QRS explanation

[Nomis21]

Hi just got a letter from cardiology.Anyone know what a QRS of 176 milisecond relates too?

In permanent AFib so guessing it's something to do with the heart rate?

Thanks

[BobD Volunteer]

The P wave is the little one before the big QRS complex on and ECG so the 176msec refers to the time of this big up and down wiggle. I'm not an expert but it doesn't sound too bad. The total wave is PQRST with the T being the last little blip.

[Nomis21 in reply to BobD]

Thanks Bob 👍

[Ppiman]

I have this. It means that there is a slight delay between the signal from the atrium and the ventricles reacting to it. It is usually caused by a "bundle block" and, in my case a "left bundle branch block" or LBBB. I was told and have since read that a few are born with these, but that, over 60 years of age, they become increasingly common and are especially so in anyone who has had any kind of valve surgery or similar. The more common one is right sided, RBBB, I gather.

Usually, I was told, it is a harmless thing, but in a few, it can cause symptoms. As a protective treatment, I was given losartan 100mg daily, a blood pressure treatment usually, to help keep my heart healthy, even though I have normal BP.

Do you have any symptoms from yours?

Steve

[Nomis21 in reply to Ppiman]

Hi Steve, thanks for that, no expert but I do have a few symptoms but I can't pinpoint to what part of my condition could be causing them.I don't know if symptoms are meds related or related to my condition of having HF/Permanent AF and a pacemaker?

Received a letter from cardiologist after a consultation last Tuesday states I have pacing induced cardiomyopathy, plan is to upgrade my PM to a CRT.

It has been stated I have LBBB but not sure what the related symptoms would be for anyone who has this?

I get breathless, tired, totally exhausted, AF symptoms, no fluid build up yet in legs but recently get very bloated around the stomach, worse after meals, nauseous, legs ache, dizzy spells, weakness, all a daily problem and I'm 53.

Thanks for your reply, appreciate it 👍

[MikeThePike in reply to Nomis21]

Pacing induced cardiomyopathy is a possible complication of pacemaker implantation. Basically a nice way of saying that your pacemaker has damaged your heart. Did they ever mention that to you before you had it implanted? It always saddens me that when it comes to the heart there always seems to be some side-effect of medication or procedures. I guess that's just how life goes but I wonder if cardiologists properly weigh up these things before suggesting 'treatments'.

[Nomis21 in reply to MikeThePike]

Hi Mike, never mentioned it to me as a risk when I had the procedure done just over two years ago, never felt right since, told I was unlucky !

Since then I've had numerous periods away from work on sick, placed on HF meds, developed permanent AF, suffer daily with breathless, exhaustion, weakness, chest discomfort, can't do anything physical and has caused mental stress.

Suppose it's better than being at risk of a clot/stroke but unsure what the future holds.

[MikeThePike in reply to Nomis21]

I am really sorry to hear that. I think many cardiologists don't bother to inform themselves or their patients of the potential long term complications of procedures or medications. I think if they did you would probably find more patients choosing to live with existing health issues rather than risk future complications.

[Ppiman in reply to MikeThePike]

Well said - I suppose one problem is the lack of ability to forecast where existing conditions will lead. I am more and more convinced that heart problems and the prognosis of the condition are in the "unknown" area more than we realise. I read recently that heart failure is still not at all fully understood, meaning that why some with respond well to treatment and others do not is simply a mystery. The suggestion by the reviewers was that genetics were likely an important factor.

Steve

[Ppiman in reply to Nomis21]

It can't be much fun at 53 to be struggling as you are. I have read that a CRT can be a really useful device for people like you and that the cardiomyopathy can reverse, i.e. that the ventricles can recover significantly. But bad luck, indeed.

I was told that the options for me are to have an ablation (which I have chosen but there's a 12-month wait, to try flecainide which I have been given but am reluctant to use, to have a PM, or even to go the whole hog and have "pace and ablate". This latter quite shocked me as it came out of the blue.

I did ask my consultant if I needed a CRT but he was surprised at the question and said I didn't. I didn't think to ask why not but it is likely because he rather seems to dismiss my LBBB and blames my woes instead on my misbehaving atrium causing increasing and daily ectopic beats, often a high "burden" for an hour or so, but over a 24 hour period not so high. This is symptomatic but not overly troublesome; I also get weekly-fortnightly AF that's not too fast these days and, again, not overly symptomatic. Both wax and wane, but far less than they used to.

Against his views, however, I have become convinced that my LBBB is an important source of symptoms simply because when I feel "rough", tired, chest-achey, or whatever, my Apple Watch shows - all too often - NSR (i.e. no or few ectopic beats) but with a very wide-looking and sometimes notched QRS segment, indicating the the LBBB has kicked in. It's going to be my number one question when I speak to my GP next and, if needed, I shall email the cardiologist / EP, too, for his views.

I have been told that it is the LBBB that causes my bradycardia. I don't know if you have that, but with a PM fitted you won't now know, I suppose? My weekly heart rate range, from my watch, shows as 40/50 - 130+. My wife recently looked up the symptoms for bradycardia on the internet, and one that stood out was confusion. Well, I have for some years had occasional odd and disconcerting feelings of being "distanced", as if the world and its sounds were somehow further away than they should be, often with a strange mild headache. I get it irregularly at its worst but quite regularly in a mild form.

It's all a worrying way to have to live but, of course, in the balance of things, many have a worse time.

Steve

[AKatieD]

images.app.goo.gl/kvwhnxxro...

[Nomis21 in reply to AKatieD]

Thanks katieD

[Palpman]

QRS of more than 117ms is prolonged.It can be caused by heart block such as LBBB or RBBB.

Scarring from an old heart attack.

Old age.