Can a pacemaker help to control hypotnesion?

[mindyrk]

Hi, I have a few questions that I hope you can help me with.  
I am a 26 year old female with a hx of psvt, ablation done 5 years ago.  Sense that time I have had hypotnesion.  I take proamatine 5mg QID, florinef .1mg QD.  My BP still ranges from 76/40-90/60.  with a pulse ranging from 42-140.  My usual pulse is normal and I only have the fast episodes a few times a week.  The slow pulse is something that has started in the last 2 months, they last a few hours each time, and have only happend 4 times. The problem I am having is that if I stand for very long I pass out.  I am a nurse and have to stand for long hours every day so this is a big problem.  Also with this BP, I just generally don't feel well.  I am tired of taking so many pills and wonder if there is something else that can be done.  Can a pacemaker help with BP?  Without the medication I pass out 3-5 times a week, but with them I have only passed out 3 times in the last few months.  I want to get pregnant soon and I assume I will have to stop the medication to do that.  Do you know if these medications are safe during pregnancy? I have talked to my cardiologist, but he hasn't given me any real answers.  He thinks I will need a pacemaker at some point but doesn't want to do it now because I am so young.  Should age be a factor in this?  Any advice you can give would be very appreciated.  Thanks so much!

[Cleveland Clinic]

midyrk,

You really sound like you have an autonomic dysfuctional syndrome.

Unfortunately in this case a pacemaker will most likely not help. The only thing a pacemaker will do is increase your heart rate.  Before considering a pacemaker, you really would need to rigourously document that your symptoms are from a decrease in heart rate and not from alterations in your blood pressure form  changes in the tone of your vessels. Not easy to do.

My recommendation would be for you to undergo evaluation in a specialized syncope center or autonomic dysfuction clinic, and if really considering a pacemaker seeking a second opinion to validate the therapy.

As far as the meds go:

florinef is class c
proamitine is class C

Both really have only been studied in animals but not humans, so usage takes place based on a balance of severity of symptoms and risk of the unknown. This is something that would best be handled by a OB-GYN.

Age is the primary factor of a recommendation to avoid a pacemaker without careful consideration of risk and seeking multiple opinions of risk.

good luck

[K.T.R.M.]

Hello Mindy,
I am 26 also with cardiomyopathy (damaged heart muscle) from chemotherapy I recieved as a child for bone cancer. I just recently had a pacemaker implanted for desyc. and am pretty unfamiliar w/ pacemakers. I don't think there are pacemakers that fix BP- but I'm not sure. However I wanted to talk to you since we are the same age and share common intrests. I was going to school to be an RN and working on the onc. floor at a hospital when I was diagnosed wtih my heart condition. I felt like my life ended. I too would love to have a baby- but it is too risky for me. It could make my condition worse- even kill me the md's say. I take TONS of pills daily also- toprol XL 200mg, lisinopril 30mg, digoxin .25, furosomide 40 mg, K+ 10 meq, synthroid, just to mention a few. I feel like **** on a daily basis- I get very drousy and tired from the meds- but it is keeping me alive. I am hoping when I get my pacemaker 3rd lead placed in march my ef will go up and I will have more energy, and maybe I can decrease my meds. I have hard times trying to deal with the pills and fatigue- and I miss feeling young. I guess I am just anxious to see if there are others with my condition or similar and my age. I feel like I am really missing out on life sometimes: babies, college, a career- anyone have any input? Also does anyone have a bi-ventricular pacemaker? Any comments are appreciated!!!

Thanks,
Katie

[Dr. Erik]

The answer is no. A pacemaker is to conrol heart rate only. You are expeiencing the low blood pressure from the medicines you're on. As long as you don't have symptoms with these pressures then you have nothing to worry about. If you are having symptoms then you might have to titrate your medication doses until a good combination is reached.Good luck!

[Kimma]

i also have hypotension from my ablation for psvt. no treatment was recommended for me because i havent ever passed out even though i feel like i might alot. im also very young and want another baby but am afraid with all my symptoms it wouldnt be a good idea. do you have pvc's??? your ablation results sound similar to mine. e-mail me at ***@**** if you would like i would love to talk to someone that is going through the same thing. kim

[charchar]

Hi, my daughter has had a pacemaker for 7 months now and she feels like a entirely different person she would also pass out if she stood for a long period of time and she had done this since she was 4 and now she is 19 and she had the pacemaker put in when she was 18 she had tried toprol and florinef and some other meds that i can't remember but her problem was she had a slow heart rate and bp also and if her bp started to fall her heart wouldn't beat fast enough to pick it back up and she would pass out. The difference has been like day and night she looks better and feels so much better . Every now and then she might have a "breakthrough" episode but nothing like before and if she starts to feel bad they can reprogram the pacemaker to fit her needs. When she started this at 4 years old nobody could tell me what was wrong with her she had series of test on everything but her heart and when she turned 18 and graduated from HS she just started passing out all the time and couldn't work or go to college because she stayed sick all the time and the meds made no difference.I can't say this would help you but it made a world of difference in her and she is now working and going to college and has more energy than ever.