Bradycardia and sleep

[Karen]

Hi!
I'm a fairly consistent runner - 25 miles a week - so my cardiologist is unsure if my bradycardia - around 42bpm - is the result of fitness or if I have sick sinus.  I'm 28 and healthy, been running about a year.  My grandmother received a pacemaker a few years back for heart block, mom has MVP and sister has a murmur.  I am symptomatic, although I've never fainted so the cardiologist said it's my decision as to whether I want the EP study or not to test my sinus node.

During the inital workup the cardiologist sent me to a sleep doc to rule out apnea causing the fatigue.  No apnea, but overnight my rate sinks into the low 30's, which the sleep doc said causes the tremendous headache I wake up with every day.   The sleep doc said my brain doesn't get enough oxygen overnight so I get the headache.  This bothers me.  Doesn't oxygen deprivation result is brain cell loss?  I've noticed a definite deterioration in some of my mental functioning in the past few years - I'm too young for that to be happening as the result of 'aging'.  My cardiologist was non-plussed however when I mentioned to him what the sleep doc said.  Am I losing brain cells?
Thank you
Karen

[Cleveland Clinic, MD]

A low heart rate won't cause headache so I'm not sure what the sleep doctor meant by that.  Are you having any symptoms at all?  There is no indication for any kind of testing or pacemaker if you're not.  If you are then perhaps an EP study would be appropriate.

[Deb]

Hi Karen,

I too woke up tired and with headaches for years.  I also noticed that AIRHEAD Syndrome creeping in now and then.  My family said it was old age, only I was late 30's early 40's.  NOT FUNNY !!  After passing out time and again It was caught on a monitor in the ER.  I was having sinus arrest !! I finally had a pacemaker put in and I have it set at 60, but I am having it changed to 70 for the low rate.  I have the night time rate set at 50.  I am having that raised to 60.  I wake up a tiny bit tired, but I know that when it is changed up to 60 overnight I will be ok.  I had it set there before and I was not tired.
I was also told that I was to young for Sick Sinus Syndrome.  But I have a friend who is 27 and also has it. But I was also told that a EP study is not the best for finding this.  You may want to ask another Ep doc about this too.  I know the docs on this board will help if anyway they can. Take care.

[Deb~ Thanks! It's so good to get input]

from others who experience the same things.  Question:  Were you able to exercise normally (if you did)?  Often people say that since I can run, there's no problem.  Truth is I run becuase it helps me feel better.  Once I get my heart rate up, through exercise, I usually feel more energetic.  It would seem that if I had sick sinus, wouldn't I have breathing problems and such when I exercised?   Heard of anything like that?
Thanks!  Karen

[Deb]

Hi Karen,

I also have what is called Tachy-Brady syndrome, which is part of SSS too.  I also get some a-fib but very short episodes and far between. I could barely do anything, I would be so tired.  I worked in a hospital and on my feet all day. I never had the hard to breath thing though.  Never thought much about it.  I do remember it being hard to walk up stairs and for long period of times.  Then I was short on air.  I still am at times, but I need to have rate response turned on in my pacer, then I will get the atrial kick needed to keep me from getting winded with exercise. I did other things to keep my heart rate up like drinking huge amounts of coffee while at work.  Dumb, now in hind sight !  Never drank it before I worked in the hospital. I still do, cus I am trying to not feel my pacer pacing.  I have a few minor things on it that needs tweeking and then I am sure it will be fine.  If your doc and you decide a pacer is the way to go, you can mail me direct and we can chat about it before it goes in.  It has really helped me and I have other pacer friends who are much better with one.  I even have a friend who had one placed while 4 months pregnant !  She was 26 at the time.  Take care, DEB

[tanja lynn]

I am 36 years old and was diagnosed with Sick Sinus after experiencing episodes of inappropriate bradycardia.  I am getting a pacemaker on Wed Oct 13.  My doctor, too, said I was too young for SSS, but nonetheless, I have it.  I did not have an EP study; he said that it is not the best diagnostic tool to discover SSS.  I had a tilt table test which clearly showed the sinus node dysfunction.  
I have been tired for a long time, with episodes of chest pressure and shortness of breath.  It has been very hard for me to get around due to the breathing stuff.  The doctor tried to raise my HR with theophylline which was very uncomfortable!
I would love to chat more with both of you since you are experiencing similar difficulties!

[Deb]

Hi Tanya,

Yes, please mail me I would love to chat. Heres how you do it.
Click on the "Support" area, enter "pacemaker" in the search window. You will see my name, Debra in Wis come up, also SSS and pacemaker too.  You then Click on my name and it will send you to my e-mail.  I run a support group in town for the Younger pacer patient population.  There is another one here for the older patients.  Many issues are the same, but many of the life style issues are very different.  I am also in the medical field too.  I know of other much younger people who have had a pacer placed.  I might be able to have them chat to you too.

Take care and hope you can mail me BEFORE the pacer goes in.  I have a few hints for you to ask your doctor.  I know they will work with you to make this a very good experience.

[I'm on theophilline too!]

Although I dont' really have problems with it - except for adjusting to it the first week.  That was horrible!  I notice a difference for a few hours after I take it, in terms of a boost in energy.  I so understand that it's some kind of stimulant so that makes sense.  With your SSS, do you feel your heart beating out of rhythm?  Or just fast and slow?  My beat is very consistent, but just slow, which is why there's some question as to the SSS diagnosis.
Thanks!  
Karen

[Darren]

Karen,
I was suffering from bradycardia for about two months. I'm 29 and fairly healthy (although not a runner). My heart rate was steady but slow at rest but would rise appropriately when standing/walking etc. My cardiologist was perplexed as my blood tests were all ok and several ECG's showed a perfectly healthy heart. I had a date for a pacemaker but was put on thyroxine as a 'we will try this' experiment. 25 days later my pulse was up from 44 at rest to between 64 and 74 at rest and has stayed up ever since (the last 3 weeks) and I feel a LOT better. I've been back to my cardiologist who says the viral infection that kept showing up on my bloods may have affected my thyroid gland causing hypothyroidism, even though it didn't show in my bloods that I have a thyroxine shortage. The interesting thing here is that I showed no symptoms of having any infection for about two months (e.g. sore throat etc.), even though my blood tests showed I had some kind of infection. As it does not harm you to take thyroxine when you have a healthy thyroid (the thyroid just reduces the amount produced naturally) wouldn't it be worth a try ?
Just a thought. Darren
P.S. Tanja Lynn, At last you have a diagnosis !. Sorry to see you have SSS, I hope your pacing goes well and that you are feeling better soon. I'm sure, like me, you will be glad to get your life back!

[tanja lynn]

Karen,
I haven't had any irregular heart beats yet, just very slow at times.
I am off the theophylline now and am getting the pacemaker in on Wednesday.
Keep on researching and asking questions!

[Cleveland Clinic, MD]

Thanks for your comments.

[tanja lynn]

It is great to hear that you have a solution to your bradycardia.
I did both the thyroid and anemia routes, too, and was hoping mine was caused by my thyroid.  
I hope you continue to do well and keep us up to date!
Good luck to you.

[Cleveland Clinic, MD]

Thanks to all for your comments.

[Deb]

Dear Dr. CRC:,

My heart rate would fall to low 30's at sleep, and at times during the day.  I was also told that having a slow heart rate can be the cause of the headaches, that I also woke up with.  The reason for this, was because of the low BP I had during this time.  I have SSS and after passing out many times, and then having caught sinus arrest on monitor a few times while in the ER, I had a pacer placed.  I now have a sleep timer set to allow my rate to go to 60 at sleep, and I do not have the headaches anymore. Don't know if this really was the cause, but I am glad I do not have the headaches anymore. Also, my BP is not low anymore.
Thanks for all your wonderful help. :-)

[Karen]

Yes Deb, that's what I was told by the doctor that did my sleep study too.   That the slow beat overnight wasn't providing enough oxygen to my brain, thus the headache.  

CCF - you asked if I have symptoms.  Fatigue mainly.  I was dizzy and lightheaded all the time but my cardiologist recommended increasing my salt and fluid intake to elevate my blood pressure.  That has helped with the diziness.  I still am too fatigued for a 28 year old healthy person though.
Karen

[Cleveland Clinic, MD]

Given your symptoms maybe you should pursue an EP study +/- a pacemaker.  I would talk it over with your doctor and see what he thinks.