunately mine can’t be labeled type 1 or type 2 because it’s 2:1 and difficult to know because of that. Since it’s in the AV Node it can’t be labeled type 1 even though that’s where a majority of type 1 blocks are. It’s usually reversible and mines not.  Second degree is a hard one to diagnosis even for medical professionals. The other thing is since it’s symptomatic exercise induced second degree it’s a Class I indication for PPM. I was just curious if it would ever progress to advanced block since my doc said it wouldn’t. This condition is very uncommon and most doctors have never had a patient with my condition. So that’s why I came here. To see if others had experience with this or similar. If it weren’t for EP study, he wouldn’t know where the block is because you can’t tell from my EKG readings. 

Odd man out.....

by BOBTHOM - 2018-08-13 22:31:22

I'll be the odd man out in this discussion.  An ICD was strongly recommended for me back in 2005.  I declined.  For me, it was not going to improve my heart function, at that time was pretty much irreversible so I said no.  I was hoping for another therapy (stem cells) that would actually improve my heart function.  I finally relented in Jan 2017 and had the ICD put in.  I am not happy with it.  And I'm still hoping from stem cell research to advance enough to help as that really is the only option for my situation.

If it will improve your life go for it, if not, hold off and hope another solution presents itself, espeically if your doctor is saying you don't need it.

Just my 2cents

Bobthom

by PacedNRunning - 2018-08-14 00:55:13

It will improve my life in the sense I will be able to go back to my normal exercise routine of running, biking, volleyball and lifting weights. My doctor has never said I didn’t need it. He said this is the only way to fix it and make it better. He just said I can take my time and when I’m ready to get one he is there for me. Eventually almost everyone with this condition gets a pacemaker at some point. Seems the average is about 6 mos. this is from reading research articles since it’s so uncommon no one really knows what happens to those that don’t get a PM. 

Hmmmmmmm...

by donr - 2018-08-14 23:19:59

...6 months, eh?  You've already doubled that, so give it up already!

Donr

Donr hahahahahyoe

by PacedNRunning - 2018-08-15 02:24:02

Your the best!! 😂😂😂 taking with you has really helped me come to terms with all this. I’m normally a laid back chill person but this whole thing has me the quite opposite. I’m down to 7 more days until!!!!!!! So far my head is gearing up for it. I will let you know how it goes. 

Glad I could help...

by donr - 2018-08-15 11:01:40

...even if it is just a little bit..

The worst part of the PM process is the age of most recipients:

Sort of like soldiers - at age 18, they KNOW they are going to live forever - they are indestructable.  At age 65, they know that they are on  the last stretch of road, so it's just another day in the office.  It's all those ages in between that are problematical - they know how swet life is and want the road to be as long as possible.

Just keep pulling your Bat act!

Donr

Bing! Bing!

by PacedNRunning - 2018-08-15 12:01:18

You got it! It’s the age! At 46, I never thought I would need a pacemaker to stay active. Who knew?? I became a grandma last year and then this! Lol. What the heck!  You helped more than a little. I was ready to postpone this last weekend! It’s been so back and forth that my hubby jokes with me and says “until tomorrow!” Basically saying I will change my mind tomorrow. I’m doing it dam it! Lol. I went for a walk yesterday because I can’t  run and during my walk I decided to run. Wanted to see how far I could get before it started. That was a joke. Took less than a minute. Maybe 50 secs and got punched in the chest. My poor AV node is struggling. I guess when my doctor says he’s glad I’m getting a PM, what he’s really saying is you need it. Lol. 

Thanks again! I will let you know

how it goes. 

why wait

by dwelch - 2018-08-28 03:59:43

I have complete, level 3, heart block.  Am on pacer number five.  Damn glad to have one.  With number one it was very noticeable the affect it had.  If you wait too long you may not have the desire to be active again, where you get one now you can be better tomorrow than today and go back to running, take up new sports you couldnt do before the pacer, etc.   Yes there is a recovery period, yes you have to get used to it, yes you have to go back to the doc every year or maybe not with the beside things they have now.  But you might have to go to the doc more often without.  Certainly feel it more often without as you cant do stuff you want to do.

Pretty simple answer for me, but I have been paced 31 of my 50 years.  I dont think about my pacer any more than I think about my nose.  I see it in the mirror after a shower, (well the scar) I know its there, but its just another part of my body, like my nose.  Unlike my nose I get a new one every 10 years give or take, better than the last one.  Its the only part of my body that is better every 10 years, everything else is just getting older...

Hey think about it this way, unlike other doctors officies where you are pretty close to or at the age where instead of saying "we can fix that" they say "just get used to it"  you go into the cardiologists office and there is a lot of "you are so young" , "you are my youngest patient", "thats all, thats all the meds you take"

Hmmm, looks like I am too late, you just got your device.   Ill post this anyway...maybe support you feelling you did the right thing.

This info is great

by PacedNRunning - 2018-08-28 12:10:24

yes. I got the PM but your post is very helpful. I’m going through getting use to having this thing controlling my heart. I already went in for an adjustment bc I was going into junctional rhythm which wasn’t there before. It felt like those self tests it does but I was having them a lot especially at night so they turned it off. Now he’s thinking I have a sinus node exit block issue and perhaps that’s been the problem as along masquerading as an AV node problem. Crazy. I had it again last night and I shouldn’t so I’m not sure what is going on. So far I haven’t really noticed it only things like you said when I see the scar or move a certain way I know it’s there. I thought I would have a hard time after getting use to this thing but it’s not that bad. Thanks!