Smitty...this one for you

Hi Smitty... (or any one else who might know!) Had my pm checkup yesterday and concerned. I have AV node ablation with 99.7% pacing and in afib all the time (single lead) hearblock and on coumadin for life (until yesterday) My pm showed that since Oct 15, I had Ventricular High Rate episodes 3 times ..first 213 then 226. The odd thing is that they happened during the time of day that I would be resting. I don't remember any feeling of dizziness, but concerned because now my cardiologist said it can't be overlooked. He has taken me off Coumadin because I did have bilateral subdural hematoma surgery after a bad fall about three years ago. He faxed my info to my EP and has ordered an echo and a cardiac nuclear imaging scan. The echo is o.k., but why stress my heart anymore? The atria is already massively enlarged. I am asking you Smitty because as I see it your heart problems are very similiar to mine. My rate response is about identical to yours. I don't mind being put on aspirin because I took myself off Coumadin for about six months before my pm was put on. I guess it it the thought of the difibrillator (possible) and stress test that is worrying me because I have felt just great with my pm since Aug 2007... Thanks for any advice or thoughts that you (or others) might have... aldeer

3 Comments

Heart Problems

by SMITTY - 2008-04-24 06:04:35

Hello Aldeer,

I'm not sure I can offer much in the way of relevant information. I do know that ventricular tachycardia (which I think is what you describe) can be anything from just a nuisance to downright serious with life threatening possibilities.

I did have a problem with V-Tach a few months before I got my PM in '00 and I think it happened when I was asleep. I was in the hospital with a heart attack for about 5 days and on a monitor. The monitor picked it up, otherwise I probably would not have known anything about it. From what I know V-Tach can occasionally lead into V-Fib and that is very serious business.

If your doctor is talking about a defib unit for you, my GUESS is that is the reason. I was checked out by an EP to see if I was a prospect or a defib unit, but I got a dual lead pacemaker instead. If it sounds puzzling to you, welcome to my club. I never understood all of that and since the doctor is no longer in that hospital I guess I'll never know.

Of course the coumadin is probably a precaution because of the A-Fib. As I understand it, during episodes of A-Fib blood can "pool" in the atrium and evidently blood clots can form pretty qucikly. A couple of times I have been on coumadin and I know it was a pain in the rear for me, with the easy bleeding, and bruising.

As for the nuclear cardiac imaging, again I am guessing, but I think that may also be what is known as a chemical stress test. If I'm correct on that, it is not a bad test. Uncomfortable, yes, but more boring than anythng because of the time it takes and there is nothing to do.

In case you are not familiar with this test, for me it meant injecting a blood vessel dilator (dipridamole for me) following by a radioactive element (thallium for me). A few minutes later I was lying under a Geiger counter where they could get pictures of the blow flow in my heart. Now I don't know what the imaging device is actually called but like a Geiger counter, it can detect minute amounts of radiation and in this case it is connected to a computer where a map of the areas where radiation is detected is produced. I was shown some pretty color photos of my heart with the doctor pointing to areas where he said there was a insufficient blood flow due to arterial blockage in my heart. The entire test took about 2 hours.

When it is all said and done, my advice is take the advice of your doctor.

I wish you the best,

Smitty

Thank you, Smitty

by aldeer - 2008-04-24 07:04:13

Thank you so much.. yes, he will be checking it for v-tach, and yes, he really scared me when he mentioned the life threatening "could be".. I did have the chemical stress test once and fainted a couple of hours later in a pet shop while trying to find a chair. Ouch!! Guess it will be wise to take your advice to wait for the doctor to find out results and go from there. Is your arterial blockage the reason for your stents? Do you have any idea of what causes shortness of breath when resting. I can easily walk a little over a half mile in 12 minutes and swim straight for 30 minutes without shortness of breath, but sometimes find that just kicking back in my favorite chair in the evening I am suddenly sob... Thanks again for the details. I think I will ask to see the "pretty pictures"... aldeer

+

Conduction system pacing

by Terry - 2008-04-24 11:04:32

Hi, aldeer. Please ask you EP about His bundle pacing after you check this out

http://jama.ama-assn.org/cgi/content/abstract/288/24/3115?ijkey=fc54101eeb36560b8f5865583bbdd2
a50bd26de4&keytype2=tf_ipsecsha

Let me know by privae email if you need a referal to someone who does His pacing as standard of practice, or if you want to read any more scientific papers.

Bset wishes,
Terry

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