To pace or not to pace?

I am thrilled to get a response so quickly! Thank you so much for sharing your valuable input! Up to this point I have felt alone and worried about this subject.

By saying "no blockage" I meant no electrical blockage. Also, my second opinion Dr. Told me it was impossible for anyone to die of a slow heartrate. He said they would have to also have some sort of a block or underlying problem. I am all for conservative treatment, but 28bpm in my sleep is just scary. I started to feel like I was being a hypochondriac with my chronic fatigue and slow hr. I just wanted to do what I could so my kids wouldn't find out my heart just stopped in the morning.

9 Comments

disagree

by Tracey_E - 2009-10-03 03:10:48

You may not die of a slow heart rate, but you can die of the side effects of it- the risk of clots as well as the damage to your organs when they are starved of oxygen. And Inga, I have to disagree with your comments about the heart restarting itself. Sometimes, yes. Most of the time, I don't think that statement is valid. At our social in Tampa last week, one of the speakers talked about Sudden Cardiac Arrest. 90% of people do not survive this unless they are lucky enough to have a defib or be near a portable defib device.

It's just my opinion, but the dangers are irrelevant. It sounds like the fatigue has taken over your life and there's a very simple solution.

sudden cardiac death

by golden_snitch - 2009-10-03 04:10:34

Yes, Tracey, but sudden cardiac death refers to ventricular fibrillation and not a slow heart rate caused by a sick sinus node or a heart block. It's very important to differentiate here. An ICD would not shock unless you have ventricular tachycardia or fibrillation. With sick sinus or heart blocks, the heart is very well able to re-start even after several seconds; the big community here is the living proof. We have lots of bradycardia patients here, lots of heart block patients, and they all survived.

The risk of blood clots is related to atrial fibrillation or flutter, not to heart blocks or other bradycardia, at least that what's I have been told and also read.





Ejection Fraction

by Alamb - 2009-10-03 10:10:19

I really appreciate the feedback I am getting from everyone. Please forgive my lack of knowledge on this subject. I never heard about EF. I do understand Smitty's explanation; however, how does one find out how many cc's their own heart is pumping per beat? Via the EKG results? Pulse Oximetry?

Blood Volume Pumped

by SMITTY - 2009-10-03 11:10:17

Hui Alamb,

Good question. I never thought about the volume of blood my heart was pumping as all I have been interested in is the EF

There are several ways (that I know of) they can measure EF and so far as I can tell they are all guess work to a degree. One is with an echocardiogram, one is with a MUGA and one is when a catherrization of the heart is performed.

Now this is my understanding. In each of these tests a video is made of the hearts pumping and with this they can do a frame by frame examination of the heart's size before and after contractions. They measure the size of the ventricle when it is filled with blood and measure it after the ventricle contracts to pump the blood and from the difference in sizes of before and after they determine EF.

I feel sure an experienced cardiologist can estimate the volume of blood being moved with each beat, but that is one I have ever thought about because, as I said, I just wanted to know the EF.

I do know that when my EF was in the 60% range I could participate in many outdoor activities but as my EF has declined so has my physical activities. Of course I keep being told that being 80 yrs. old has something to do with my lack of physical activity.

Wish you the best,

Smitty

Get One

by SMITTY - 2009-10-03 12:10:02

Hello Alamb,

I can understand why you always feel like an eight clock that has been running 12 days. Based on what you tell us I certainly agree with the others, a pacemaker may provide a tremendous improvement in the way you feel. If you don't mind I will take this a step further and put the cause of your felling so poorly in numbers by talking about the volume of blood your heart is pumping each minute.

When it is all said and done, the way we feel and the way our body functions is dependant on the amount of blood flow we have. And the number of heart beats we have each minute is directly connected to the amount of blood our heart pumps each minute.

You don't say what your ejection fraction is and I'm not trying to insult your inelegance. But, in case you are not familiar with term ejection faction, it is nothing more than a numerical means of determining blood volume pumped with each heart beat. Let's backup a step here. A normal heart (I can't tell you exactly what a normal heart is, but I can guess it is one where every things works as it should, except in your case the heart rate is slow) is one where there are about 200 cc of blood available to be pumped with each beat, but a normal heart does not pump the full 200 cc. It will pump between 50% and 70% of that 200 cc.

For our example we will say our normal heart here is pumping 60% of that 200 cc, or 120 cc with each beat. If that normal heart has a heart rate of 70 beats per minute that means it will be pumping 8,400 cc of blood each minute.

Now lets's look at your heart, which we will say is normal in every way, except it beats only 37 times per minute. That means your heart is pumping 4,400 cc of blood per minute or about 53% of the amount of blood a normal heart is pumping. With this amount of blood being pumped it is easy to see why you feel tired and rundown.

So, if your doctor says a pacemaker will help you, get one an let him pick the rate and the other settings he thinks are best for you and the BPM may or may not be 70. Take me for example, my pacemaker was set at 60 BPM once, raised to 70 BPM a few years later and is now 80 BPM, but I now have an ejection fraction of only 40%. So with 80 BPM and the 40% EF my heart is pumping only 76% of what a "normal" heart will pump, but I certainly feel a lot better than when it was set at 70 BPM.

I wish you the best,

Smitty

right

by golden_snitch - 2009-10-03 12:10:08

Hi!

Your doctor is right: there's hardly any risk of dying from a slow heart rate, especially not when there is no heart block or underlying heart disease. The heart has a pretty good backup system, and even after pauses as long as 10 seconds, it's able to restart the rhythm on its own. There are, of course, a few cases of people with an underlying heart disease who died from a heart block or very slow rates. And then there are cases of people who died, but not because of the slow rate itself, but because they fainted and got into an accident for example.

However, most people with heart rates as low as yours, feel awful, and a pacer will most definitely make you feel much better and enable you to live a normal life. In your case I'm pretty sure it would help a lot if you got one.

Best wishes
Inga

SLOW HEART RATE

by pete - 2009-10-03 12:10:47

You certainly can die from a slow heart rate. A clot can form and pass to your lungs or brain etc and you can die from that. Cheers Peter

agree

by golden_snitch - 2009-10-04 03:10:40

I agree with Frank, and I have also mentioned that in my first reply. The risk is that you pass out or get very dizzy or something like that while driving, riding your bike etc. The accident that can happen is the life-threatening part, not the slow rate itself.

Dying of slow HR

by ElectricFrank - 2009-10-04 12:10:50

Don't ignore the effects of developing severe brady while driving and passing out. There are a lot of ways to leave this world.

I keep reminding my cardiologist of this as I get closer to a replacement and he isn't concerned about it going to end of battery life mode.

frank

You know you're wired when...

You run like the bionic woman.

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