Can someone explain Heart block please.

Im 44, female and last december was taken into hospital after a suspected heart attack. Luckily it wasnt, but after having the 24 hour monitor the results came back saying that at one point my heart paused for 3.9 seconds and a few hours later it registered 4:1 heart block.
I am waiting to see a cardiologist who at the moment is being very unhelpful in answering the questions i have, thank god i have a fantastic GP.
I have been told i will need a pacemaker, but id like someone who has been through this to explain it all very simply to me if possible. Thank you :-)

13 Comments

Bexy: Let's start w/ a quick lesson....

by donr - 2014-04-20 02:04:44

....on how your heart works. Will make the understanding of heart block easier.

1) We all know it has 4 chambers, two Atria (Top Chambers) & 2 Ventricles (Bottom chambers)

2) The Ventricles do the heavy lifting when it comes to distributing blood throughout the body. It's the ventricles contracting that gives you the pulse you feel at the wrist or elsewhere.

3) the Atria are in reality, just superchargers for the ventricles - they help them fill up easier & make them more efficient.

4) The Atria & Ventricles are connected to the lungs & body via a bunch of plumbing - the blood vessels.

5) So how is this pumping & plumbing nightmare controlled? Glad you asked!!!!! It is an ELECTRICAL CONTROL SYSTEM!

6) The heart (Pun intended) of this system is a pair of NODES - called the Sino-Atrial (SA) & Atrial-Ventricular (AV). Now, as logic would have it, the SA controls the Atria & the AV controls the Ventricles. So Far, so good.

7) The SA is also the master controller & makes sure that the heart beats regularly. It starts EVERY heart beat you ever have - while it is healthy.

8) The SA is connected to the AV via a bunch of electrical tissue that has very special properties. When the AV gets the signal (Known in western movies as the "High Sign") it makes the ventricles contract.

9) Now, when the chief hydraulic designer put the heart together, he (She) discovered that if there were a short delay between the Atria contracting & the ventricles contracting the whole lash up worked more efficiently. So She (He) went back to the electrical control system designer & asked for a short delay. That designer said "Sure, no sweat" & built the electrical connections such that there is, indeed a short delay introduced by the AV node before it makes the Ventricles contract.

10) All well & good. Your old ticker ticks & tocks away faithfully for years till one day, JUST like your TV set, something goes wrong & the signal stops getting from the SA to the AV - it is BLOCKED!!!!!!!!! Hence the name - "Heart Block!" Note that it has nothing to so w/ PHYSICALLY obstructing the blood flow like a heart attack does in the coronary arteries.

11) The block means that the Ventricles do not contract, so the body (Including the brain) gets no blood for a while.

This sounds like a SECOND DEGREE block where it has 4 good signals get through & the fourth does NOT. These kinds of blocks can take on any ratio - 2:1, 3:1, 4:1, 5:1 - etc. They can turn into a permanent block, where NONE of the signals ever get through. Now if you have a near 4 second pause, it really means that nearly 4 signals in a row did not make it. These kinds of things can make you pass out - NOT GOOD.

12) It's a simple fix - a PM does the trick. It looks for ventricle contractions & if they don't show up on time, it gives the old High Sign to the ventricles & they contract.

13) Now there are other reasons for a near 4 second pause - the SA node could be sick & just not generate the signals for the heart to beat. This one you need to get clarified by your Cardio.

You have given very sketchy data to really answer your question, but this is a start for an Easter Sunday afternoon when the Sun is shining & everyone is out barbequeing, picnicking & just generally horsing around in the fresh spring weather. Everyone but me - someone has to mind the fort!

Hope this starts you off.

Donr

Heart Block

by Dee224 - 2014-04-20 02:04:49

Welcome to the club!

I am a 59 year old woman who had sudden onset of complete heart block in Feb, resulting in having a pacemaker implanted Feb. 24th. It was explained to me that heart block is an electrical problem, a communication disconnect between the upper and lower chambers of the heart. In my case, with 3rd degree or complete heart block, the upper and lower chambers were beating independently of each other. For me this resulted in a very slow heart rate (bradycardia). My resting heart rate averaged 35 - 38 and dipped as low as 27 prior to surgery.

Since having a pacemaker implanted the dizziness, foggy brain, and lightheadedness have gone. At 8 weeks I am back doing laps in the pool and feel pretty much amazing (except for my aching arthritic joints). Life after implant is very good!

I hope this helps, but by all means do some research of your own online and ask questions of your doctors (insist on answers!). There is a lot of good information on heart block to be found, just make sure you are getting that information from reputable sources.

At 49, you should definitely inquire about having an MRI compatible pacemaker implanted. My doctors never told me about this option, and I wound up insisting on it while being prepped for surgery.

Good luck with your surgery. You should feel dramatically better afterwards!

Talk about Genes...

by donr - 2014-04-20 03:04:42

...I got my Mother's side of the family genes for heart problems.

Mom died at 94 from her heart just wearing out. She has three brothers hosting PM's & Her Mom sported on back when they practically had to be carried in a suitcase.

Grandma died somewhere after 84, Uncles still alive & all three are WW-II vets & in their 90's.

I got my PM at 66 & have had it for 11 yrs now.

Forget the nerves - the PM is a boon for those of us w/ electrical problems. Consider yourself lucky. It could be a plumbing problem & those can be infinitely messier & more crippling than electrical.

Donr

explaining heart block

by bexy - 2014-04-20 03:04:50

Thank you very much for your reply Dee and Donr, you have explained it better to me than anyone, thank you!!
Im due to see the cardiologist on 30th may but my gp is trying to fast track me as the shortness of breath is beyond ridiculous now, i cant climb a flight of stairs without having to sit down for half an hour and the palpations are worrying me.
Im worried, scared and nervous of having to have a pacemaker, but if it improves my quality of life then its got to be a good thing right?
My fathers side of the family are riddled with heart disease, trust me to get those genes!!

palpatations and Pacemaker

by kmom - 2014-04-20 04:04:57

Hi Bexy just wanted to welcome you to the Pacemaker club. There are a LOT of great people here on these boards with a wealth of information! I just got my PM put in on April 7! and I feel great! I don't think I had any heart block but I did have what's called Sick Sinus Syndrome (SSS or SND for short) and also I deal with A-fib which is another very common occurance It can also cause a lot of heart palpitations. Heart palpitations are generally harmless themselves but can signal other issues like heart block or a-fib. I was also having near syncope episodes, I was almost constantly lightheaded and walked around most of the time as if I was "drunk" although I don't drink anything ha! since the PM that has all mostly gone! vanished! kaput!! i'm still dealing with a-fib issues but they've bumped up my propafenone which has helped, i'm cutting out the caffeinated sodas and hopefully with in the next month or so may have the setting turned on my PM to help me with the a-fib--I don't know if it would help in my case --i'll let my dr. decide but for the most part i'm feeling a TON better in fact better than I have in YEARS! and I was only diagnosed with the arrhythmia problem last year!

Right about that!

by JLeslie - 2014-04-20 10:04:15

Kmom is right that there are a lot of great people who oversee this site and help others. It includes her and a number of others, including donr, whose explanations are so clear and helpful. He kind of reminds me of the fictional doctor Gregory House, but without the attitude.

I got my ICD in February and am just happily reading all about it on this site. Feeling good. Going in for an "interrogation" on Tuesday and I am going to ask the EP to print out all the diagnostics, etc. Regards. John

Hearts of gold

by JLeslie - 2014-04-20 10:04:40

Kmom, you and others who are willing to participate and share are the lifeblood of this site regardless of whether you "oversee" it in some technical sense or whether you have piles of knowledge or just good common sense. I have read the concerns and comments every day for a few months and marvel how good people to be to each other when they recognize they share a common interest and can help that person. I just thought I would make a comment now to acknowledge how valuable this site has been to me and ask everyone involved to keep up the good work. Happy Easter! John

@JLeslie

by kmom - 2014-04-20 10:04:59

Thanks for the comment although I do NOT oversee the sight ha nor really know much but I do like to reach out and help anyone I can with what little knowledge I have Thanks

Great people!!

by bexy - 2014-04-21 06:04:27

There are some great people on here and im so glad i came across it.
I think it will prove to be a god send for me to be able to speak to people who understand how im feeling.
I do have a wonderful twin sister who fortunately is a nurse and would do anything for me and a wonderful partner who does fuss quite a bit...lol!!
The rest of my family dont really understand how i feel and dont understand how this is affecting me.
In regards to siblings, would it be wise for my twin sister and brother to have a heart check to be on the safe side?

welcome!

by Tracey_E - 2014-04-21 10:04:18

I strongly believe everyone should have periodic cardiac work ups but the odds of your siblings having the same thing are low because heart block is not genetic. Often when we think of heart disease we think of plumbing problems which come from a combination of genetics and lifestyle choices. Block is an electrical problem, unrelated to all of that, and it often happens in a structurally normal heart with clear arteries. It can happen from infection or some medications, but often we don't know what causes it. I was born with it, no one else in my family has it. It's just an electrical connection that either was never there or was there and broke down.

St Judes has wonderful animations on their site explaining how the heart beats, what block is, how the pm works
http://health.sjm.com/arrhythmia-answers/videos-and-animations

I'm 47 so a few years older than you, but my heart block is congenital so I've dealt with it all my life. It is a very simple fix with the pm and leaves us with a normal heartbeat. There is nothing I want to do that I cannot. I'm healthy and active and no one sees a heart patient when they look at me. If you have any questions about the surgery or recovery, don't be shy. We've all been there. It sounds scary but most of us find it's not that bad, we quickly recover and move on with our lives.

Same here

by kmom - 2014-04-21 12:04:56

John This site has been very valuable to me and there are some of the most wonderful people here on this site too! You have a happy Easter too
Lisa

this is great info

by cb - 2014-04-22 12:04:48

I had to tell all the posters to this question that I just printed out the info (and special big shout out to donr) so that I can refer to it often to understand this thing that is complete heart block. It is still so new that I need to study it. I really really appreciate ALL of it. cb

Why a PM?

by HK - 2014-04-25 08:04:35

Please do not be afraid!! The pacer will save your life and, believe it or not, you will feel better and you should be able to carry on as you did prior. You may even feel better. I had a sudden onset, still unexplained, of complete to 3rd degree heart block. I am otherwise healthy as are all other heart functions. However, the electrical system in my heart is shot. I am getting normal sinoatrial node activity but zero ventricular note response. I am 100% PM dependent. If you get to 2:1 block you will not be able to function and so the pacer has to be set to not allow this to happen until you reach a significant heart rate. 6 months after my pacer insertion I still had complaints of severe shortness of breath and my EP, Cardio and Medronic Reps all said my pacer worked fine at rest. Heart block simply means the wires no longer carry the electrical impulse. That's it in a nutshell. Thankfully we live in a time when such an easy fix is available. Imagine if this were 100 years ago?? I know I would be dead. Back to the 2:1 block, this means the pacer is set, when your heart rate gets to a preset rate, begins to stop recognizing any increased need for a higher rate and begins to have 2 atrial contractions for every on ventricular contraction. THIS IS NO GOOD!. Like I said it took 6 months for me to convince everyone that there was something wrong. Nobody, including my loved ones believed me until finally I got the nerve the tell my Cardio that the PM may be working fine (at rest when they test it) but I got severe shortness of breath on exertion. Just to appease me he ordered a stress test and sure enough (you should have seen the look on his face) my own pacer put me into 2:1 block at 130 beats per minute. No newby PM patient will ever be able to rehab if his/her own pacer does this. With the ECG evidence in hand I went to the EP who spent the better part of an hour changing the settings to allow my heart rate to get up to 180 before my PM blocks me and now, 1 month later I am back my normal level of activity. I did get off topic but understand that the PM is your friend, you need it to connect the wires and you will be fine. Initially I had 7.5 sec pauses even when in CCU flat on my back. That means I was passing out every few minutes until they put an emergency external pacer in. By then I was so weak they had to wait for 1o days to implant my perm PM. Don't worry but if, aftter your PM is implanted you do not feel well push your physicians to help you until they listen. Do not take "no" for an answer!!! Best of luck.
HK

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