Making the decision

I am a 54 yr old female. I started having difficulty while teaching my spin class. My heart rate would be in the 140 range and suddenly drop to 50. I would feel faint and weak.

I thought it was low blood sugar. I ate before the next class and if happened again only sooner. This time when I hit 125 on HRM. Stress test results were the same. Transient heart block was the diagnosis. Since then a heart scan, sonogram , holter monitor several ekgs and an MRI of my heart ...I have been told no calcium deposits, NO heart damage, no anuresiums.

I am scheduled for an EP study and have been told that they are 90% sure I will need a pacemaker. I want to make the right decision...this is all a shock and moving very quickly for me. I welcome other experiences on this topic.

8 Comments

Similar problem

by WillieG - 2014-11-22 07:11:12

Hi! I am a 61 y. o. female who experienced a very similar experience last May while biking on steep hills. Stress test showed 2nd degree heart block but they could not tell if it was Mobitz I or Mobitz II with 2:1 conduction. Like you, my heart rate cut in half, although at higher levels. My low has been 72 so I don't feel dizzy or faint and could continue to bike uphill thru these episodes. I had an EP study and they determined with "physiological atrial pacing" that I had Mobitz II and put in a pacemaker while I was asleep (I had signed a consent form unfortunately). Afterwards, I still had HB biking uphill. My settings were changed twice and at the 6 week voltage turn down, I learned I had 69% ventricular pacing. That was not necessary for me and could cause Afib and other problems long term. My doctor did not respond to my letter with questions so I went for a 2nd opinion at the Cleveland Clinic. They changed the settings to let my intrinsic beat go until I had skipped a few ( not sure exactly how many). For some mysterious reason, my heart block only happens now once a month unlike a few times a day (with exercise where my HR was over 140) 6 months ago. I feel my pacemaker could have waited until my disease progressed, if indeed it would. I seemed to have improved and even feel like if I watch the monitor, I could prevent it! If I were you, I would get a 2nd opinion.

Good luck and I will wait to hear about your decision!

Still questions

by dlruddick - 2014-11-22 08:11:12

Thanks for your response. I am able to prevent "episodes" by keeping my heat rate under 120. Unfortunately for me that is not something I feel can live with. I have always been able to work out in a higher range until this September. I am also a competitive water skier and have struggled with energy levels all summer . Heart rate and Blood pressure have also run low during the work day leaving me exhausted one day and fine the next.

My EP guy is the Number one guy @the hospital I am going to and has written numerous publications. A retired radiologist (with whom I ski with on a daily basis) tells me I am with the right guy.

I am having an EP study in 2 weeks and they will put a pacemaker in if I need it that day. What king of questions would you ask if you had it to do all over again?

Making the decision

by dlruddick - 2014-11-22 08:11:14

I elected to have the EP study to see if we can get an answer as the reason for my problem more for my daughters and sister. My father died @ 44 of what was labeled as a heart attack. I do not have a clue if the small hospital in a small town in Indiana in 1981 was correct about his death . But, if I could give my girls more info, the EP study does not really scare me.

I really appreciate all of the responses and will continue to think this through.

Again, I welcome suggestions of what I should be asking my doc.

holter

by Tracey_E - 2014-11-22 08:11:18

IMO, the holter told you all you need to know so there's no need for the EP study. EP's studies aren't awful or anything, but they are invasive and it's not going to tell you anything you don't already know. Most of us with heart block have a structurally normal heart that works great except for a short circuit so that sometimes the signal doesn't get from the atria to the ventricles. The reason I say I'd skip the EP study is because the Holter will tell you when you are in block, and there are no other fixes for block. It won't go away on its own, there are no meds. If you don't have symptoms and can do what you want, then you can just keep an eye on it. If it affects your life and keeps you from doing what you want to do, then it's time to fix it.

Electrical problems just happen and we usually don't know why. That's probably not what you want to hear! Know that nothing you did caused it, nothing you could have done differently would have prevented it. Sometimes it's caused by surgeries, medications, infection but more often than not, it's just a fluke. The good news is it's a simple fix. The pm watches. Every time the atria beats, watches and gives the ventricles a fraction of a second to get with the program and beat. If it doesn't, it paces. I have complete block, so I pace every beat, have for the last 20 years. I feel great and have never had bad side effects. There's nothing I want to do that I cannot.

Got My Pacemaker

by Runningmama - 2014-11-22 08:11:58

Hi! I'm 34, a real go go exercise, type A, super mom, always on the move type..until earlier this fall when the "episodes came again". Long story short, I was diagnosed with type 2 stage 2 av block after many tests (stress test, holter (showed right up there), MRI, echocardiogram, etc.). I would go from a normal beat right to random bradycardia, heart would drop to like 37 and then the pauses were the worst (seemed like forever before my heart would beat again). My EP and normal cardiologist told me a pacemaker would be my fix. I had my Micra TPS pacemaker implanted at Emory University 12 days ago. My leg has healed from the procedure and I feel better than I have in 2 years. No more dizziness, tiredness, or pass out episodes. I have so much more energy already, and it is AMAZING to feel the strong beats after a pause (I know my device is saving me)...I am paced at 50, so when an episode starts I have to wait til my heart drops to 50 before my pacemaker steps in, I'm getting used to the process and know it's not long before I stop paying attention at all. I was on the fence too, but from what i was told, " stage 2 heart block becomes stage 3 heart block, it won't fix itself, so let's fix it today."~ end quote from part of my medical team..I did fix it that day and will be back to normal in about 2 weeks, have to start slowly and let the device grow into my heart but I'll be running again before Christmas. My birthday is in January, my gift to me this year was supposed to be optimum physical fitness, but instead it was a pacemaker, which I believe will give me many more birthdays....(it's taken me a while to get to that belief and still I have frustration and a hard time emotionally)..

I'm glad I listened to my doctor(s), care team, specialists, and self... and it came down to fix, so then I fixed..Believe me, I didn't want it at first (I'm 34, fit, healthy, why me?), I didn't believe it all, but now I would not have it any other way. I will not have to lose one more day to heart block episodes.

Hope this helps!!! Let me know how it works out.

It's a mental shock

by Theknotguy - 2014-11-22 09:11:43

It's a mental shock when they let you know you need a PM. Unfortunately I didn't get that chance. Passed out on the trail, woke up in the hospital after a six day coma. Already had the PM. So no chance for the - I want it - I don't want it mental discussion. Anyway it's a shock.

It doesn't matter that you were physically active. I had a heart problem, knew it, was doctoring for it, and taking my meds as instructed. Even though I was retired I was volunteering at a charity woodshop. I moved 2300 pounds of wood the day before the event. Walked 3 1/2 miles with the dogs and was out on the trail with them. Then the "heart event" happened. Never saw it coming. No one else did either.

So now I had this lump in my left shoulder. A bulge that didn't go away. Nice scar. What am I going to do?

Fortunately I had had a discussion with a nurse right after I ended up in the hospital after an afib session. She said, "You're a guy. Guys like to fix things. You're not going to fix this. You won't waste as much energy, won't be as frustrated if you learn to live with it instead of trying to fix it. You'll be happier in the long run." It was some of the best advise I ever got.

What am I going to do? I'm going to try to make the best of the situation. Worked that way during all my rehab. Listened to the nurses, did what they told me. Tried to be the best heart patient they had. Made sure they wanted to have me as their patient - it wasn't hard - to be the best patient that is. Courtesy goes a long way.

Oh yeah, had the pity party - why me. Talked with a psychologist. Got rid of the anger, concentrated on making the best of the situation. What did the Wizard of Oz say, "You are talking to a man who has laughed in the face of death, sneered at doom and chuckled at catastrophe. I was petrified. "

You said you used to do competitive water skiing. How many times did you run into a situation where the course wasn't right, ski was loose, water was choppy instead of smooth, boat and motor wasn't the best, driver wasn't what you wanted? Did you just turn around and quit? Or did you go out and make the best of the situation?

So now life has thrown you a curve. Betcha you didn't see that one coming, hmmm? So are you going to do, quit? Or are you coming out fighting?

In the heart disease world nurses don't get a lot of winners. When I woke up from the coma the nurses told me they didn't think I was going to make it. I was a win. I had a lot of people pulling for me. When I got out of intensive care several came down to visit me in the regular ward. They were tired of losing, they wanted a win - I was winning.

There are a lot of people who will help. There are a lot of people on this forum with a lot of knowledge - they'll help too. Feel free to take advantage, people like to help a winner.

Yeah it's frustrating when you see some overweight, overeating, taking a smoke person, who seems to have gotten away with it. They may have - for a short while. You're the person who was out there exercising - you'll survive an event they won't. Hang in there.

My last conversation with my EP was - condensed - sorry your grandparents swam in the wrong gene pool. Nothing they can do about the random afib events. But medical science has made great advances. The newest PM's fit inside the heart. Another member on this forum just got a PM with quad leads. The PM has tremendous control over his heart problem. Medication I'm taking now wasn't available ten years ago, some wasn't available five years ago. Software on my PM wasn't available until this year. My PM is just over a year old and it's already been eclipsed by newer models. Things are changing constantly. For the better.

Hang in there. Life gets better. Let us know how it goes.

EP study

by WillieG - 2014-11-23 10:11:48

They are probably doing the EP study to determine if your 2nd degree heart block is Mobitz I ( the more benign type) or Mobitz II, which requires a pacemaker. If I remember correctly, if you had 2:1 conduction, they can't see a decreasing P wave on the EKG as you are skipping every other beat. So the EP study determines where your block actually is. Could be in the AV node or below in the Bundle of His. They study was fine for me...just a little tenderness in the groin area where the catheter was inserted. I was drugged so I didn't feel anything. Good luck with your procedure and let us know what they find!

Pacemaker 1 week anniversary

by dlruddick - 2014-12-12 07:12:17

One week Post op and I now know that this was the correct decision. I am amazed how much better I feel just on a daily basis . I have Ridden a recumbent bike only twice and choose to push it just once. The HR monitor got to 130 and then...boom I felt was seemed to be an internal kick. My HR di not drop back to the 60 or 70 rate as it had been with exercise. I backed off immediately. I will push harder when I am told the leads and PM are healed enough to do so.

I still have a lot of questions and actually read my manual for my pacemaker. (helpful!!!)

Maybe I am in the" honeymoon phase," but I made the correct decision.

My daughter has a friend on her swim team who lost her battle with brain cancer this week (10 year younger than me).

This , my friends, is somewhat minor in comparison.

Thanks to everyone for your support.

You know you're wired when...

You have a shocking personality.

Member Quotes

The pacer systems are really very reliable. The main problem is the incompetent programming of them. If yours is working well for you, get on with life and enjoy it. You probably are more at risk of problems with a valve job than the pacer.