Second Opinion

I'm a 52 year old personal trainer, who has been diagnosed with a bradycardia -- slow heart rate to a 3.5 second pause and a wandering pacemaker. I don't know if the bradycardia is causing my dizziness, but I have noticed that I get dizzy when my blood pressure drops. Lots of unstable blood pressure. The last cardiologist decided that since my ejection fraction is 65%, I don't need a pacemaker. I don't know what one has to do with the other? Should I get a second opinion?

10 Comments

forgot to say

by Tracey_E - 2014-03-03 06:03:01

yes, get a second opinion! There are a lot of drs who will automatically say no pm needed on someone relatively young and healthy. If you don't need it, then that's great, but if it will fix your problem, then age is a stupid reason to tell you no. When a slow heart or pauses is the root of the problem, it's an easy fix.

bradycardia and pauses

by Tracey_E - 2014-03-03 06:03:06

3.5 second pauses alone are generally watched, not treated.

You are correct, EF has nothing to do with need for a basic pm. EF is a function of how much blood your heart pumps on each beat. Pacemakers speed up a slow heart. There is a particular pm with a third lead that synchronizes the ventricles (CRT) which can be used to increase EF if it drops too low, like under 25% or so. That's not even remotely an option for you.

Brady just means under 60bpm. The question is how much under 60 do you get and how long do you stay there. Have you had a Holter to see what your heart does over several days?

Have you had a tilt table test? That would look for sudden drops in heart rate and/or bp with positional changes. The pm can only help with the hr drops. Sometimes the bp drops are caused by the heart pausing/dropping. In that case, yes, the pm can help because it will prevent pauses. If your bp is dropping but hr stays steady, a pm won't help you but diet and/or meds can sometimes help bring it up. All a pm can do is make the heart beat faster, that's it.

second opinion

by wjs1954 - 2014-03-03 08:03:15

I would say yes,

My cardiologist from my first appointment before she did any testing said no pacemarker. After all her testing and recommendations of a EP, even after the EP called and said pacemaker she said are you sure. He was i have a pacemaker one week now. Not saying it will be the same outcome for you but in my opinion worth checking out. I am 59 and was/is in good health. Good luck.

Second Opinion (reply2)

by bgaineshunter - 2014-03-03 08:03:39

TracyE, what about a 3.5 second pause with a substantial bradycardia. I was told that "It get way down there and stays a while."

wjs1954, that what my cardiologist did, too. Makes me not trust him. You'd think they run a test before jumping to conclusions, especially when you are complaining about symptoms.

getting down there

by Tracey_E - 2014-03-03 10:03:00

It depends how low you get, how long you stay down, if it's happening at the same time as your symptoms. A holter will tell them all of this. If it's getting down low enough to cause symptoms, then yes a pm will help, pauses are irrelevant in that case.

Second Opinion(reply3)

by bgaineshunter - 2014-03-04 01:03:21

I believe it is one 3.5 second pause that occurs after a long period of bradycardia. I can probably look over documents to figure out how low my heart rate goes. I've seen it at 54 at 1:30p in the afternoon.

I also recently found out that I have a benign tumor on my left adrenal gland. It could possibly also be affecting my heart rate, because the adrenal glands secret aldosterone, which is a hormone that regulates blood pressure. I'm having the tumor evaluated. I may have Cushings Syndrome. I looked like I had congestive heart failure, but te cardiologist said the problem wasn't my heart, but never said that the emergency room report obtained from another hospital showed the tumor and a few other things. I guess he was waiting for my primary care physician to read the report. She claims she never got it. In any case, I'm not sure that the tumor could cause bradycardia. It can cause unstable blood pressure and tachycardias.

17 BPM

by gleesue - 2014-03-04 01:03:40

One big question? You say a 3.5second pause. You don't say if it's one (no big deal) or a bunch of them in a row (big deal). If you have several that would be 17 beats per minute, extreme Brady and dangerous. You will get dizzy and maybe to the point of passing out.

You need to get in and get this figured out.

Jerry

At daytime?

by golden_snitch - 2014-03-04 03:03:26

Hi!

If these pauses happen at daytime and you are symptomatic when you have them, a pacemaker might be indicated. At nighttime pauses of that length are usually not treated, and bradycardia at nighttime is pretty normal, too. But if you have pauses and brady at daytime and it matches those times when you have symptoms, I'd either talk this through with your current cardio again or seek a second opinion. How slow does your heart rate get? Anything below 60 is defined as bradycardia, but the worrying and the treatment often doesn't start before it's lower than 40bpm.

Inga

54 does not look that low

by wjs1954 - 2014-03-04 09:03:18

My average 180 hour total was 44, when I had the holter monitor for 24 hrs my rate dropped to 34 for 45 minutes in mid afternoon just went down stayed than back up to 40. It had dropped to 30 at other times just not for that long. My Cardiologist still said no PM, only after EPS showed SSS and pause did EP say pacemaker. I see you have other issues just saying all DR are different, I really do not know if they all agree on what a report means. Guess they are just human like us, bad thing is we depend on them for our well being. I am sure all will work out.

Second Opinion (reply4)

by bgaineshunter - 2014-03-04 10:03:47

Mine is likely SSS, too with a pause. The tachy may or may not be caused by Cushings Syndrome. That's why I will likely have to take care of the adrenal gland tumor first.

Also, I don't know if you are male or female, but men have larger hearts and lungs than women do and, therefore, they generally have lower heart rates, because their hearts push through more nutrients with each beat. The hearts of women and children have to beat faster to push more blood through.

It's funny, Someone told me that cardiology was probably the most objective field of medicine. That seems not to be true when it comes to treating arrhythmias, however.

Thanks for being so good with the replies. I think I should have been participating on more peer forums and reading more blogs. Seeing that others are having similar experiences dealing with doctors is reassuring. It's not just about me.

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