Questions and more questions

Doctor wants to put in PM. I was told on Feb. 4 2009 my cardiologist wants me to get a PM implanted. This all began not because of symptoms, I have no physical problems, but because of family history. I had a nuclear stress test to check for blockages, not conclusive pictures. They did find that I had a Left Bundle Branch Blockage. A delay of 160 milliseconds. A heart catheterization, no stents inserted or major blockages. An echo gram that shows a low ejection factor. Still no phisiological signs, shortness of breath, swelling or dizziness. Cardiac nurse says I am non symptyomatic and cannot explain why. I know I am a prime canadate of a PM because of the LBBB and hopfully this will help the ejection factor. If I had a heart attack I never noticed it. I like my job as an industrial electricain and am working around large motors. I love playing hockey. What questions should I ask, I am really, to put it mildly, scared

7 Comments

Questions abound

by mrag - 2009-02-07 01:02:53

Seems like Part 1 is clear, you need a pacemaker. Part 2 about work and large motors, you'll have to ask (where, what, when, why, how, etc). Part 3 on being scared, welcome to The Club. Although all things considered, for the most part, a pacemaker is not a "big deal," it is fairly small and unobtrusive, particularly for men. They have been used for many years. The "big deal" is WHY you need a PM in the first place. Since you are now asymptomatic you should remain asymptomatic (THE question to confirm). Jot down any questions beforehand and if you can, take someone with you to review the questions and answers with the doctor. If you are comfortable with the cardiologist (and make sure you are!) this should be "a piece of cake."

Why the low ejection fraction?

by BillMFl - 2009-02-07 05:02:18

And how low is it? No blockages requiring stents, etc is good. How about your ECG? Do you have a normal sinus rythm aside from the delay due to LBBB? If you have had a heart attack in the past, there should be at least a small abnormality in your ECG. The echo and cath should also indicated if you had any thickening or dialation in the heart walls or faulty valves. Something pretty specific must be causing your low ejection fraction. How many minutes did you walk/run on the treadmill test? It takes me 10 min just to get to my calculated max heart rate, and they make me stop after 12 min because they get nervous if an old guy keeps running up hill (i'm 66). If your heart rythm is bad enough to give you a low ejection fraction, then your ECG should have looked pretty abnormal in my opinion. So either you aren't able to give us a full and accurate dx, or you need a second opinion, because what you have said just doesn't seem to add up to me. Not that I am a qualified Cardiologist, haha. But in the past 8 years I have had lots of stress tests, and dozens of ECGs, and my wife, an ICU RN, has taught me what to look for on my ECGs and while I was being evaluated for a PM we always requested copies of everything, And I mean everything! Your patients rights allow you to have copies of all your labs, scans, cath report, etc. You can hand carry those to a second cardiologist and get his opinion before anybody starts cutting you open.

Seems like you haven't been given the full picture...

by maryanne - 2009-02-07 06:02:21

I would have to agree with BillMFI....seem like some pieces are missing in this puzzle. First question what is your ejection fraction? You should ask....I am having difficulties understanding why they would opt to implant a PM for someone who is non symptomatic, had a false positive MIBI which was confirmed by your angio which showed no blockage.....are they basing most of this on your echo? If so I would ask to have another echo performed...maybe their machine was malfunctioning that day? Stranger things have happened.

You really need to get some more answers....getting a PM just because there is a family history of cardiac desease doesn't cut it....I mean that would be like giving some one chemotherapy just because a family memeber had cancer.....

If I were you I would ask lots more questions and don't give the go ahead until YOU are confident they have provided you with the information you need to make an informed decision.

Like BillMFI's wife I too am a Critical Care RN and always ask for copies and explanations...it's your body you have a right to know....

All the best...please let us know how you make out....

cheers....Mary Anne

other questions

by Tracey_E - 2009-02-07 08:02:01

job- Some motors are a problem, specifically the big magnets. If there's a doubt, some pm manufacturers can send a rep to a work place to see if it's safe. Most new pm's are pretty well shielded against every day electronics and motors, but industrial isn't every day.

hockey- ask your doc to be sure but it should be ok as long as you have extra padding. Tell them about it when they do the surgery, they can sometimes modify where they put it to fit your needs and lifestyle.

scared- we all are at first! It's really not a bid deal living with a pm. I'm 42 now and have had one for 15 years. I honestly rarely give it a thought and most people who know me have no idea I have it. I'm active and healthy and my heart doesn't hold me back from anything I want to do.

get another opinion

by Tracey_E - 2009-02-07 08:02:27

as Mary Anne said, family history is not a reason to get a pm. I'd be asking more questions and getting a second opinion. How bad is your EF and how low is your hr? I'm not up on the numbers to know how bad the delay is but the pm's are usually put in to bring a dangerously low or irregular beat up to the normal range. Will synchronizing (by eliminating the delay) improve your EF? That's a question to ask.

Low EF may be the reason

by ElectricFrank - 2009-02-07 10:02:41

LBBB is no reason for a pacer. I had that for over 10 years before I got the pacer. Like mine it may progress to AV block, but that can take a long time if ever. Family history is no reason either.

TraceyE's suggestion that it may be to handle the low EF, but if you aren't having symptoms it doesn't sound like that is down to the critical stage yet. EF usually progresses slowly with plenty of time to deal with it when it becomes a problem. Of course a heart attack can lower EF suddenly, but that doesn't sound like you.

What kind of motors do you work around. It is the older motors that don't contain their magnetic field well that could possibly interfere, but even there I doubt it. I am an electronic engineer and have been exposed to all sorts of fields. A couple of weeks ago while out in the desert in my Jeep I drove right along one of the Los Angeles Water and Power substations and had no problem. This is megawatt stuff with large transformers.

frank

One last comment

by BillMFl - 2009-02-08 08:02:05

The echo EF can be compare to the EF they measured during you Cath procedure. They should be relatively close. You should have two ejection fraction results to compare. The Cath is usually more definitive for any abnormalities. The echo is non invasive and good for preliminary screening, but the cath is very revealing and more precise for any function defects. If you have a "clean" cath report, the problem is most likely to be electrical, but like Frank said, if you are asymptomatic then why a pm at this time.

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You run like the bionic woman.

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