ER visit for PM

I almost passed out Friday night just all of sudden. I was a passenger in a car. Pacer was not keeping heart rate at 60 setting when I checked it. After going on for an hour called Dr. to do a reading over the phone and they could not do during hours the device clinic was not open. Could not believe this.We live 1 1/2 hours from my clinic. They said to go to the ER where we live. They don't have the device to check my pacer. But decided we would go to our local hospital. The physican in the ER called Medtronics and they were coming up from Kentucky to do a check. Told they would be here in about 2 hours. Finally came and checked pacer. He said it was a good thing that we did come in. The reason for the PM was SSS and he said that I was having heart block and changed the mode form MVP to DDDR. Does heart block just come on or what caused this? I have a dual lead PM and he said that it was sending the signal in the ventricle but now having heart block and the skipping beats that it was unable to get the signal through in the MVP mode. I had been having shortness of breathe for about a week. Thought I was eating to much salt and had really cut back and even with my water pill and cutting back was not helping.My cardio is out of town and I can't discuss this with him. He said that know I was pacing 100% in the ventricle. Will this always be? Thanks for any help !

Amy

2 Comments

Explantation of Heart Block

by Vicki - 2007-09-17 07:09:48

Hi Cottontop, sounds like a very scary time for you. I have a PM for complete heart block. The signal wasn't getting through the AV node. When I first joined the site two months ago Stepford Wife posted the following for me. Hope it helps. Heart block can just happen all of a sudden. It did me. I had no symptoms, never fainted and always had a rapid heart rate. Then one day I felt faint, breathing problem, weak in the legs and went to the ER where I was told I was in third degree complete block. Anyway, here is the explanation:

Heart block is a disorder of impulse conduction, meaning that an electrical impulse is impaired from traveling along its normal pathway. Heart block is also called atrioventricular block, because it often occurs in the atrioventricular, or A-V, node, which transmits electrical signals from the atria (the upper chambers of the heart) to the ventricles (the lower chambers of the heart). Depending on its severity, A-V block may be an abnormal delay, a partial interruption, or a complete interruption of the impulse. Delays often have no symptoms, but can cause the heart rate to fall so far below normal that it causes dizziness or fainting. Certain forms of intermittent block may occur in normal people during sleep and cause heart rates of 40 beats per minute and even lower.

Physicians classify heart block based on the length the delay:
In first-degree heart block, the ECG shows one QRS wave for every P wave, but the pause is greater than normal.
In first-degree heart block, the ECG shows one QRS wave for every P wave, but the pause is greater than normal.
First-degree heart block: Heart beat impulses are delayed in the A-V node, but ultimately reach the ventricles. Sometimes, first-degree heart block can eventually lead to other forms of heart block.

Second-degree heart block: Heart beat impulses are delayed or blocked in or around the A-V node, and some of the impulses fail to reach the ventricles; Second-degree heart block is further divided into two sub-types:

* Type I second-degree heart block, also called Mobitz Type I heart block or the Wenckebach phenomenon.
* Type II second-degree heart block, also called Mobitz Type II block.



In second-degree type II block, notice that the P wave (4th bump) isn't followed by the QRS wave, because the ventricles weren't activated.
In second-degree type II block, notice that the P wave (4th bump) isn't followed by the QRS wave, because the ventricles weren't activated.
Third-degree heart block: Also called complete heart block, each sinus node impulse is completely interrupted in the A-V node or beyond, and the ventricles must generate their own impulse to contract. Depending on its cause, third-degree block may be transient (temporary) or permanent.

WHAT ARE THE SYMPTOMS?

Heart block symptoms can vary according to its type, frequency, duration, and whether underlying structural heart disease is present. Heart block can contribute to bradyarrhythmia, or an arrhythmia that causes an abnormally slow heart rate (fewer than 60 beats per minute). People with bradyarrhythmia may experience the following symptoms:

* Dizziness or lightheadedness;
* Low blood pressure;
* Palpitations (the sensation of skipped beats);
* Fatigue; and
* Syncope (fainting).

CAUSES AND RISK FACTORS

Heart block may occur at any age, but commonly becomes more frequent during middle age and is associated with aging. Among people without heart disease, the exact cause of heart block may be unknown. Milder forms of heart block may be caused by certain medications, including:

* Adenosine;
* Calcium channel blockers;
* Beta-blockers; and
* Digitalis.

Certain diseases can cause heart block, including:

* Endocarditis (inflammation of the tissue that lines the heart);
* Myocarditis (inflammation of heart muscle tissue);
* Lyme disease;
* Lenègre disease;
* Lev disease;
* Coronary heart disease; and
* Heart attack.

Some kinds of heart block can be caused by what physicians call increased vagal tone, which occurs when the vagus nerve, which controls involuntary bodily functions including heart rate, is stimulated, causing an abnormally slow heart rate. Heart block, especially in children, may also be congenital, meaning present when a person is born. People who have undergone corrective heart surgery may also develop heart block.

DIAGNOSIS

Because heart block may be unpredictable and brief, the condition can be difficult to diagnose. In addition to taking a person's medical history, listening to the patient describe symptoms, and conducting a physical examination, the physician will use one of the following tests: resting electrocardiogram, or ECG, or an ambulatory ECG using a portable machine called a Holter monitor.

TREATMENT APPROACH

A person's heart block may resolve naturally. In some cases, heart block may not be frequent, sustained, or bothersome enough to require treatment. Other forms of heart block can be controlled once the underlying heart disease. For example, in people who take a heart medication that may cause heart block, physicians may discontinue the use of the drug. When a person develops complete heart block following a heart attack, for example, the heart block may resolve with the healing of the area of heart muscle affected by the heart attack.

More severe forms of heart block that cause symptoms may require treatment, including pacing, which is the use of a pacemaker for electrical stimulation of the heart, and medication.

Common medications for heart block include atropine and isoproterenol. These drugs may be used in the short-term to treat a slow heart rate that causes symptoms, but second- and third-degree heart block may be unresponsive to atropine.


Proper Programming is essential

by maestro - 2007-09-23 08:09:32

Amy,

You're living proof that surgeons who put in pacemakers are not electronics experts.

I think it is wonderful that Medtronics responded as they did and got your device programmed properly to support your changed needs.

I hope you rely upon Medtronics personnel to do your PM programming in the future. My doctor has promised me he will always have a Medtronics expert interrogate and program the device because two cardiac surgeons made terrible programming mistakes which could have cost me my life.

Good luck

Maestro

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