Syncope

 I've had my pm since March 2018 and adjustments and checks had gone well until my latest routine check-up.

The technician said she was slowing the pm down, I felt nothing. Then she said she's speeding it up. I said, that's horrible and that's all I remember. I had passed out! I came round with her arm round me shouting my name.

The technician brought a doctor in who then consulted the duty cardiologist. They said my aortic stenosis could have got worse.

Subsequent thorough EKG etc showed I had not got worse since more than a year ago.

Has anyone experienced this or have an explanation? I'm not looking forward to future check-ups!

 

2 Comments

Fainting with aortic stenosis

by Selwyn - 2019-07-20 08:33:59

During pacemaker checks the technician wants to see whether the PM is able to take the heart rate to the set maximum. In your case, with you having aortic stenosis, this is not a good idea! ( as you noticed). Basically, as your outlet from your pumping heart is narrowed, any increase in heart rate puts a pressure increase into your heart and you are not able to get enough time to let his pressure out before the next heart beat pumps. The result is a fall in blood pressure [ Betzold-Jarisch reflex (stimulation of left ventricular pressure receptors may lead to low blood pressure, a fall in venous return, and consequent slow heart rate)], potential damage to your heart, or an arrhythmia, as the left ventricle 'gives up', sometimes with fatal consequences.

I would be very cautious in having a similar racing heart episode ( and that goes for exercise). An EKG cannot tell you  the severity of your aortic stenosis. You need an echocardiogram and if necessary a pressure catheterisation measurement. ( They measure the pressure gradient ie.  the back pressure in the heart over the heart aspect of the aortic valve and the aortic aspect of the valve) 

I would be seeking some firm reassurance that I would not become a fatality. The pressure gradient across the aortic stenosis is fairly well defined for risk of this happening.

If you want the full horror read:

https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-3/vol3n42-Title-Is-Sudden-Death-a-Threat-in-Aortic-Stenosis

or similar. 

Take care,

Selwyn. 

Syncope

by BionicBry - 2019-07-20 08:39:26

Thank you, Selwyn. That explains very well. They have noted the episode on their computer and I'm now waiting a hospital letter,

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