Bradycardia

[wen]

Female, mid 50's, 5'4", 112 lbs. Have been running for 5 years - about 20 miles per week. Prior to starting the running program I changed my eating habits  to an extremely low fat (but balanced) diet, (which I maintain) and lost over 60 lbs.  I suffer from insomnia - awakening about 4 AM - so I get only about 5-6 hours sleep.  About two years ago I was told I had very low resting pulse rate - about 42, but no symptoms. This was then attributed to my running.
Two weeks ago, while hearing some gory news, I fainted - with no warning signs. I was taken to the hospital, and because of the low pulse rate, was monitored for 30 hours.  During this time, although I did not feel any symptoms of lightheadedness, I was told my pulse rate twice got down to 28, with other instances in the 30's.  A thallium stress test was done with normal results.  I have since had an echo - also normal.  I sometimes feel very enervated - kind of "not in the moment", and I fall asleep inappropriately - like in a theater -   but NOT as though I'm going to faint.     The dimemna:  When I was discharged from the hospital I was told I needed a pacemaker.  I sought a second opinion, and this doctor concurred.  However, after the echo, and when I reiterated that I did not feel like I was going to faint, he issued an event monitor, which I am to wear for a month.  I'm really not sure when to activate it - since I don't feel in danger of fainting.   One more thing:  I MAY have passed out once before, about a year ago - only I can't be sure whether this was "passing out", or "falling asleep".
What should I do?   Other than the risk of accident if a syncope occurs, are there other risks of living with bradycardia?  Particularly, absent syncope, with very low pulse rate, is the brain in some chronic oxygen deficit?

[Cleveland Clinic, MD]

Dear Wen,
With an awake HR below 30 but with no symptoms proven to be due to the slow heart rate you have a Class II indication for a pacemaker.  This means that some cardiologists would recommend having one and others would say to wait.  My opinion based on what you hae presented here is that you will probably eventually need a pacemaker but that there is not a need to rush into it.  The event monitor is a good idea and may provide the "smoking gun" needed for you feel sure about getting a pacer.  You may also want to discuss a work up for sleep apnea with your doctor.  This could explain some of your symptoms.

[pacemaker]

I don't have the answer to your question, but in the event you do need a pacemaker, I want to offer some reassurance.  I am a female, age 47, and have had a pacemaker/defibrillator for three years.  I am paced 100% of the time, and cannot feel it at all.  When my heart rate gets down to 50 I feel awful--dizzy and weak (I don't know how you function at 30!).  My pacemaker allows me to lead an almost normal life, and for me there has been no downside whatsoever.

[Carol]

I too also have a pacemaker, I had mine put in just over a year ago. My normal rate was about 72/min average. I had a heart rate below 20/min. and was alert but sluggish. I was able to get help. I also had an event monitor on at the time. If you feel like you are getting tired or short of breath turn it on so that it can get a strip. I also had trouble with a fast heart rate that would go up in the 200's. I was diagnosed with Sick Sinus Syndrome caused by a viral infection. After this viral infection happened I had a rate between 30-50/min. I have not had any trouble with my pacemaker it does about 90 to 95% of my pacing due to the S-A node not functioning properly. It took me a long time to get the cardiologist to do anything, said there was nothing wrong, but when I came in with a rate of 20/min. he had no choice.

[Deb]

Hi,

If you do need a pacemaker be SURE that an EP doctor does the pacemaker not a cardio doc.  There is a HUGE difference when it is done.  Some cardiologist don't even know how to make a pocket and have surgeons do it.  Also DO NOT get followed by one either.  EP docs have the MOST knowledge when it comes to pacing. Here is a web site that may help you: www.Naspe.org

If you can find a woman EP doctor that would be best, since so many women have had so many male cardio and EP docs tell them they are nuts when something is wrong.  Then they find out something really is wrong with the pacing.  

Good luck.