recent bradycardia, mulling next steps

New to the forum, I don't even have a formal diagnosis yet, just trying to think ahead. I'm 60 years old, male, fairly fit. My bradycardia just popped up four or five days ago. I now have a resting heart rate of 40-43 when it was 65-70 a couple weeks ago. And during cardio exercise my heartbeat now gets up only to 72-75 when it used to reach 115-125 at the same effort level. I huff and and puff walking up hills with dizziness which goes away when I stop and sit down. I'm scheduled for an EKG and Holter monitor next week after which the doctor and I will talk. My question is this. If the doctor recommends a pacemaker, is it ok to wait for a while just to see? I'm supposed to take an overseas trip the middle of next month, just for a few days. I'd like to do that trip and come back before thinking about next steps. Your experience or comments? How long was it for you from the time your bradycardia was first noticed to the fitting of a pacemaker?

15 Comments

Caution....

by Terry - 2013-10-26 05:10:17

The pacemaker scientific literature, as your Dr. knows, warns against ventricular pacing in the apex of the right ventricle, still the classic place to put the pacing electrode. PacemakerPatientAdvocacycom teaches how to avoid the detrimental affects of excessive ventricular pacing. Note that this should not be of concern to you for the time being if you have sick sinus syndrome however, because then you need not be paced in the right ventricle.

All the best to you and yours,
Terry

We're all different

by KAG - 2013-10-26 05:10:24

For me, aged 59, I had no idea I had a heart problem until mid-May I noticed I was getting out of breath when walking up hills. I thought it would go away so I ignored it for a short time but the SOB and fatigue stayed and I started getting nausous which was not normal for me. I checked my BP (was OK) and noticed that my HR was in the 40's when resting. Went to the Dr (end of May) and diagnosed with 50% AV block, and to make the story short I had my PM installed within 2 weeks in mid June. The day they installed it my AV block went to 100%, and I'm totally dependent on the PM.

For me waiting would not have been a good idea, but we're all different. I guess knowing what I know now I would not want to take a chance and pass out unexpectedly. I doubt it would happen at a good time.

You have to decide

by ohiolaura - 2013-10-26 06:10:50

On whats best for you,I agree to listen to the Dr,as they have the knowledge.Then you have to decide, my issue came on suddenly,I was 49,fit ( I think) and female.
Within 2 weeks of the first sign of something wrong,I had a PM put in.
I had first off feeling on a Sunday,the following Fri after working out,went to the ER as I was having PVC's,sent to another hospital and stayed overnight,went home next day with a 24 hr holter monitor,so that was a Sunday I was sent home.
On Wed,3 days later,left work with issues,went to another ER,and from there,I had the choice of where to be sent,and I chose the Cleveland Clinic,as Im close to there.
That was Wed,the following Monday,I had surgery,I stayed at the Clinic from Wed as my HR would drop to 42 or so,and then go back up,and down.They kept me til they could fit me in,which was Monday morning,I was the 1st to go,which was good.
I was diagnosed with Mobitz2 block,and haven't been paced a lot,but Dr said it will get worse.
I am glad I had it done,as I don't think I had a choice really.
I started to walk again a couple week after,and at 6 weeks the Dr gave me the green light on everything.
I have been back to doing everything for a long time now,the surgery was July 2012.
You have to decide,its a lot to take in,unfortunatly many of us have no choice in the matter.
Good luck,keep asking questions.
Laura

ery Important:Don't mess around

by zuxx - 2013-10-26 07:10:31

I think John is correct.
You should take care by yourself.

Good move!

by lbdina - 2013-10-26 08:10:22

Erik,

Get all the trustworthy data you can and then you will be more prepared to make a quality decision.

I gotta say (at least for me) it was a real relief to finally find the cause of my issues and find a workable, long-term solution. I was really tired of unexplained meltdowns. I don't regret getting my PM implant...it was clear I needed it. I'm totally comfortable with my decision. Knowledge is power. Get the data, listen to your EP, and weigh the pros and cons.

We look forward to hearing how everything comes out, regardless of your decision. Trips are important, but your health takes priority. Wishing you the best!

thanks all

by erik - 2013-10-26 08:10:33

Thanks everyone. I'm still trying to absorb all this. Four days ago I didn't even know that a heart rate could even be too low! EKG next Tuesday then we'll see.
Erik

Recovery

by valley01 - 2013-10-26 10:10:47

I'm very new to this. I'm 43, female, fit and had a heart rate of 37 that dropped to 30 after ablation and I ended up in the ER feeling like I was going to pass out. I got my PM that day (October 1st) and I ran a 5k today. I couldn't have waited because I could hardly function but I'm also glad I got it so fast and wasn't sick for weeks or months waiting for it.

Great answers...

by donr - 2013-10-26 10:10:49

...BUT Not a single one of us knows where this man is going "Overseas" or, for that matter where HOME is!

What if "Home" is next door to the Cleveland Clinic, or the equivalent in the UK or Australia & "Overseas" is into the jungles of the Congo, miles from anything but a tribal shaman?

What if the trip is by plane & the flight time is across the Pacific Ocean. Erik's heart goes south on him in mid Pacific means as much as 6 hours from appropriate medical care. There are no cardio care facilities to implant a PM on Wake Island. Even a flight across the Atlantic from New York to London is a minimum of three hours to such a facility.

This is NOT a wise move,

Don

Personally, I don't think any cardio worth the certificate on the wall will participate in such a course of action as Erik proposes.

As rapidly as electric problems can occur & change & get worse, it is too much of a gamble to take.

Don't mess around

by Jonny - 2013-10-26 12:10:02

If the dr says have a PM get it done asap, for all the reasons mentioned by Ibdina and Smitty. As both of them say if it drops further and you pass out while driving your car you could end up causing a major accident.

John

What Would I Do

by SMITTY - 2013-10-26 12:10:32

Hello Erik,

I say follow the dr advice. All I have to base my decision on is some numbers you posted, the dr has more information about your heart.

Now look at this another way. Your heart rate dropped a good bit apparently in a short time. If it were to drop more you may pass out. Let me repeat that "If it were to drop more you may pass out." Would you feel safe, or comfortable, if that were to happen during your trip?

My recovery from my pacemaker implant was just a few weeks and was not painful. But if you have questions, or want confirmation of what this dr tells you, get another opinion.

Yours is not an easy decision, but from what you say you say, your dr is not one of theses that says "we need to do it right now" and if it were me I would feel comfortable following his recommendation.

To answer your question about how long was it between when my bradycardia was first diagnosed until I go my PM? About 10 years at age 71 and I got a PM in 2000. Two things that make my situation different from yours. My resting heart rate was in the low 50s and I never had a problem.

Good luck,

Smitty

Welcome Erik!

by lbdina - 2013-10-26 12:10:38

Erik...I'm 63, in reasonably good health, but have bradycardia, sick sinus syndrome and vaso vagal syncope. I passed out on top of an extension ladder due to these unresolved issues and nearly broke my back when I fell. Syncope can be dangerous if you are driving a car, on a ladder, or in other situations that can hurt you. My problems came on slowly over many years and we only discovered the cause after my fall, while I was hooked up to a heart monitor in the hospital. I must have had around 20 syncope episodes over the last dozen years, but we never connected the dots or caught the problem on a monitor. I suspect we are all different.

Yours apparently has come on rather quickly. I guess you need to weigh the risks of passing out, especially if things continue to change. If your heart rate only goes up to mid 70s during exercise, you will also need a pacemaker with a good rate response to help your heart beat faster during exertion. If you are huffing and puffing during your trip, at best it won't be much fun. At worst, it could be dangerous, depending on the diagnosis.

Definitely do the EKG and Holter and have a frank discussion with your cardiologist/EP. Find out from him if your condition requires immediate attention.

I wish we'd figured my problem out 10 years ago...it would have saved me many nasty episodes. I've smacked my head on hard bathroom tiles 3 or 4 times when passing out. Not fun.

Lou

Welcome to the club

by Grateful Heart - 2013-10-26 12:10:56

Another consideration, if you know and trust your Doctor, you may not want to take the chance of having your HR tank even further and needing an emergency implant by a Doctor you are not familiar with while you are overseas.

In any case, discuss this with your Doctor so you can make an informed decision.

Best of luck.....let us know how it goes.

Grateful Heart

did EKG today

by erik - 2013-10-29 06:10:56

Don, I belly-laughed over your message but you make good sense. My doctor "advised" me to cancel my November trip "until we get to the bottom of this." I will do so. (It was indeed across the Pacific, US to Asia). Today I had my EKG and per doctor's orders am wearing a Zio patch, not a Holter monitor...the Zio gathers heart data over a two week period. My EKG shows a 1st degree AV block which is not new info, I've had a 1st degree block for decades. Today's PR interval was"quite noticeable" at 0.46 (normal is 0.20 or below.) But this morning happy to see my resting HR was back up to 60bpm.
So for now I'm in limbo. Unless I deteriorate all I can do is wait for the Zio to collect two weeks of data after which I mail the device directly to the vendor who then takes several more days to make the data available.

Darn! The Old Curmudgeon...

by donr - 2013-10-30 07:10:05

...Stumbled onto one again!!!

Don't you hate it when someone guesses a course of action you are contemplating?

I've made a couple trans Pacific trips before & remember the loooooooong stretches of water w/ no place to go in the advent of a life-threatening emergency aboard. Seattle - Tokyo is a strange one - you are most of the time not too far from land, but never near anywhere to set down for emergency help. Then there's LAX or SFO to Asia - some really long legs over open water; definitely no place to stop there. Not even for an aircraft emergency.

Glad you elected to postpone the trip. Let's just hope that your problem is easily solved - & doesn't get worse.

Don

Doc says get a pacemaker

by erik - 2013-11-15 01:11:09

Well, I handed in my Zio Patch a few days ago (14 days of continuous heart monitoring) and met with my cardiologist yesterday. In the meantime I was feeling better and better. Bradycardia went away, HR now back to normal at 65 resting and up to 135 or higher when exercising. Still, he said I had twelve instances of 3rd degree heat block while wearing the monitor, when asleep at night, ranging up to 11 seconds of asystole. Most asystole episodes were in the first few days of the monitoring when I was feeling worse, but a couple in the last few days when I was feeling better.

He said it's "black and white" that I need a monitor. I asked, why did the bradycardia go away then? He said, the top part of my heart may have returned to firing away like normal but the bottom part gets delayed and on rare instances doesn't fire at all. As for type of pacemaker, he said I need a dual chamber one that most of the time will let the top part beat as normal and then trigger the bottom part to beat soon thereafter. Sometimes the top part may need assistance too.

OK, so I'm scheduled to get the pacemaker Nov 22nd. Now I want to learn more about pacemakers. I'll start reading around but any tips on how I can educate myself?
Thanks
Erik

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