Decision Problem

As a newbie here I need some help in my pacemaker decision:
My history is I am a fit 72 yr old who has had a slow resting pulse for many years, now 40 BPM. About 12 mths ago I had an EKG as a routine rest for hospital admission for eye surgery, this showed a resting pulse of 33 PPM & caused the hospital to request I got a cardiologist to clear me for the hospital admission & operation. The cardiologist cleared me OK & op went off OK as he commented he thought I had an athletes heart which accounted for my slow rest pulse. The Cardiologist asked me to come & have a check up in 6 mths & wear a Holter monitor, as well as having an Echo Cardiogram. The results of this were that the Echo was OK but Holter monitor showed a resting heart rate down to 20 BPM whilst asleep. Daytime pulse still around 40BPM. So now the cardiologist is recommending a dual chamber pacemaker implant.
As I am a symptomatic I am now trying to decide on my best course of action, do I have the pacemaker implant, or seek further opinions? I know my Cardiologist is pushing me a bit toward the pacemaker. I do have an Appt with the surgeon that will do the operation in early Jan 2012 .
Maybe you can help me in this difficult decision.

8 Comments

another perspective

by Zia - 2012-12-19 01:12:19

If you are in doubt, get a second opinion and a better diagnosis than "he thought" it was athlete's heart. I got my first hint of a problem also from an EKG for other purposes, at age 75. Another couple of factors may go into your decision. At our age, it will probably only get worse, not better, so if you're going to do it, now is the time. Knowing what is causing the condition may help you feel more certain of your decision either way. BUT it is YOUR decision, not the doctor's.

So know as much as you can and then do what you think is right and I wish you the best either way.

A difficult one

by IAN MC - 2012-12-19 09:12:57

Hi Ausb I would not rush into any sort of surgery if you are asymptomatic ! You really do need a definitive diagnosis.

Athletes heart as you know can be caused by people who indulge in really intensive exercise over long periods of time. This results in an enlarged heart and thickened heart muscles. This leads to bradycardia and it is not uncommon for people with this condition to have resting Heart Rates in the 30s. I haven't a clue how low their HRs fall when they are asleep. It is normally considered to be non life-threatening.

I was diagnosed with the condition and lived with it quite happily for a few years before I eventually blacked out and had to have a PM fitted
( I was an obsessive marathon runner but would never describe myself as an "athlete" }

As you probably know there is another condition "Hypertrophic myopathy" which is an inherited condition which can lead to sudden cardiac death, Many of the physiological signs are identical to athletes heart.... enlargement of the heart, bradycardia etc but doctors can do a differential diagnosis and find out exactly what condition you have.

The statement that "he THOUGHT you had athletes heart"
is not good enough. You should see your Dr again, or another Dr, and have further tests to give a reliable diagnosis. Once you know what your condition is you can make a decision based on the likely risks of having that condition.

20 bpm is fairly low and is not far from passing-out levels but I would still get a few more facts before agreeing to a PM

Best of luck

Ian



Hi Tracey

by IAN MC - 2012-12-19 10:12:30

I almost disagree with myself and was interested to read your response. When I was first diagnosed with athlete's heart the cardiologist told me that people with this condition can have extraordinarily low heart rates and still get enough oxygen pumped around for their needs ...the tail-end of the normal distribution curve and all that !

It is just possible that Ausb's HR during his sleep has been falling to 20bpm for the last 50 yrs and he only finds out about it during a an unconnected test ... unlikely I know, but possible !

so, Ausb, it really is no big deal having a PM and you would probably feel a bit more secure when you fall asleep every night BUT I'm sure you would rather know exactly why you need one .

Cheers

Ian

decisions

by Tracey_E - 2012-12-19 10:12:38

I'm going to disagree with Ian :o) While it's great that you are asymptomatic, in my opinion 20 while you sleep is a reason to just do it, no decision to make. You may feel ok, but your body needs more oxygen than that and it damages our organs when they don't get enough. At 20 bpm, there's no room for it to drop further and your first symptom is likely to be passing out. We've had members pass out on stairs, while driving cars. It's better to do it now before it gets worse.

No big deal

by RobertS - 2012-12-19 11:12:10

I'm pretty much a newby too having had my dual chamber pacemeaker implanted 8 days ago.

I had severe sudden onset bradycardia and my HR dropped to about 35 and wouldn't go up so I was gasping fror breath on any exertion, even talking fast, and my muscles hurt through oxygen starvation. Resting I was fine but moving about pant! pant! I am nearly 70 and had been fit all my life with no indication of any heart problem except mild hypertension. I was a distance runner, fencer and TaeKwonDo practitioner in my younger days till about 10 years ago when the poor old knees complained.

My pm was put in three days after first symptoms under local anaesthetic. Took about an hour in day surgery and outcome has been brilliant as far as I am concerned. The procedure was not particularly painful - I didn't even need diazepam or other relaxant.

The wound was sore for a day or two afterwords but nothing that paracetamol didn't solve. And now I have pretty much full movement back in my shoulder and a three inch scar.

My symptoms have gone and I find am sleeping better than before [It may be that when asleep before my heart rate was slowing down and waking me up but I didn't know it]. Hardest thing now is not doing too much too quickly and displacing the leads. I am out walking gently until the leads are fully embedded and my first check is in six weeks.

So don't let the idea of the procedure itself put you off. Your surgeon or cardio guy should talk it all through with you first so go armed with any questions you have. As to whether to have it for medical reasons I hesitate to advise.

If it was me and my resting HR was as low as yours, symptoms or no, I'd go for it. As my cardiologists said to me it isn't going to get better and it will just get slower and stop! I'd call it good insurance at a cheap rate. Major heart surgery it isn't.

Best of luck whatever you decide.

Robert

Thanks

by Ausbill40 - 2012-12-20 03:12:23

Thanks all for your comments on my decision on pacemaker implant decision. I am giving it all serious thought & am making a list of questions to put to the implant surgeon in Jan. If you have suggestions on what I should ask please let me know as your experience is of great value.

What kind of lump can I expect after implant? Should I make a point of asking this of the surgeon as obviously we all prefer it to be small as possible.

Also life/ recovery after implant comments would be great.

Thanks again all for your help, have a happy Xmas to all.

How big a lump

by RobertS - 2012-12-20 06:12:33

depends on how you are built. I'm tall and skinny. All the weight that used to be on my shoulders and chest seems to have slipped south! I blame Isaac Newton. They can tuck it well under the fat if you have any or the muscle but you should ask your surgeon how he intends to do it. Most surgeons don't like to leave a big scar or lump - reflects badly on them!

My surgeon while making the pocket to put the pacemaker in described it to me as like working on a 'tough old rabbit' but its 9 days now since the implant and I don't think the lump is particulaly prominent. Visible yes but only close up. The scar is about 3-4 inches and on my right shoulder [I'm left handed] just below my clavicle. When the hair grows back I probably won't see the lump.

I have had no recovery problems at all. Can't really believe it was so trouble free. I guess a lot may well hinge on what is causing you to have the PM in the first place.

There is plenty of advice on living with a pacemaker here on this site. I'm just taking it easy for a few weeks so as not to displace the leads and then I;ll be back to normal. I see one person on this site is running again three weeks after implant.

Hope that helps and have a super Aussie Christmas - our son in Brissy is having a barbie - surprise, surprise. Wish I was there.

Help Appreciated

by Ausbill40 - 2012-12-20 08:12:33

Thanks Robert I will keep your comments in mind when I have my meeting with surgeon. Will have to sit down & prepare a list of issues I think.

Have a nice Xmas, I have a son in Brissy but not going there this Xmas.

Bill

You know you're wired when...

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Member Quotes

Since I got my pacemaker, I don't pass out anymore! That's a blessing in itself.