What do they mean by working fine?

I've been reading up on this for a few days because my mom is having problems. I have a few general questions about checkups.

1. The heart doctor says the pacemaker is working fine. This checkup involves a couple of leads placed on her chest and some machine in the doctor's office. Not an ultrasound. I take that to mean that it is sitting there twitching away as programmed. Can it tell if the heart is actually functioning correctly? i.e., is there a feedback loop?

2. Ejection fraction -- Is this the number I'm looking for that tells me how the heart is actually performing? Can blood pressure tell you the same thing? Or is that just pressure and not flow? Is an ultrasound the only way to measure EF? She had a "tilt table" test that was apparently pretty miserable -- did they measure EF during that?

3. Could it be something as simple as timing issues? She is very tired, dizzy. I keep going back to the car engine analogy when I try and troubleshoot. The distributor can be working great and the cylinders, compression, too, but if the sparks don't arrive at the right places in the right sequence you get misfires, low power, etc.

Thanks for any comments or suggestions.

Catherine57

5 Comments

Caretaker?

by BillH - 2016-01-02 02:01:13

If you are your mothers caretaker you need to be asking the doctor questions.

And even if not, and your mother agrees, you should go to her appointments with her.

1. It sound like an ECG (also called and EKG). It records the electrical activity of the heart (and also the PM). But only during that it is connected.

PM makers can also record some of that same information. But the amount and detail are limited.

"2. Ejection fraction -- Is this the number I'm looking for that tells me how the heart is actually performing?"

It is one main measurement. There are a number of different ways of measuring it. But echo is the simplest and most common.

Also the echo can show other parameters that can effect the performance of heart such as valve problems.

Way too many factors affect BP beside EF to related the two.

3. Could be, but that should be shown in the echo.

General answers

by Theknotguy - 2016-01-02 02:01:25

1) There is a lot of information provided by the pacemaker. It patiently stores data in a condensed form as it goes along. The pacemaker can tell if you are having some specific kinds of heart problems. In addition to reading the pacemaker, they also do a test of the pacemaker functions and check to see if the leads have a problem. The next time your mother has a reading, go along and talk with the tech. Lots of information. I always get a print out of my pacemaker readings at the time. While the pacemaker can't tell you everything that is wrong with the heart, it can tell a lot.

2) Ejection fraction tells you how much blood is being pumped out with every beat. Kind of like water going our of a hose. If it's a fast flow, good. If it's a trickle, you've got problems. Blood pressure is like the difference between squeezing on a balloon and a basketball. If you've got high blood pressure (like squeezing on a basketball) the heart has to work harder just to get blood throughout the body. High blood pressure can lead to a stroke, kidney failure, heart problems, all sorts of stuff. Think of high blood pressure as a kink in a water hose. Not all high blood pressure is like that but a blockage in an artery can lead to high blood pressure. Tilt table is a test to see if the heart will stop under certain conditions. Needless to say, all sort of bad things happen when the heart stops.

3) All sorts of reasons why your mom doesn't feel good. The heart problems that led to her getting a pacemaker, pacemaker settings, heart medications, high blood pressure, low blood pressure, all sorts of stuff. The pacemaker is making sure the heart beats at a specific time. So your "timing issues" shouldn't be a problem. My pacemaker is set at a low speed of 60 BPM. That means I'm going to get a minimum speed of one beat per second while resting. It was strange at first to have a steady heartbeat as I hadn't had that for years.

Some pacemaker settings such as rate response can cause problems but it's usually when you need your heart to speed up. Dizzy and light headed problems can be caused by medications. If you read comments on the forum a lot of people complain that Metoprolol makes them feel like a zombie. I get along fine with it. Other medications can make you feel pretty bad. High blood pressure can cause headaches and dizziness. Low blood pressure can make you dizzy too. Since doctors can't tell how you will react to medications it sometimes takes a trial and error time period to find out what works best for you.

If your mom is willing, I'd go along with her during her check ups and ask questions. Or, if she's not willing, write up some questions and see if she can get the doctor(s) to answer. While there may be some things you can't change, being an informed advocate for your mother will help her, and could possibly help you in the future.

I sense a little frustration on your part. Medical problems aren't like going to Mickey D's where you walk in, order what you want, tap your foot three times, and walk out with your order. Medical issues can take a while to resolve. Because if the trauma I received prior to getting my pacemaker it has been over two years and I still have some lingering problems. I can tell you broken ribs don't completely heal from CPR after two years. For other heart issues I had, some were resolved within the first three months. However I'm still dealing with the afib issues and probably will have to deal with afib for the rest of my life. The pacemaker has made sure my heart won't just stop but I still have other issues. So try not to get too frustrated because your mom isn't 100% cured and may never be.

Thanks Bill H and Theknotguy

by Catherine57 - 2016-01-02 04:01:26

Yes, I'm a little frustrated, partly because I'm 800 miles away. Also, my mom puts up with too much, IMHO.

She's had a pacemaker for 6 years. It worked great most of that time. She said she pretty much forgot about it except for the phone checkups every 6 months.

But then about 6 - 8 months ago she started feeling bad -- some of the same symptoms as before she got the pacemaker. Really tired, dragging, feeling faint. She saw her GP and the cardiologist and they couldn't find anything wrong. She gave up driving after blacking out and running off the road.

Then all of a sudden after one of those telephone checkins they wanted her to get her pacemaker replaced. They said the battery was running low and they thought one of the leads had a corroded connection. So she went in and came home with a new PM, same leads, and same symptoms. If anything, she's worse. Tired, faint, and now short of breath and a pressure in her chest.

The only medicine she's on is Losartan for her blood pressure. They've cut back on her dose twice now, but no real improvements. They told her that her arteries are fine, it is just electrical problems.

The cardiologist said the PM was working and offered to check her in to the hospital for more tests. I'm thinking I should encourage her to do that. I could go down and get some numbers out of those guys.

My mom is 84. I'm not expecting miracles, but it seems like she should be getting better results. She is a pretty tough old bird and not a whiner, but I'm thinking maybe she needs to speak up a little more. OTOH, I hate to push her if she really is just tired of fooling with everything and has given up.

I'm not hoping for 100% cure, just more comfort that she has now. But, I don't know if that's reasonable.

I like this site. There seems to be a lot of good information here. Are there any others you'd suggest? If I go down and talk with the cardiologist I want to ask the right questions and be up to speed. Again, thanks for your answers.

EP

by BillH - 2016-01-02 05:01:14

If she is seeing a "plain" cardiologist ask her to get a referral to an EP (electrologist).

The are sub-specialist cardiologist that only deal with heart electrical issues.

"OTOH, I hate to push her if she really is just tired of fooling with everything and has given up."

That is always a possibility, specially at that age. (And while I have a few years yet I can see that happening).

Because of HIPPA you can't get information from her doctors unless she approves. But if so you should call them and discuss this.

One question that I would have is about the leads where they bad? Or maybe just questionable and due to her age and the conditions of the leads they decided not to replace them. What are they showing now?

And ask them exactly what the condition was that the PM was suppose to treat and how well it is doing that.

Depending on how much time you can stay with her and if you can get her to go into the hospital for more test I would suggest that you go about the time that they have finished the test. Thus you can discuss the latest findings with the doctor and then can spend some time with your mother and if needed discuss any new treatments.

Those Leads

by Catherine57 - 2016-01-02 06:01:09

I've been wondering about those leads, too, specifically the one they thought "might have a corroded connection". I assume they can and did check its impedence and determined if it was still in an acceptable range. I know she has two leads, but I'm not sure if they are the kind that shoots the voltage down and completes the circuit internally or the kind that shoots the voltage down and grounds through her body. Or one of each. I'm still trying to figure that out. I've worked a little with wires and circuits and sometimes what tests fine when the wire is straight will not work when the wire is bent or stretched.

Her cardiologist's write up claims he does Cardiac Electrophysiology, along with everything else. He does not claim to specialize in that, however. That might be a way to get her to consult with someone else. She picked this guy because he is at a nearby hospital and treated my dad.

I read up some on her losartan. It has some side effects that might be all or part of the problem. She's been taking it all along, though, and the new PM is a known change. Her GP took some blood last time she was in and she expects the results from that on Monday. I'm making a list of questions. I don't like to badger my mom, but there are a lot of unknowns here. I'll probably call her sometime soon and see how much she can remember about the history of the first pacemaker and what it was correcting. She is still pretty sharp and enjoys her independence.

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