Advice?

Good morning...

Well the cardiologist at hospital was very concerned . However the cardiologist I just had switched to send saw once, just chalked it off.

My primary Dr is also very concerned. I have an appt now on tue with my EP. As I swear I feel something is definitely wrong.

Why would one cardiologist feel nothing to worry about, another cardiologist extremely concerned as well as my primary  Dr.

Am I losing my mind here?:(

I pace in atrium and right ventricle Soo my atrium SHOULD contract...I'd think.

Hopefully this attached here too..

On verge of tears...

Thank you!!!

Summary:

Please note that during the echo cardiogram the patient had transition from sinus rhythm apparent loss of her atrial contractility as evidence by lack of both p wave and an A wave by velocity.

Left ventricle ejection fraction 60-65

Accurate diastolic assessment was impaired by the patients transitioning atrial rhythm.

Trace mitral and tricuspid regurgitation.


6 Comments

Seem right?

by My3sons845 - 2019-03-13 14:16:23

Wow Robin1..

You've had a long road too.

Interesting what you write and true. Seems I didn't have any leaky valves and my atrium was contracting prior to my PM placement. 

I just can't understand why it's not contracting since one lead is in there? I'm clueless...about it all and have to wait till tueTues to either hesr- it's normal or not.

I'm feeling not...

Any thoughts? Anyone

Pacemaker stuff

by Dave H - 2019-03-13 15:40:08

I've found (the hard way) some EP's aren't worth the proverbial plug nickel.  Way back in 2012, I had developed a NSR heart rate of 125.  EP at the time did nothing to address the issue (he was too busy being narcissistic).  After four months a major A-Fib event erupted, and I chose A-V Node ablation w/pacemaker instead of another try at atrial ablation.  Couple years later, a heart failure Doc I was seeing made this comment while he was performing a PM optimization on me: "You know, that EP who allowed you to stay in a 125 heart rate for those 4 months was probably the prime reason you developed what's known as a Tachycardia Induced Cardiomyopathy."

You're not clueless --you're RIGHT!

by Gotrhythm - 2019-03-13 16:33:00

When two doctors completely disagree, it doesn't mean you're crazy. It means one or both doctors are misdiagnosing your problem.

I don't think you are clueless. I think the echo report is pretty clear. I think the doctor who said everything is OK is clueless. You don't have to be a medical doctor to know that an atrium that doen't contract is a problem. It isn't normal. Ever.

An atrium that doesn't contract even though it has a pacemaker lead isn't normal. Ever. Either something is wrong with the atrium or something is wrong with the pacemaker/lead. Or both. But something is definitely wrong.

In either case, you probably don't feel very good and your intuition that something is wrong is spot on.

I wasn't sure which doctor you are going to tomorrow. I hope it's the EP who sees a problem. You need and deserve a rational explanation of the echo report. And you need a rational treatment plan. You definitely need to see an EP.

Do not go alone. Take someone with you. Tell them your concern and ask them to help you listen for the answer. Tell them to question anything they don't understand.

 

Clueless

by My3sons845 - 2019-03-13 17:27:45

Gotrythm,

Thank you..thank you.

I felt it wasn't "ok" that my atrial was barely contracting and at times not at all on the echo..but went from knowing this was wrong by hospital cardiologist to seeing the one I see which I don't care for- telling me it's nothing.. was wrong!!

I couldn't find a thing to back my gut feeling up on Google either.

I see my EP on Tuesday. Funny too as Everytime I've been getting my pm checked I've been saying doesn't seem right. I'm out of breathe, weird heart beats etc tired..I even left last time and cried in my car on way home.

I'm ok with something's wrong here it was being the middle of it's nothing to it's very complicated has to be seen by your EP .so I sat on it.:(

Seems the fraction is ok at 60-65 but not good that atrial not really contracting with the lead in.

It's all so frustrating and confusing but thank you again for easing my " I'm not crazy" feeling as my anxiety is sky high and I battle to begin with.

:)

EF of 60-65 is Good

by KonaLawrence - 2019-03-14 03:09:40

Hi MY3SONS845,
I'm not a doctor of any kind, but I've read about Echo's a lot.  AND, I've had quite a few myself.
As was said by the other people,  you deserve an EP who can clearly answer your questions.  If you've been seeing this same EP for years and yo are anxious, you might consider seeing another EP.
If it helps your state of mind, I see in your Echo results that you have an Ejection Fraction of 60-65%.
Any EF above 50% is acceptable/normal.  At 60-65, yours is great!  That means you have a strong heart that is pumping as much blood as is possible for anyone in perfect health. Only extreme athletes with enlarged hearts get an EF of 65-75%.   The other notes in the Echo should be answered, but may not be serious since your heart is pumping so well.  
Since you've had so many procedures done you probably already know this...cardiologists are often referred to as "plumbers" since they deal with the physical parts of the heart (muscle, veins, etc.).  On the other hand Electrophysiologists (EPs) deal with the electrical system.  A cardiologist could look at your structural situation and say it's "OK".  An EP might look at the same data and have some conern about the electrical system.  So heart docs can disagree and both be right!  Of course, there are also docs who speak carelessly and yes if it's not your speciality, heart electrical issues seem "complicated"!  
Good Luck, Lawrence
 

LVEF of 65%

by AgentX86 - 2019-03-14 08:45:09

That's great! To put a point on Lawrence's post, above (I'm not a doctor of anything). With a a 65% EF, I'd be looking elsewhere for the cause of your breathlessness. You can live a perfectly normal life without any atrial function at all. The atria provide a "kick" to the ventricles function by improving the filling of the ventricles. With a 65% LVEF, that's not your problem. It would limit an athlete but not normal activity. Something to be concerned about? Perhaps. Something to worry about endlessly? No.

I had an AV ablation (ventricles disconnected from the atria) and am paced ventrically only (no atrial lead at all). Because of the dyssynchrony between the atria and ventricles, my atria actually have a negative contribution but, like you, my LVEF is 65%. I'm no athlete but I walk a lot every day.

By all means, though, if you aren't happy with you doctor, ANY doctor, find another who makes you comfortable. I'm not saying to find someone who will tell you what you want to hear, rather someone who will tell you how things are and teach you what you need to know. This is critical to your wellbeing.

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