PM types?

Hello. I am a 58 year old female who had always been physically active and was always told I had an Athlete's Heart with a RP of 30-40. In the last two years I became symptomatic (dizziness, shortness of breath) and was just told by 2 cardiologists that I need a pm. Does it matter that neither of these cardiologists checked on the sinus function? Or, are all pms the same for treating all causes of extreme bradycardia? Thank you very much.

6 Comments

PM SYNCOPE Research Analysis

by djohnston - 2016-05-15 08:05:57

http://www.stars.org.uk/files/file/Patient%20Day%20Presentations%202012/120923-Pacemakers%20&%20neurocardiogenic%20syncope,%20A%20Brandes.pdf

Yes you need a PM

by IAN MC - 2016-05-15 11:05:28

Having a resting heart rate of 30 to 40 is outside the normal range but is fine as long as you aren't having symptoms. But you now ARE having symptoms and these are likely to get worse over time.

Dizziness / shortness of breath may progress to occasional fainting which is best avoided

The Drs may possibly put a label on your condition; they may call it sick sinus syndrome or they may say that you have some sort of AV block but in a way the diagnosis / naming of your heart condition is secondary. It is symptoms which make us feel bad so symptoms have to be treated and it seems that you are showing the symptom of bradycardia.

The only treatment for bradycardia is a pacemaker, there are no drugs which can reliably be used for bradycardia.

But having a pacemaker is no big deal and is much better than fainting.

Best of luck

Ian

bradycardia

by Good Dog - 2016-05-15 11:05:28

An RP of 30-40 is abnormally low. The Cardiologist checks the sinus function by reading the EKG. A PM is used to treat bradycardia pretty exclusively.

bradycardia

by Tracey_E - 2016-05-15 12:05:06

Bradycardia means your rate is under 60. Everyone with a pacer has bradycardia. There are quite a few causes of it, sinus dysfunction being one of them. If you had an EKG, echo or Holter, they know what your sinus function and what causes your brady.

If you are active and have sick sinus, it will affect which pacer you should get. All pacers fix a slow heart rate, but some of them are better than others at rate response. Rate response is the feature that detects you are active then raises your rate for you if it doesn't go up enough on its own. This is for sure a discussion to have with your doctor before surgery. The other discussion to have is where they're going to put it. Many put it just under the skin, just under the collarbone because it's easiest and heals the fastest. They can put it a little lower and a little deeper, or they can put it under the pectorals or off to the side closer to the armpit. If you are very active, you might prefer it out of the way.

Another question for your doctor when making the decision which one to give you is how high it goes. At least one of the mri compliant ones only goes to 150, which isn't enough for an athlete. Most go to 180, there are 2 which go to 220.

You are probably going to be in for a very pleasant surprise once you heal and get back to being active! Most of us decondition and have more symptoms than we think we do. It comes on so gradually we don't realize how bad it got. My hr went from low 40's to 30's to 22 when I was admitted. I felt like I'd been mainlining coffee the next few weeks, I felt more alert like a fog had been lifted. It will probably feel very fast at first, but that feeling goes away. Normal feels pretty darned fast when you've been doing half that for a long time.

If you have more questions, ask away!

PM types?

by Heartfelt - 2016-05-16 02:05:00

Thank you for your detailed explanation. I actually experience dizziness throughout the day and have anxiety when falling asleep at 30 bpm. During the day, after rigorous morning exercise, my RP remains 30-40. I am drinking more and more coffee to keep my metabolism active and boost my pulse. I am trying to evaluate the best pm for my situation. It seems the Medtronic is most popular and therefore more reliable. So glad for this site!

Heartfelt

by IAN MC - 2016-05-16 04:05:17

You say that you have always been physically active and that you do " rigorous morning exercise "

Some pacemakers are better than others for people who exercise. An important question that you must ask your cardiologist is :-

" Am I chronotropically incompetent ? " If the answer is "Yes" that means that your heart rate doesn't increase with exercise the way it should and you need a pacemaker which will help you out by i ) detecting when you are exercising and ii ) will then trigger off extra heart beats via the Rate Response function

Medtronic is OK ( I have one ) but the way that it detects when you are exercising is not particularly sophisticated; it simply detects upper body movement. This is hopeless if you are cycling for example or for any activity where your upper body is relatively stationary

There are other manufacturers which have dual sensors.( eg Boston Scientific and Sorin ) These measure upper body movement AND any increase in breathing. I believe that these are better than Medtronic for people who regularly exercise.

Do discuss these options with your cardiologist before you choose the make of PM. They are all equally reliable

Ian



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