Pacemaker and possible Diastolic Dysfunction

Wrong Title fpr your post ....

by donr - 2016-07-24 08:43:01

...Should be "Complicated"!

I went back & reviewed a bunch of your posts/comments thinking that I may have said something about it.

A couple of observations:

1)  Granted - you were very justified in heading to the ER when you did - but that isn't a place where you can get any sort of a dsecent second opinion.  Their purpose is merely to preserve life & get you out of their bed so the next emergency can get into it. I think I am preaching to the choir here, since you have gotten yourself to other Cardios.  You just have not gottten to the one who has the answer,  You are on ther right track, taking Tracey's advice & trying to get into the U Was Med Sxchool hosp.  Don't take "NO" for answers, bulldog them till you get seen.

2)  It bugs the crap out of me that a cardio will not just stick you on their treadmill to get your HR up so the can actually SEE what happens.  Face it, just sitting in that chair beside their desk isn't gonna make you pant like a dog hot on the trail of a running rabbit.  I consider my Cardio top notch & even he would not do it for me when I had some of the same symptoms.  BUT - he did pull up a small 8" high platform & have me step up & down on it a bunch of times to see what my heart would do under the kind of physical exertion you describe.  &^%$^^& breathing didn't do it!  What a let down.

3)  I'm no Cardio - but - you no longer have Brady!  that is defined as "Slow HR" in the vernacular of us normal human beings.  If, as you say, your RIGHT ventricle is paced 91%, you now have some sort of a AV block.  Still appropriate for a PM, but it is NOT what you started with.  There is a laundry list of things that can cause Vent pacing at high rates like that & just about all of them have the word "Block" in them.

4)  Selwyn actually nailed one real world cause of your SOB, but did not complete the dot connections.  Now he is a rela, live, retired UK MD, so he knows what he is talking about.  But - let me give you a few tthoughts from the patient's char in the exam room.  AS ONE WHO HAS EXPERIENCED the psychological aspects of cardiac issues:

5)  Psychological issues can mimic cardiac symptoms - ESPECIALLY SOB - very easily & scare the living crap out of you.  BTDT & have a drawer full of those tee shirts.  Unfortunately, it is often impossible to pin that down as the cause of the SOB w/ a test - it has to be the LAST cause & used because you rule out everything else.

I've been on this road ever since 9:20 PM, 15 March 1979 when I had my very first symptom of something being wrong.  Yes, it was dramatic - or I would not have remembered the exact time it occurred!  In retrospect, it was truly a cardiac event - one very simple PVC, w/ stress induced fear following it that has bugged me till this day. I'll do the subtraction for you - 37 yrs of it.  My PM did not come till 2003, so I went a bunch of years w/ zero cardiac problems, but significant stress problems.  In my case, it was diagnosed as PTSD brought home w/ me from Viet Nam. Unfortunately, PTSD was not even characterized as something real till about 1980 & no one recognized that I had it till 1984! That's 5 yrs of un-explained SOB!

6)  Actually, Napoleon nailed this one back in about 1806 or so & he wasn't even thinking about things medical.  One of his Maxims of war was that "In battle, the mental is to the physical as three is to one."  That applies equally to medical issues, & especially to things cardiac & pulmonary!  One little hiccup & your imagination can take off like a shot, making  pant like that dog after the rabbit!  The higher your innate stress level for some other reason, the worse it can be.  Throw in some little problems like pericardidis & a new PM w/ ventricular lead problems & it can really be "Katy, Bar the Door" for you.

7)  I went to see my Cardio last fall w/ SOB problems & laid it out as I saw it - I had FIVE issues that could be causing the SOB & layed them out for him.  The last was pcychological!  Now from our 13 yr history, he knew that & also knew that I realized it, so he works w/ me to rule out the physical from the mental.  He scribbled a few things on his pad & said - "No, Don, there are SEVEN things that could cause it."  On the spot, he ruled out  all but three with a quick ECG, followed by some discussion of symptoms & other long term items.  Turned out that this case was actually caused by lumbar spine problems - very physical & very real, augmented by the good old subconscious mind. Thirty min w/ a good chiropracter explained it all.  He started by pushing on just the right spot down there, causing me to yelp from the pain.  He worked his way up my back, asking "Feel that?" as he went, got to my lower cervical spine at the base of the neck & again made me yelp from the pain when he pushed. Now he did NOT solvew the problem - it cannot be solved, but he EXPLAINED it & stripped off the subconscious part & dreamatically reduced the SOB.  

8)  Have you ever heard any Dr. EVER talk about psychological causes in an intelligent manner as a very REAL, possible cause or exerbation of a problem?  Absolutely NOT!!!!!  If they bring it up at all, it is in the statement "It's all in your head, just forget about it, go home & RELAX.  Next patient, nurse."  If you are a woman, you are immediately characterized as "...just another hysterical woman w/ a vivid imagination & bored by time on her hands..."  Even female Dr's & nurses take this attitude very often.

9)  There is a point to this random rambling - You commented about your mother falling, breaking some bones, including a hip, & how terrible the situation has been for you.  Well, Mom is at least 20 yrs older than you, so probably a bit more fragile & susceptible to complications following a fdall & her injuries. That cannot help your stress level, following the two plus yrs you have had REAL physical heart problems.

10)  You started out w/ a question about PM/hypertension linkage.  I'll wager that the answer is "Most likely NO connection."  But, it should be ruled out.  Hypertension is a funny thing - it can go all over the map for so many differrent reasons, a lot of them not even related directly to your heart.  A lot of them stress related, especially when they don't follow any particular explainable pattern.  Worse, a lot of them can never be discovered - HBP just occurred - like being struck by a lightning bolt.  Like suddenly needing a PM because of an unexplainable electrical problem in the heart.

11)  This guy is saying "I'm nuts!" Nope, he's just saying you are a normal human being, likely to be reacting to stress related issues just like Napoleon Bonaparte said they would react. So, just keep Psychologcal issues in the back of your mind - not necessarily asthe priary cause of the SOB, but as an exacerbater of somethiong else that is purely physical.

Good luck to you w/ that next opinion.

Donr