Aortic stenosis a pacemaker.

Sorry this is long...I went  in with symptoms of heart problems and get diagnosised with bradycardia and murmur. I received a 2 lead pacemaker then 2 months later a 3 lead in 2012. I have had random symptoms a pacemaker checks, asked questions and now just had generator replaced 2021. My murmur has never been addressed. I find out at that time just pre surgery that the 2 lead had put me into congestive heart failure..the 3 lead took me out of CHF and that 1 year prior ago  I was moderate to severe stenosis due to genetic bicuspid aortic valve.  Post surgery in 2021 and another echo and I am in severe stenosis.  Should I not have been followed up for murmur? The  MD said the pacemaker hid my symptoms of stenosis. Is this common? Do cardiologist do any other stress test after pacemaker put in?  I requested one a couple years back and cardiologist said It was  unnecessary. Should they ever look at structure other than electrical? I am confused. Is this something I should have persued on my own?  Do I need a different doctor? Turns out a lot of my symptoms were stenosis and not electrical and pacemaker forcing the heart to pump harder.  I need advice or information please. Thank you.


3 Comments

Stenosis

by AgentX86 - 2021-05-03 16:42:34

Hi slendsley, welcome to the club.

I don't think anyone will have exactly that combination of issues.  Whether or not this should have been caught, if that's your question, maybe.  About six months after my CABG my cardiologist sent me to have an echo done of my abdominal Aorta (I assume your stenosis isn't in the arch, rather the decending part of the Aorta) and then a CTA of my carotids.  Stenosis in one place is a hint to look elsewhere.  Nothing was found (needed a further cath on my carotids because the CTA showed blockages).  I don't think these are common tests unless a problem is suspected.  I wouldn't think a valve or electrical issue would be a cause to look for a structural problem outside the heart.  I don't believe an ECG would show a problem with the Aorta.  Am echo of the heart wouldn't show stenosis of the abdominal Aorta.

I did have a stress test before getting my pacemaker because of my history and they didn't have a clue what was causing my near-syncope.  I'd had years of electrical problems so after ruling out the obvious, they assumed electrical again and sent me home with a 30day event monitor (which I returned to the doc three days later and had my PM implanted three days after that.  I don't think they would have done a stress test unless I'd had a history of stenosis.

Should they have suspected stenosis instead of electrical?  Who knows.  I'd think they'd do a stress test before coming to any conclusions.  Sometimes the tracks really are from a zebra. OTOH, echos are so cheap that one would think they'd do one if there were any possibility of a structural problem.   I get one a year on both my heart and neck.  Thinking about it, I wonder why they don't also look at my abdominal Aorta.  Maybe they are.  ??

 

Aortic valve follow up

by Sharron2 - 2021-05-03 22:18:42

I am new here too and know really nothing about the new pacemaker my husband recently recieved, but he has had a congenital aortic valve problem for 40 years. His valve was loosely followed by his doctor for about 6 years with echos, electrocardiograms and stress tests. His doctor said he would develop extreme fatigue as the valve struggled. He actually had a small stroke in his eye that pushed it all over the edge and at 6 years in (1989) he had his valve replaced. It would seem that you would have at least chemical stress tests, electrocardiograms and echos. I look for a cardiologist attached to a medical school if you can and get several opinions for your care. Just know that there is not much to do for a valve problem except watch and wait till it gets bad enough to replace. But the watching should be done thoroughly and I think yearly with the best cardiologist you can find.

Aortic valve

by Julros - 2021-05-03 23:42:03

I have been out of cardiac care for a few years, but as I recall, Sharron2 is correct in that aortic valve stenosis is treated with replacement when a patient becomes symptomatic, usually chest pain.

Your heart failure was likely related to dyssynchonity from right venttricular pacing. Instead of both lower chambers contracting at the same time, the right side contracts first, causing the middle wall, the septum to shift to the left, and then the left side contracts. Because the two ventricles aren't squeezing at the same time towards the septum, they don't empty as well and the left side dilates and "fails" to empty properly. As the ventricle dilates the mitral valve doesn't close and causes a murmur. The third wire stimulates the 2 ventricles to squeeze in unison.

Perhaps the heart failure murmur obscured the aortic murmur? although these happen at different times in the cardiac cycle and are easily distinguished. Murmurs are usually evaluated with echos, not stress tests. And no, stress tests are not usually performed unless a person is symptomatic as they do not show improved outcomes. 

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