Pacemaker Needed

[Dogglebird]

I had angina symptoms (light-headed, breathlessness, tight chest) and was referred to my local hospital for a stress test on a tread mill which I had this morning. My BP was checked every three minutes while I was walking. Started off fine - no problems - BP 160/90 while walking briskly. After about 7 or 8 minutes, I stated to get breathless and felt super-dizzy and my BP suddenly dropped to 60/40. They had to help me off the machine. I was told to sit and given water to drink. I felt fine after 5 minutes and my BP was back to 145/75. The cardio-nurse, reviewing the findings, said I had a normal P wave throughout, but said the QRS wasn't present while I was having the episode and, after the interval, I went to a T wave. That doesn't mean anything to me as I'm a linguist, not a medical person. She said the consultant had instructed her to put me down for a pacemaker and to expect to be called in for an echocardiogram in the near future, and possibly an angiogram after that. I am trying to make sense of it all.

[Hidden]

If you need a pacemaker it is an electrical problem. There are some specialist cells in the heart which 'pace" the heart beat but some times it is like there is a a short circuit causing the heart is not beating rhythmically, everything gets out of synch and so blood is not pumped out to the body sufficiently leading to the drop in blood pressure. The pacemaker, once fitted, paces the heart artificially. I think the tests are to find out if there are any other problems with your heart for example sufficient blood getting to the heart muscle through the blood vessels, the valves of the heart working properly and the muscle of the heart working strongly enough.

[Dogglebird in reply to Hidden]

Thanks for the reply. I was told that they would do a "full heart MOT". I would rather not have the pacemaker fitted so, if there are no other issues, I will ask the cardiologist if there are any alternatives, like medication.

[Buddy00 in reply to Dogglebird]

There is no medication as an alternative to having a pacemaker. Having a pacemaker is no major issue.

[PinkKizzie in reply to Dogglebird]

Hi Dogglebird, I wasn't sure about getting a PM either. However, decided to go for it, but it didn't go to plan and I don't have one. I only take medication and feel really well. Take care.

[Dogglebird in reply to PinkKizzie]

Thanks for the reply. I don't fancy having one but I've been told I don't have much choice - medication won't do the trick. Glad you're feeling well, though.

[L8Again]

As said above, cardiologists will not fit a pacemaker unless/until there is clear clinical evidence to show that one is needed. For example, my wife had one fitted last year after 5 years of occasional episodes of 20 second heart pauses resulting in the loss of consciousness.

Our eldest daughter also has a pacemaker and she takes a number of medications for heart failure. The latter come with significant side effects - two of them being very low blood pressure and a feeling of constant fatigue.

[Dogglebird in reply to L8Again]

That sounds like a nightmare. Making a patient wait like that when losing consciousness is outrageous. It was the cardiologist who said I should have one fitted based on the stress test result alone. I am expecting an appointment for the echocardiogram soon.

[L8Again in reply to Dogglebird]

Yes and no. Our NHS healthcare is based on the Occam’s Razor principle: that is, the most likely cause is probably true. TLoC can apparently have a number of simple causes: eg, low BP due to a particular BP medication such as Atenolol. Getting a diagnosis was tricky given that my wife’s TLoC episodes were often 6 months apart, and by the time that she had an ECG there was nothing of significance to report. Similarly, with holter monitors.

It was clear to me that an ILR was needed but no cardiologist will fit one until all the other tests have been carried out. As it was, the ILR proved what I had known for some years. The slight irony was that when she went to have the ILR fitted, the pacing team asked my wife to describe her symptoms. They were in no doubt that she would be back to have a pacemaker fitted. A couple of weeks later she was admitted for her pacemaker.

In truth, I was the one living the nightmare of not knowing when my wife’s heart would stop. Twenty to 30 seconds of unconsciousness (no pulse/breathing) seems like an absolute eternity! Thankfully, pacemakers do work.

[Dogglebird in reply to L8Again]

That must have been terrifying. Glad she's sorted. Thanks for sharing that.

[Digger0]

The electrical trace in your heart is a repeating shape, repeats about every 8 seconds. The letters P, Q, R, S, and T correspond to specific parts of the wave shape and specific actions of the heart. P is the contraction of the top chambers, the atria. Q , R and S is the contraction of the lower chambers, the ventricles and T is the relaxation of the lower chambers to allow refilling.

ECG scan

[Dogglebird]

Thanks. The specialist cardio nurse showed me the ECG printout and pointed out the P wave and what she said was the lack of QRS. She said that, when exerting myself, the heart signal seemed to be absent from that phase. I would have thought that would be dangerous.

[EMBoy]

I have a condition known as Mobitz type 2 heart block, in which a number of my P waves are not followed by QRS complexes, so my heart is missing beats. In may case, I have a 2:1 block which means that every second beat is missed. The only treatment for this is a pacemaker which I had fitted about 5 years ago after passing out while I was loading some heavy shopping into my car. I also had an echocardiogram and a CT scan. It was supposed to be a CT angiogram, but I reacted to the contrast medium.

Don't worry too much about it - your cardio team will sort it all out for you and if you do need a pacemaker, it will give you a new lease of life.

I'd just like to correct something that Digger0 said - the P QRS T shape is repeated about once a second, not every 8 seconds.

[Dogglebird in reply to EMBoy]

Thanks for the info. I was told pretty much straight away that I would need a pacemaker and other tests - e.g heart valves. My daughter, a consultant (but not in cardio) looked into it and said she thought the most likely problem is third degree AV block.

[bluemoon572]

If the P waves were not followed by a QRS complex,this indicates that transient AV block occurred during exercise accounting for the symptoms and the drop in BP as no heart muscle contractions occurred during the AV block. A pacemaker would have obviated such an occurrence.

Of concern is why the transient AV block occurred during exercise and one of the reasons could have been due to a blockage in the right coronary artery. Thus, the cardiologist is recommending an angiogram to check for this.

[Dogglebird in reply to bluemoon572]

Thanks. Is that not urgent? Would it require surgery?

[bluemoon572 in reply to Dogglebird]

Since you had such an adverse reaction while performing the treadmill stress test,I'm sure your cardiologist advised you to abstain from any unusual exertion. I'm sure he/she feels cardiac catheterization & angiography are rather urgent. Surgery may not be necessary if any blockage found could be opened by angioplasty&stenting. The team will determine whether you should have a permanent pacemaker installed and may want to look at results of an outpatient cardiac monitor recording first before making that decision

[Dogglebird in reply to bluemoon572]

Thanks for your reply. I wasn't given any advice at all - not even about avoiding strenuous activities or exertion. I was just told my QRS complex was missing in many heartbeats and during the stress test so that meant a pacemaker. I was only seen by a cardio specialist nurse, but I believe she had spoken to the consultant beforehand. I wondered afterwards if she had seen my "Dr" title and assumed I already knew about heart conditions - which I didn't. She just told me there is a waiting list and it would be several weeks before I heard, but to sit tight. I would be called for an echocardiogram at some point. No mention of outpatient monitoring. I was reeling from the news that I needed a pacemaker so perhaps didn't ask all the right questions.

[bluemoon572]

In the meantime it appears that you'll have to work with your GP and ask about advisability of taking a daily low dose aspirin,getting a prescription for nitroglycerin to use as needed for angina episodes,staying away from beta blockers in view of that high degree AV block incident,observing for worsening angina symptoms such as more frequent episodes,more prolonged episodes,being awakened from sleep by angina symptoms,all of which could indicate unstable coronary artery status and would warrant attention.

[Dogglebird]

Thanks. I was told to keep aspirin on hand and I was supplied with a GTN spray, but told to use it sparingly. I am occasionally awakened at 3am or 4am when my chest feels uncomfortable (no pain as such). I was told if the symptoms change or become significantly worse, I should go straight to A&E.