changed my mind

I have chickened out, this ICD scares me. My appt. is 1week from today. This is so crazy, I just found out I have Bundle Branch Block. My heart only pumps at 35% and meds are not helping.  The doctor said it’s not any worse but it’s not any better. Treated me with meds for 3 months; now they say I need an ICD.  I didn’t even feel bad until they put me on meds.  I don’t even feel like there is anything wrong with me.  Is 35% really bad enough for an ICD?  What should I do?  Can anyone help me understand it a little better?  I have been trying to get the Drs. office to talk to someone.  Their office has been closed due to bad weather.

Susan

5 Comments

ICD

by ElectricFrank - 2011-02-08 02:02:14

Bundle branch block by itself would rarely be a reason for an ICD. When you add the 35% ejection fraction though it looks like you have a degree of CHF, which could be due to heart damage of some sort.

What kind of doctor is treating you? I would certainly want to see a competent cardiologist and possibly and E.P. before committing to an ICD. With the meds making you feel lousy there is even more reason for this.

I would also pursue the options of no treatment, meds, pacemaker, or ICD and find out how they are making the ICD decision. With a mild case like yours there are certainly trade offs to be made.

I will say this however, making such a decision simply on the basis of "chickening out" is not the way to go.

good luck with it. I hope your weather improves.

frank

ICD?

by AmyS - 2011-02-08 04:02:52

I think you may need a pacemaker, but an ICD seems like overkill to me. Correct me if I'm wrong fellow PM Club members, but isn't an ICD used for defibrillating? Do you have any other heart issues, Susan, that you would need to be shocked? Come to Dallas (I see you're out in Longview) and get a second opinion. Private message me if you want a referral to a good cardiologist/EP. Amy

ICD & ICD

by J.B. - 2011-02-08 06:02:59

At one time ICD stood only for Implanted Cardiac Defibrillator. Now both patients and doctors use the acronym to mean Implanted Cardiac Device (pacemaker). My guess is she means a pacemaker has been recommended..

I Don't Agree With Pebble In Shoe

by SMITTY - 2011-02-08 10:02:49

Hi Susan,

This will be long because I am tethered to an oxygen machine for a couple of hours this morning and I'm not going anywhere, so my sweet little wife tells me. But my real reason for writing is because I think you may have been given some bad info. In doing this I'll try to add a little to what Frank has said. But first let me say that I agree with Frank totally, not that anything he ever say needs confirmation from me. I especially agree with the last line of his comment “I will say this however, making such a decision simply on the basis of "chickening out" is not the way to go.”

Now let me back up a little. I missed your first message so I went back and looked. I think the Dr, or someone in his office, did you a huge disservice by saying "it will be kind of like a pebble in my shoe." If that surgeon knows sheep dip from wild honey about implanting pacemakers that is not true. Sure you will be aware you have a pacemaker a few percent of the time, but that will only be when you think of it and feel the implant site or there may be other occasions when you notice it but they should be few and far between. I know you say you are small frame and true enough that can make a difference, but there are thousands of small frame people walking around with a PM without thinking there is a pebble in their shoe. So, I say if that Dr thinks his PM implant will feel like a pebble in your shoe, look for another Dr now.

The following is my layman's description of what takes place when our heart beats. I'll admit it may not be technically correct in every respect but I hope it will give you a general picture of what takes place and why a PM may help you.

Now about the heart block and how it figures into your needing a PM. Our heart has its own electric system which generates the impulses necessary to make our heart beat. The cells that generate these electrical impulses are located in the upper right portion of the heart. The impulse goes from the cells where they are generated and travels along a specific route. The impulse first goes to the upper chambers where it causes them to contract and transfer blood into the lower chambers where the impulse causes them to contract thereby completing the heart beat and in so doing pumps blood out into the body.

To get an ejection fraction when the impulse leaves the upper chambers it and goes to the lower right and left chambers and soul arrive at each at the same time. But if there is a "bundle branch block" the impulses may not arrive at both at the same time and the result is the heart does not pump the maximum amount of blood it is capable of pumping. So I'm guessing the bundle branch block has the two lower chambers beating out of sync and causing your low EF.

A little more on EF can mean. A normal heart contains about 200 CC of blood. The amount of this blood that is pumped with each beat is called the ejection fraction. I have been told a normal ejection fraction is between 50 to 70 percent of that 200 CC. For our discussion we will take the average of 60%. This means about 120 CC blood is pumped out into our body with each beat. You have been told your EF is 35% which means your heart is pumping about 70 CC of blood each which 58% of what is considered a normal amount.

This is where the PM comes in. A pacemaker (called a bivent PM) can make the lower chambers beat in sync and by so doing improve your EF. Left alone a low EF usually does not improve.

While I'll not say absolutely that you should get a PM, based on what you tell us I can see where one may help and possibly hold off bigger EF problems in your future.

Finally, I do think you need another opinion because I know a PM does not have to feel like a pebble in your shoe.

I wish you the best,

Smitty


ICD - A great decision I made

by randall - 2011-02-09 03:02:27

I had open heart surgery in 2004. Also, had a pacemaker inserted. My ejection fraction rate was 42. A 66 EF rate means the heart is 100% effectient. A 35 EF or less is when a ICD is recommended.

I have branch bundle block and I also have an irregular heart beat.

In 2006, my EF had dropped to 35 and I was told that due to my irregular heart beat, if my heart stopped , it would not restart. They inserted a CRT-D (ICD).

I had already started a competitive swimming program and was doing okay. The pacemaker was set at a maximum of 120 heart rate which was somewhat of a problem. With my CRT-D, they raised the maximum to 140! My EF has increased to 45 - higher than it was in 2004.

In 2008, I went to the United States Masters Swimmers National championships in Austin and won 5 medals including a medal in the butterfly.

I work full time,compete in 9 or 10 swim meets a year, work out 5 days a week and I'm involved in charity work such as feeding the homeless, cooking meals at Ronald McDonal House and working with the Special Olympics kids and adults in swimming.

I will be 70 in June.

There are 100,000 ICD implanted a year. Like Amy, I also live in Dallas and can recommend an outstanding surgeon. In fact he has me talk to some of his patients who are nervous like you.

If you come to Dallas I would be happy to met if you like.


Randall

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