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Concerned
I have had a pacer for 9 years and now my dr wants to change it to a ICD. I have had a veinogram which indicated a blockage. Could the blockage have been caused from build up around the lead? I have been extremely short of breathe also - could the blockage be part of the reason for that.??? Thanks for any help I can get.
3 Comments
Blocked veins
by golden_snitch - 2014-07-05 03:07:43
Hi MaryKay,
Usually blockages associated with pacemaker or ICD leads are in the subclavian or cephalic vein on the side where the pacemaker is implanted. Sometimes the innominate vein or even the superior vena cava can become blocked, too. These veins carry blood coming from the arm on that side (in case of cephalic/subclavian vein) or from the arm and head (innominate vein/SVC) back to the heart. So, a blockage usually leads to swelling of the arm, which can be painful, and you can sometimes see the veins through the skin. If the veins carrying blood from the head back to the heart are involved, you can typically also have pressure in your head and neck, headaches or dizzyness.
I'd not say that shortness of breath is a typical symptom, unless a blood clot from those blocked veins has traveled to the heart and then made its way to the lungs causing an embolism. But that normally does not happen with blood clots in the upper body, its rather typical for deep vein thrombosis in the legs.
Blockages in veins with pacemaker leads are quite common, and often happen unnoticed. Unlike arteries, veins are able to develop bypasses around the blocked area quickly. If a blockage is associated with symptoms such as swelling and pain, a blood thinning medication is usually prescribed to try to clear the blockage.
I have severe stenosis of the left subclavian and innominate vein most likely due to the presence of the pacemaker lead. Since I also have a surgically re-constructed superior vena cava, it was decided to put me on Warfarin at first, now Apixaban. But it's only because of my SVC history. My cardio, EP and cardio-thoracic surgeon all said that usually a blocked subclavian vein soon develops collateral veins (bypasses), and then the symptoms improve.
What you should definitely ask your cardio about is how he going to place an ICD lead (much thicker than a normal pacemaker lead) through a blocked vein. Maybe he's planning to move the whole system to the other side, where the veins are still fine?
Best wishes
Inga
Lucio
by MaryKay - 2014-07-05 12:07:08
Thank you - have family that live in Sao Paulo. Also know pediatric cardiologist in Recife. Thanks for the advice.
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by LuCas - 2014-07-04 09:07:45
Hello from Brazil,
Dear MaryKay,
I am Brazilian and live in Brazil. Whenever I enter this discussion site (Pacemaker Club), it is always a surprise to me to hear people say things like " I went through so many doctor's before I found one I have some faith in." While living in a "developing country", I feel very reassured that we usually have very dedicated doctors and very sympathetic ones. If you ever happen to need one Brazilian cardiologist, perhaps you'll have a very good surprise. They will treat you very well. Be sure about that.
At to you blockage, your physician should have already told you the reason. Next to the lead, it could be made by tissue formation. I don't know the percentage of how often that happens, but it does happen to some patients. If you are above weight and your collesterol is high, it could be fat deposits and you should be already aware about a low fat diet. Thirdly, I GUESS (I am not stating anything - ask you physician) it is not a clot or an emergency. If it was, doctors would suggest you to go to emergency care. If it is a complet blockage, then you would be sent to a catheterisation (the baloon procedure) to fix it as quickly and as invasivelly as possible.
But, if you know you have blockage and feel chest pain, go to an emergency service at a hospital. They have the obligation to tell you exactly what you have and the level of risk to you.
I hope that you find the answer as fast as possible. Living in doubt is the worse thing in life.
I hope that you feel good soon.
Lucio