Passing out / fainting

Im 51 male , diagnosed with electrical problem with my heart.

Ejection fraction is just over 40 , resting heart rate 45 , inlarged heart , left nerve block damage ..

Im very active , was a heavy vehicle diesel mechanic and competed in kickboxing , muay thai , martial arts for 30 years.

Im on the fence weather to get a PM installed.

I have had 2 cardiac professors give me 2 different opinions. 

One said you need a PM the other you dont.

Vasalvagal is my problem..

I only pass out / faint when in severe stomach pain or de hydraited.. They are my triggers..I have had a loop recorder fitted and has picked up a 15 second flat line on my last episode..

My question to you all is, Do you have triggers which led you to get PM fitted ?

Or was your fainting random ?

Im realy confused , thankyou..



by athena123 - 2021-06-02 21:48:42

Hi, i see your on the fence. I was at the gym little over two years and my heart was racing(trachadia) half way through my exercise and its nothing ive ever experienced in my life. I was giving baby asprins at hospital and put on a holter moniter for 24 hrs. Well, next thing yiu know im back at the hospital because one of the hospitals cardiologist said my heart would pause up to 7 seconds at night. He attributed to my having sleep apnea for many years. Sleep apnea messed with the electrical in my heart. I had no idea so i was also on the fence about a pacemaker. I remember being on a cpap machine which did bring the pauses down a bit but got the PM anyways. I was confused and i did panic. Anyways, fast forward and im seeing an EP dr instead of a regular cardiologist who questioned the implanted of my PM. He told me with anti arrythia medicine and use of a cpap i could of been fine without one. I went through 6 heart Drs untill i found my dr now. Im keeping the pacemaker but he adjusted my meds so i think the question being is what to decide. I would definately go for a sleep study because yoiu want to make sure you recieving enough oxygen. Make sur you see an EP who works on the electric part of the heart because 40s is low for your heart rate. good luck and i wish yiu the best. 

Triggers or not

by AgentX86 - 2021-06-02 22:17:14

If you're passing out because of asystoles, you need a pacemaker.  First, a fifteen second flatline is half-dead (and the other half isn't looking so good).  Asystoles are only ended by a random electrical process.  For each second that passes, the chances of the heart restarting in the next goes down markedly.  Rinse, repeat.  OK, heart not beating (ever again) is the obvious.

Perhaps less obvious (but it should be), is that any syncope is a deadly risk.  If you're at the top of a flight of stairs, you might not survive (or worse).  If you're driving, the child in the car in front of you may not survive.  If you're driving at this point, I'd vote to convict of voluntary homicide.  Yes, it's that serious.

Back to your question...  Dehydration is an obvious "trigger".  Dehydration doesn't just mean that you need to drink more water but you need more "electrolytes" or "trace metals" (sodium, potassium, and magnesium).  These electrolytes are critical to the functioning of all nerve cells, particularly those controlling muscles.  Without them, muscles don't work.  You may notice leg cramps (or maybe even your stomach pain).  These are very often caused by a lack of one or more of these metals.  The heart is just one big muscle, so...  Vasovagal nerve damage is another cause but really in the same general class.

Hydration can be controlled but there is a reason you're getting so far out of whack.  The body controls the concentration of these electrolytes.  If this was a once-off thing, it wouldn't be so scary but this isn't a one-off thing.  Something in your body isn't doing its job (often kidneys). 

The result of this imbalance can be catastrophic so, yes, IMO you need a PM.  Pronto.  I was scared s***less at 6-seconds and had a PM three days later (Friday to Monday).  I didn't have to ask anyone.

BTW, a PM isn't a big deal.  You'll be able to do almost everything you did before.  Martial arts, particularly kick-boxing may be a problem.  A direct hit on the box won't hurt the box but it will certainly hurt you.  It may also damage the leads.  A shield can help but it's still going to hurt like hell.



Fainting / passing out

by Rizos - 2021-06-03 07:24:35

Thankyou for the feedback. It sounds like you have a wealth of knowledge regarding these issues.

My fitness level is great . The doctors are telling me your 99% perfect its that 1% we are concerned about. If you manage what you eat and go on a fodmap diet and keep hydraited does that elimate your problem if thats your trigger or do we install a PM for that 1% .

Having 2 Cardiac professors giving me to different opinions it makes my decision so hard.

I do weight training  , walk 10 klms ,yrain teenagers kickboxing / martail arts and feel great..

Dont have the traditional or classic PM diagnosis. Even the doctors cant give me a correct diagnosis after doing all the relevant tests several times over..

Im stuck !!

15 second flat line

by Tracey_E - 2021-06-03 10:27:21

That's all I need to read. Did the doctor who said you didn't need it see that?? Because 5-6 seconds is the cut off where they recommend pacing. Yeah, you might be able to control with careful hydration but wouldn't it be better to have a safety net? After 15 seconds, your heart may not start up again. 

You are also borderline to be a candiate for CRT, which paces both ventricles (regular 2 lead pacers pace just one) which forces them into sync and can raise your EF. 

That 1% may not seem like much, but please reread Agent's comments on passing out. It only has to kick in once to save your life. 

Odds are you'll feel a lot better with a higher resting rate. 

I don't know why they'd tell you you don't have a typical diagnosis. True, many of us have av block or sss (tho the argument can be made that your low resting rate is sss), but people are paced for vasovagal all the time. It's not ucommon and pacing is the answer for pauses.

Being active and feeling great isn't a reason not to get it, it's a reason to DO it, so you can continue to be active and feel great. 



Get the PM

by Mike417 - 2021-06-04 18:25:25

My brother was 58, had his own construction company.  He was at his office working late when he had to go to the basement to get some files.  He remembers standing at the top and woke up at the bottom with a broken arm and a concussion a couple of hours later.

I agree with what others said, get the PM.  There is little downside.  If you have vaso vegal syndrom that is not fixed with a PM.  How do you know you have this problem?  Did they do a test?  If you stand up suddenly do you get dizzy, or climb steps rappidly?  Or if you are running and suddenly stop do you feel like you are going to pass out?


Need for a PM

by Bionic Beat - 2021-06-04 20:09:37

Yes, you need a pacemaker.  Yes, you have a normal reason for having a pacemaker.

Syncope IS a reason for the implant and you should get it in ASAP.

15 seconds is a LONG pause.  Could cause sudden death.

Lastly,  being fit and feeling super has NO correlation to the need for a pacemaker.  

Let us know when its in.


All the Best,


Bionic Beat


by AgentX86 - 2021-06-04 21:01:58

Bionic, you're absolutely right.  I know I've beat this horse but I hope it isn't dead yet.

One of my brothers had an asystole when he and is wife were in the UK on vacation (she's a Brit), nine or ten years ago.  His heart still hasn't restarted.  He was in great shape (swam two miles, three days a week) and felt fantastic.  Don't screw around with this stuff.

get it!

by gillcatdec - 2021-06-05 01:59:13

I know i'm a little late to the party, but i would seriously advise you to have the pacemaker implanted. 


My situation was almost exactly the same. I'm only 19 and despite doing marching band and other activities all throughout high school, i suddenly passed out. My tilt table test showed a bpm of about 6 for 15 seconds. So basically nothing. At first they said dehydration, but after the test it was just an unclear diagnosis, definitely some kind of electrical problem, possibly vasovagal syncope, still not 100% sure, but mainly they just said to get the pacemaker. 

I'm also very worried on why a professional would tell you you don't need it. A 15 second pause is way too long. Like people have said before me, that 1% could prove fatal to you and others. Think of the pacemaker as a backup generator. Even if you're fine most of the time, there's no reason not to have it to prevent a rare but potentially serious case.

I don't do marching band anymore but 2.5 months post-op I feel better than I ever have. I thought i felt fine but there's definitely a difference in my overall energy and health. You will adjust to the pacemaker and be able to do basically everything you do now. I wish you the best of luck. Let us know how it goes!!

agree, gillcatdec!

by Tracey_E - 2021-06-05 11:26:17

 I thought i felt fine but there's definitely a difference in my overall energy and health. 

I've said this more times than I can count. We compensate and tell ourselves we just need to get a better nights sleep and we are fine, but it can happen so gradually we don't even realize how bad we feel until we feel good again. 

Fainting-19 second pause

by BHD - 2021-06-14 10:33:53

I am a 42 year old male and my story is very similar to yours. Active my whole life until last thanksgiving when I passed out doing the dishes. I have passed out 5-6 times since then, hospitalized twice and a slew of cardio and neurological tests which all returned with excellent results. Fast forward to last week and I had my first pacemaker implanted due to a 19 second pause the week before which was captured on a loop recorder I had impanted in March.  I was diagnosed with sick sinus syndrome. The people on this site have a wealth of information that I don't have since this is all so new to me (still trying to get my feet under me with this) but what I can contribute is that my cardiologist expressed that I did not have a choice, and that the length of the pause I had, not getting a pacemaker would eventually kill me. I have little kids and so dying on them was not an option.  Honestly I am so new that I have more questions than I can articulate but I speak up here as your case and mine seem very similar. My two cents, for what they are worth. Good luck 

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