I Am SO CONFUSED!!

Hi all,
Okay, so I have posted here a few times since I found this site, however I read the posts everyday. I must say I am amazed at how in tune so many of you are to what is going on with your hearts. I guess I should start with a somewhat long summary of my problems. Six years ago(age 44) while living in Maryland I had an episode of shortness of breath, chest tightness, extreme heaviness in in my shoulders. My work called EMS and off I went to the hospital. Unfortunately, yet fortunately in the ambulance they gave me nitro spray under the tongue twice and by the time I got to the ER the symptoms were gone.Nothing was found. Good stuff! Over the years I kept having alot of irregular heartbeats. Finally went to a cardiologist. Still found nothing wrong accept some PAC's & PVC's. One year after moving to San Antonio, Tx. in a 24 hr period I had a heartrate of around 50 (usually in the 90's/ 100/s) and my BP was very low ( I have high BP). Went to the ER and they found nothing wrong. The doc was just coming in to release me when looked up at the moniter and saw a junctional rhythm (???) They kept me in for a 3 day cardiac work-up. Everything looked good.When I followed up with my doc. he stated (I don't know why they put you in the hospital for that.)Well needless to say I found a new doctor the next week. From then on everything moved fast. My new doc picked up on an arrythmia and sent me to an EP. Diagnosis was PSVT. Did an ablation. Within 24 hrs. I was back at the ER with Paricarditis. After that cleared up all was good for a couple of weeks, then started having continuous rapid heartrate. My EP had me come in for a 24 holter. The next day he told me that I had Brady/Tachy. and recommened either another ablation or a pacemaker. I didn't know what to do so I called my primary for advice and he said to think of the PM as safety net and go with that choice. Well I did and after all the kinks got worked out things are great now. Ok, so here comes the confused part. I still have weird heartbeats and skipped beats (i think)and I don't have any idea what is going on. How do you guys know the difference between all the different irregularities? I don't know whats what? I know this turned into a book and I am sorry for that. But I am SO CONFUSED!!! :( Most of the regulars to this site are so in tune with what is going on and I want to be that way too. Does it come with time? March will be my 1 yr. PM anniversary. Any tips?

Willing to learn!

Jessame

5 Comments

AFib.

by jessame - 2009-01-17 09:01:14

Hi mikenc,
Thanks for the input. I forgot that during the 24 hr. holter they also picked up on Afib. There are so many terms that I have encountered at the dr.'s that I forget what they tell me and when they find problems. I guess my primary was correct in saying that PM's are safety nets. The main reason for my pm was that I have high BP and the meds that I take slow the heart rate down, so it becomes a problem because of the brady/tachy. So now my pm is set not to drop below 60bpm. Our problems sound fairly similar. I hope I am explaining everything right.
Thanks again and take care
Jessame

Hi Jessame

by mikenc - 2009-01-17 09:01:59

You have come to a great website to get feedback and hear the different experiences we've all had. From what I've been told, in regards to your irregularities....the pm is not a cure or a corrective device for what problems you are having with your heart rhythm.....it is a safe guard to keep your heartrate from dropping below a certain rate, like mine is set to keep me from going below 60 bpm. I've had afib for over 14 yrs...... I went in brady/tachy in november and got my pm implanted then. Hope this helps what you r talking about.

Take care...
mikenc

A few thoughts

by ElectricFrank - 2009-01-17 11:01:25

Most of the arrythmias that we experience can be traced back to a irritable heart tissue. The nerve bundles in the heart are located in this tissue and when there is inflammation or a chemical imbalance they don't function well. There are two different effects which can appear alone or together. One is that nerve conduction is impaired or blocked resulting in skipped beats and a slower HR. The other is where signals appear that aren't part of the normal process and have the effect of speeding up the HR. There are medical terms to describe all this.
Three common approaches to dealing with these problems are a pacemaker, an ablation, and meds. For blocked pathways a pacemaker can supply the missing signals and cause the heart to beat. Since a pacemaker can only add beats it isn't very effective in slowing the heart.

For problems like afib or vtach and all the cousins the first try is usually meds to calm the irritable tissue. If that doesn't work ablation destroys heart tissue in the problem areas either eliminating the offending areas or cutting its ability to be conducted to one of the chambers. Since this approach usually cuts one of the necessary routes for a normal heart beat, they implant a pacemaker to wire around it.

Now, this is how it is supposed to work and often does. The problem is that ablation can create new irritable tissue in the same way that any surgery leaves inflammed areas and scar tissue. These create their own arrythmias and often require follow up ablations until the offending areas are isolated.

I realize I've gotten pretty long winded so I will ablate my typing hand for the moment.

best,
frank

Junctional Rhythm...

by chip - 2009-01-18 10:01:59

I’ve been suffering from a junctional rhythm for some time now so I can empathize with your plight.

When you’re in a junctional rhythm you feel terrible and experience hypotension (at least I do) along with an overall tired “nasty” feeling.

The ordeal you describe sounds a lot like mine as I started with a tachy heart and had an ablation for it. Then the brady (slow rate) set in so I got a pacemaker.

But then I began experiencing almost total cessation of any atrial activity. In my case the junctional rhythm was secondary to the atrial failure, just my heart trying to keep going. My pacemaker would no longer pace the atrium either. Long story short – My EP corrected the problem using a new lead and placing it in the coronary sinus.

View the procedure here: http://wwwp.medtronic.com/newsroom/content/1213706985403.video.wmv

This is not saying that you will need surgery. A junctional rhythm can be controlled in many different ways they just didn’t work for me.

To put it simply (and to the best of my understanding) a junctional rhythm is defined as follows:
In a normal heart the sinoatrial node or SA node sets the pace for your heart beats acting as the hearts pacemaker. The beat starts in the SA node then causes the atrium to beat. It then passes from the atria through the AV bundle, traveling along fibers to the ventrical causing the ventricle to contract thus pumping blood to your body. This is the “sinus rhythm” in which the atria contract before the ventricles.

In a junctional rhythm the SA node does not control the heart's rhythm. The heart's atrioventricular node takes over. (natures backup system) With a junctional rhythm, the atria will sometimes actually contract with the ventricle and try to pump against the closed valve.

The electrical impulses start at the junction between the atrial and the ventricle areas of the heart thus the term junctional rhythm.

Stay on top of your doctors and don’t let them tell you that you have to learn to live with it because you don’t or that it’s no real big deal because it is! There is treatment out there you just have to seek it out.

Please drop a message back and let us know how things are going for you!

If you have anymore questions please don't be afraid to ask.

God Bless & Live Well

Check your meds

by Philman - 2009-01-18 11:01:57

It is wise to educate yourself about your medication. Some times a slight adjustment (less) can make a tremendous difference. It has been my experience that docs over prescribe rather than start low and work up. It would be good to talk to your medical team about your symptoms and measure their response. Good luck and let us know the outcome.
-Philman

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