pacemaker causing heart failure?

am a 33yr old female with 3rd degree heart block, happily married, 2 children and a 6yr old pacemaker. Recently, (Nov. and Jan.) phone checks have made my heart race around 150 beats a minute. The first on lasted about 15 min. and the second on was for an hour and a half and an ER visit. Both converted on their own. I had an echo done right after the conversion. Last week, my doctor visit was a shock. EP said that my heart was functioning at 35%. My only options are drugs or an "up-grade" as he put it. I am scared and frustrated and feel very, very pressured. The meds he suggested would lower my BP which is usually 90/60 but nonetheless he thinks it will help. He could put in a third lead but if one is causing failure wouldn't another do more? The defib was only mentioned as a "possibility" for up-grade (sounds like I am worse not better). I asked about exercising more, vitamins, supplements, anything....his answer was nothing will help but the med coreg. Has anyone else experienced this? I could use any input. Please!

4 Comments

My advise

by Holly - 2008-01-20 01:01:24

It is nice to meet you June2901. If it were me I would go with the less invasive option first. Try the Coreg and see how you feel on it. I am also an ER nurse and Coreg is a miricle drug. Many patients improve on it. My father has Cardiomyapathy and he takes it and the doctor stated that his cardiac output improved so much from the Coreg.
I have never heard of a pacemaker causing heart failure so I dont have any input on that.
Hope this helps!!

Holly

Pacemaker

by SMITTY - 2008-01-20 01:01:27

Hello June,

Before getting started, let me tell you about my credentials. I’m not a trained medical personnel of any kind. I do have a pacemaker, but it is now 8 years old and I think PM are being upgraded and improved about as fast as computers. So anything I say is at best a guess based what I have learned from having a pacemaker and from the information you have provided.

On phone checkups, which I have every 6 months at the most you should be feeling a slight change in your heart rate when you place the magnet over the PM. If you live in the US, and I can believe what the people at the PM clinic I go to tell me, the law does not allow any changes to be made in our PM during phone checkups. I do know that when you put the magnet over your PM it changes the position of a switch and your PM will take over the function of making your heart beat without regard to what your heart’s natural pacemaker is trying to do. This can cause what I call a conflict of signals for the heart and we can get some strange feelings. However, these strange feelings should last for only a few minutes, or until the magnet is removed.

You say you were told your heart is functioning at 35%. I am guessing what he meant is that your ejection fraction is 35%. That is low, but I don’t think it would cause the problems of a rapid heart beat you mention. As for the upgrade, if you have a 35% EF, I am again guessing that he is talking about a biventricular pacemaker. This type PM is frequently used when a person has a low EF that is caused by the ventricles of the heart not operating in sync. If you currently have a 2 lead PM one lead goes to the atrium and one goes to one of the ventricle chambers. The bivent PM has a third lead that goes to the other ventricle chamber and helps keep all heart chambers in sync.

Coreg is a beta blocker which will slow down the heart rate. However, with a PM this is no problem as it will override the effects of the Coreg and keep your heart beating at a desired level. My experience with Coreg was that it didn’t lower my BP enough to even notice. But mine is not as low as you report for yours. I’m surprised that he would say exercise would not help. Every cardiologist I have ever seen (and it has been a bunch of them over the last 25 years) have been strong advocates of exercise.

But I think I’ll quit guessing here. I will make one suggestion and that is if at all possible get a second opinion. There are some things that do not add up to me and frankly from what you tell us about the fast heart rate, I think too much emphasis is being put on the results you will get from Coreg. And speaking of Coreg, go on the web (Walgreen.com is a good one) and look up Coreg. For me it had one sneaky side effect that caused me to quit taking it.

I wish you the best,

Thanks

by June2901 - 2008-01-20 09:01:36

I know I am stubborn so I am trying to be informed. I did not feel bad when I had the pacemaker put in so now that doc it telling me that it is the chronic pacing is causing my heart to weaken. I am very active and did not feel bad until the phone check. This is what happened. When I remove the magnet, it does not go back to normal. My heartrate takes over as a SVT. The doctors said it is a PMT(pacemaker mediated tachycardia). I don't want to reinact it because each time it is worse and I have a longer recovery. Like my husand just said, I do not look sick nor feel sick/fatigued. If I start the Coreg, I have nothing to base my decision on but the doctor could say it improved. What if it isn't that bad? He kept saying echos are interpretive so he wants a nuclear one done which is computer analysed. I think I am going to get a second opinion to put my mind at ease and see if I can get this test done sooner. I am sorry if I sound like I ranting I just don't feel bad.

Don't know what going on

by Cycledoc - 2008-01-20 12:01:10

My background is as a medical oncologist and I don't have special knowledge of cardiology or this problem. So understand that this is not professional medical advice rather a suggestion from an informed lay person.

I'm presuming you have some form of congenital or idiopathic (don't know the cause) heart block without other cardiac problems.

That being said the ejection fraction doesn't sound right. I would suggest that you consider asking for a second opinion from another physician and a repeat of the ultrasound. This is obviously a big decision and they (and you) should be sure of what's going on. What's causing the decreased ejection fraction--if it exists? Chronic pacing as a cause would be my last choice and only after everything else is ruled out.

Good luck
Cycledoc

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