Why no test for "ischemic heart disease" after PM?

This issue came up because my older sister had a stroke recently.  She is doing well in rehab and may escape any long term effects, but her doctor was asking her about the family cardiac history and she asked me to give her specifics about my problems that led to getting the PM.

So I looked at my hospital records from 2021.  I came across this note from the doctor who did the PM, "recommended consideration for ischemic heart disease or cardiac sarcoidosis." 

No one has talked to me about any kind of diagnostic to see if the cause was "ischemic heart disease"--wouldn't that entail a heart catheterization?  Should I ask for one? 

The last time I had a checkup I asked about the scarcoidosis and they said if I wanted them to, they could refer me to get a scan (PET I think) but it would involve going to a hospital several hours away, and I'm not sure my insurance would cover it.  And even if I do have sarcoidosis, hasn't the problem been "fixed" by receiving the pacemaker?  So I wonder if either test is worth doing, if the PM has already fixed the problem of damaged electrical signals in my heart.  Thanks.


Ask your doctor to confirm your diagnosis

by Gemita - 2024-04-01 12:45:40

Lillian, to be perfectly honest I don’t know how to interpret the note from your doctor who recommended a Pacemaker.  Could you provide more information?  The statement “recommended consideration for ischaemic heart disease or cardiac sarcoidosis” could mean anything, although I would interpret it:  "consider" ischaemic heart disease or cardiac sarcoidosis. It certainly doesn’t confirm ischaemic heart disease nor cardiac sarcoidosis, particularly since you do not appear to have had any follow up for these and yes if that note means anything, it should have been followed up.

My advice go back to your doctor and get confirmation of what that statement meant, whether in fact you have ischaemic heart disease or any traces of cardiac sarcoidosis?  I suspect not, otherwise this would have been followed up or else your doctor is grossly negligent.

So please stay calm.  It could be that your doctor was looking for clues for the cause of your difficulties when you were found to need a pacemaker - hence that note.  

No, the pacemaker will not fix either ischaemic heart disease nor sarcoid disease.  The pacemaker will only fix the electrical disturbances (like heart block or bradycardia).  

I suppose the most important question to ask you is "how are you feeling"?  If you are feeling well, then chances are that you are well, but do ask for clarification

What you need do now

by Gotrhythm - 2024-04-01 13:03:51

A pacemaker doesn't "fix" any kind of underlying heart condition--not sarcoidosis, not ischemic heart disease, or anything else.

The ICD-Pacemaker and CRT-Pacemaker do administer a kind of therapy, but they don't actually change what caused us to need a device in the first place. The pacemaker part maintains the regular, fast-enough beat that our heart can no longer do on its own.

All a pacemaker does is allow us to live better (though not neccessarily longer) with whatever heart condition we have.  

As for what further tests you might need--that's something you should be discussing with your cardiologist. A lot of times we're so shocked and overwhelmed by being told we need a pacemaker, we don't ask all the questions we need to.

That's okay. But the questions are coming up for you now. So now is the time to get an appointment. During the appointment you can inform them about your sister's stroke and any other family history, find out what tests have been done and what is the plan for your care going forward. Then you will know if you actually need tests for sarcoidosis or ischemic heart disease. And if you do, the doctor's office will make the arrangements for you to have them.

Cause and effect.

by Selwyn - 2024-04-01 17:59:27

Having a pacemaker may sort out the symptom, it does nothing to diagnose the cause of the arrhythmia. You should be investigated.

I insisted on further investigations, even thought I have never had symptoms ( pacemaker was for asystole whilst I was sleeping)  and ended up with a CT angiogram, showing a suspect coronary artery problem. An angiogram showed a 90% blockage in the anterior descending coronary artery. This was stented. I am lucky that my cardiologist agreed to further investigations otherwise I suspect I would not be alive. 

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