CRT

3 months on LifeVest. Beginning 4th month. Awaiting nuclear scan, then to meet Cardiologist for decision. I have more frequent weakness, tiredness. Spend so much time having to lie down. HR very up and down, even low 30’s. BP very up and down, can go very low. EF mid 30’s varying. NICM. Subendocardial damage low to mid left ventricle, not transmural. Septum not squeezing, but hopefully, this is electrically correctable. PVC’s many, IVCD’s frequent, LBBB. 

Should I expect much from CRT?

14 Comments

Wow! Just WOW!

by AgentX86 - 2019-03-24 13:27:17

I can't believe they're forcing you to live on a life vest for over three months. Waiting four months for a nuclear stress test? Waiting for you doctors to decide what to do with you? All I can say is FIRE THEM! No way would I put up with that.

As far as your question goes,  I really don't understand your situation well enough to know how responsive you'll be to a CRT-D it isn't a big deal. Living with a life vest isn't acceptable.

crt

by ROBO Pop - 2019-03-24 13:43:23

There is no reliable way to predict whether you'll actually benefit

Thank you, folks

by Jereems - 2019-03-24 15:29:15

Actually, the Cardiologist is great. Healing of heart muscle is taking place. I think the nuclear scan is capable of checking perfusion of blood in damaged heart muscle, that is, heart self-repairing. Then they will design treatment plan in such a way as to capitalize on the healing that has occurred. Doc doesn’t want to flog dead myocardial tissue. They need to ensure pacing be effective for my crazy septum AND sluggish myocardia. Also, I expect, Doc needs persuade insurance that there is sufficient viability to warrant all the dollars. That is my reading. 

Am I off the wall?

Thanks, Agentx86 and Robo Pop

by Jereems - 2019-03-24 15:33:20

But the waiting is frustrating. And, not knowing how effective.

Heart muscle healing

by AgentX86 - 2019-03-24 21:19:16

That makes a little more sense (waiting) but not a lot.  You're still waiting for a nuclear stress test, no?  Are you waiting for the heart to heal more?  How long? 

It's clear that you're going to need help, very likely a CRT-D, so what's the point of waiting?  I assume you have Medicare, so insurance shouldn't be an issue (it shouldn't be anyway). This stuff isn't experimantal.

I am trying to figure stuff out 866

by Jereems - 2019-03-24 22:14:54

AgentX86, I understand we are waiting for heart muscle to heal. This healing can be verified by (nuclear scan) adding radioactive stuff to the blood. If blood is accessing the damaged subendocardium tissue, it is seen by the camera, then the tissue is seen to be alive. Then, all you have to do is “flog” it with electrical “prod.” Continuing the metaphor of the horse, I would still be uncertain that a living horse may be “willing” and react as intended. Where precisely to “prod” and with how much voltage might need to be determined by Electrophysiology Study, whether via HIS Bundle, directly to subendo, or both. Then, because the septum is also compromised, this also must be examined as to how get best response. You see, my left ventricle, instead of squeezing, is kind of like clapping with one hand. Am I off the wall? I’m just trying to put the pieces together, and don’t know. 

I am trying to figure stuff out 866

by Jereems - 2019-03-24 22:15:33

AgentX86, I understand we are waiting for heart muscle to heal. This healing can be verified by (nuclear scan) adding radioactive stuff to the blood. If blood is accessing the damaged subendocardium tissue, it is seen by the camera, then the tissue is seen to be alive. Then, all you have to do is “flog” it with electrical “prod.” Continuing the metaphor of the horse, I would still be uncertain that a living horse may be “willing” and react as intended. Where precisely to “prod” and with how much voltage might need to be determined by Electrophysiology Study, whether via HIS Bundle, directly to subendo, or both. Then, because the septum is also compromised, this also must be examined as to how get best response. You see, my left ventricle, instead of squeezing, is kind of like clapping with one hand. Am I off the wall? I’m just trying to put the pieces together, and don’t know. 

Not Medicare. Private company

by Jereems - 2019-03-24 22:17:49

And they may prefer to invest in horses that have a future??

Not Medicare. Private company

by Jereems - 2019-03-24 22:17:49

And they may prefer to invest in horses that have a future??

Preferred horses

by AgentX86 - 2019-03-24 22:50:10

They may prefer a faster horse but they have a contract to ride yours. It seems you have a few laps left in you, given a chance.

How long are they going t force you to wait?  That really has to suck.

Yes. Frustrating

by Jereems - 2019-03-24 23:41:12

Yet, employer is flexible. You see, weakness comes on, awful tiredness. Some of the places I work, one really cannot lie down, which is what Cardio orders, so I often cannot show up for work, in those cases. 

Thank God for understanding employer. 

How many laps left? What odds are the bookies offering? Will I race or be put to pasture? Will the wall and the septum squeeze again?

Unanswered questions!

Cardiology fascinates me and if I had a cat, I’d love to catheterize his ventricles.

crt

by ROBO Pop - 2019-03-25 19:37:27

Your Dr is the one with a degree in Cardiology. He has a reason for having you wearing a life vest, if you want to know the reason ask him. If he thinks you may improve then you'd be crazy not to give it time. I wore a life vest for 6 months, it's not great but you'll get through it.

LBBB is where your ventricles are beating asynchronously which can cause lower force with each beat resulting in reduced EF (ejaculation fraction) ie lower blood output. in theory by forcing the chambers to beat in synch your EF will improve and in many cases thats true. They've found that if your QRS delay is 150 milliseconds or greater you are more likely to benefit from that therapy.  A CRT forces the chambers to beat simultaneously (cardiac resynchronization therapy). Now that being said there are no guarantees. 48 % of CRT patients do not see improvement. As I mentioned elsewhere in another thread I have seen no improvement but in my mind it was worth a try.

Good luck and trust your doctor, he's the smart one

Gonna give me CRT next month

by Jereems - 2019-04-13 20:27:41

MUGA EF showed 45%. Much higher than earlier readings on ECHO (30%-40%). But heart rate 40 bpm, and left ventricle not taking any instructions from Sino-atrial pacing, lots of pvc’s, QRS about 170, frequent fatigue, weakness.

just hope insurance covers it, as 45% to them will look high.  EF reading seems to reflect improved heart muscle, but not the effective consistent pumping action. 

Terribly tired!

by Jereems - 2019-04-14 00:14:41

3-1/2 months gone since diagnosis

6 weeks to wait for CRT-P

Terribly tired!

Need stop what I’m doing to get sleep in afternoon  

Is such waiting usual?

 

 

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