My Mother-in-law

She has following diagnoses at the age of 93:
1) stage 3 stable kidney failure. Has been reason for
high blood pressure and has been treated to avoid further progression -
stage 4 begins dialysis.

2) Ischemic cardiomyopathy - lack of blood flow to part of heart muscle
has heart muscle unable to work properly.

3) congestive heart failure - reason for hospital - fluid accumulated in
pericardium and in lungs

4) severe mitral and moderate tricuspid regurgitation

5) left branch bundle block

6) ejection fraction 10-15%

7) atrial fibrilation.

8) occasional stopping of a-fib with pulse rate then dropping to 40 or
so, leaving her on edge of passing out.

Were she younger, or stronger, (2) might warrant catherterization and
angioplastey, or open-surgical bypass. Similarly, (4) would warrant
open surgical repair. BUT she's not young and not strong anymore.
Thought is surgery of that magnitude would kill here.
Similarly, cardioversion would be tried on younger patients.

Cardiologist is suggesting a 3-lead pacer to try to overcome (5) by
better synchronizing 2 sides of heart to improve pump efficiency, not
sure how well those work, intent is to improve (6). Would also address
(8). Surgery is much less involved than with the
power-saw-on-breastbone that you went through at age 7--and which Dad
went through age 80.

In short, she might make it to her birthday without the pacer, but if
she is to make it past birthday to age 95, she probably needs it.


This is what my husband sent me about his mother. I have had a PM since age 7 for Complete Heart Block. I have no idea about any of this. Any input from anybody would be appreciated.

Becky

2 Comments

decisions

by Tracey_E - 2014-12-27 09:12:59

Does mil have an opinion? What does her kidney dr say? I'd worry about the stress on her body going through even a minor surgery. A two lead like we have is an easier surgery than a 3 lead but not as effective on low EF. Really, this is just a band aid,not a cure, so you have to weigh what you hope to get out of it vs what it will cost her in strength. It's not going to cure anything for her other than raising her heart rate. The pacer can send the signal to make the heart beat faster, but it's up to the heart muscle to respond to that signal, contract and beat.

When my grandmother was 95 she was in a similar situation and she was not well enough to make her own choices. Dad and I decided not to intervene. We knew she had limited time left no matter what we chose, so we didn't want her to spend that time having tests and surgeries. That doesn't mean that's the right decision for everyone and I'm in no way telling you what I think your family should do, just letting you know what we decided and why, and that we were all ok with it, no regrets.

All of the sudden

by Beckes76 - 2014-12-27 10:12:11

My MIL was doing okay living on her own until this last summer...then one of her grandsons moved in to help when he is at home and not at college. Her daughter is just less then a half a mile away. I told my husband that a PM wouldn't do her any good and pro long her life. She will be 94 in May and very thin. I don't think any kind of surgery will help at all, it might make it worse for her. He wanted some input on the situation.

Becky

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