Do I need a pacemaker?

[eyedrjenn]

I am a 29 year old WF who started experiencing episodes of fainting 10 years ago.  They occurred once every 6 to 12 months until last year when they started occurring once every three months.  Each episode was preceded by feelings of dizziness, nausea, rapid heartbeat, sweating, and I would turn pale.  Recently, I would sometimes also experience vomiting afterward.  I have had repeated EKG's with normal results.  I had an abnormal EEG, but a subsequent sleep-deprived EEG came back normal.  My doctor has also ruled out epilepsy or other brain disorders with an MRI.   I fainted during the last 5 minutes of the tilt table test.  All bloodwork I have had done has come back normal.  I have mild sleep apnea, but my doctor does not feel that it is severe enough for a C-Pap.  
My doctor implanted an internal heart monitor 3 months ago.  I fainted 2 days after I received the monitor.  The monitor recorded multiple episodes (between 10 and 15) of tachycardia and bradycardia in those first two days, but it was unclear whether this may have been a result of the codeine I was prescribed after the surgery.  
Yesterday while I was at work my middle finger of my right hand went partially numb and turned blue/purple (it has still not regained all of its color even now).  I stood up and felt dizzy then lost consciousness.  I came to, felt nauseous, then stood up once I felt better.  I fainted again after about 15 seconds of standing upright.  I went to the hospital, and my cardiologist was able to identify the two episodes from the data from my heart monitor.  He said that my heart rate had slowly dropped to about 30 bpm, during which time it stopped beating for 16 seconds, then it started beating slowly again.  Blood tests, chest X-rays, and an EKG all came back normal.  
My concern is that my cardiologist still does not know the cause of my irregular hearbeat.  Could there be an underlying cause to all of this that he has not identified yet?  Do you have any thoughts on what it might be?  My doctor has advised that I get a pacemaker.  I have still not decided whether I will consent to this.  My doctor also wants me to have a test done involving placing a catheter in my pelvis up to my heart.  What is your opinion on all of this?  Should I get the pacemaker or is there another course of treatment I should consider?  Thank you.

[jsuter69]

Honestly, even as invasive as it sounds I would go with a pacemaker,it should offer some kind of reassurance, I can only imagine how scary it would be to faint all the time, my heart will start beating extremely out of sync, almost like it has no rhythm, feels like it's really slow and pausing, I feel like I'm going to faint, I get this strange feeling like I can't get any air,and my heart feels like it's not actually beating, and get this overwhelming urge to hit myself hard in the chest, it's extremely scary when it happens, If I was offered a pacemaker, I'd probably take it, at least you would have that sense of reassurance on board.....
And I agree with Red, I'd try the CPAP, my boyfriend has Apnea, and he says he feels so much better when he wakes up in the morning, and when you're sleeping,you have that little bit of "help" on board!

[Red931]

I am curious as to why your doctor won't give you a CPAP even with mild sleep apnea. I also have sleep apnea and had surgery to correct it. I did fine for awhile but once I gained some weight back I developed mild sleep apnea again.

My doctor said that my body just can't tolerate even a small amount of extra weight around the middle and that is what is causing the problem. They way my weight swings up and down he put me on a CPAP. My machine is set at a low setting but makes a difference for sure. I don't go anywhere without it. I actually have two units in case something happens to one.

It can only help you and can do you no harm. There are so many different masks out there today that you don't even realize it is on your face once you used to it.

[Red931]

Your doctror seems to have taken all the necessary precautions thus far to diagnoes your condition. If your montior revealed that your heart stopped, my opinion is that you take your doctor's recommendation for the pacemaker.

I would get the test also. It will most likely identify what is going on with the electrical impulses within your heart. If you have had an Echocardiogram and all of your valves and chambers are normal you should do well with the pacemaker.

Good Luck to you.

I hope you get a diagnoses and the treatment you need soon.

[ireneo]

Usually folks with extreme drops in their heart rate end up with a pacemaker. The pacemaker will bring the heart rate up to normal when needed. Since yours drops low enough and pauses long enough for you to pass out, it seems like a pacemaker would help you quite a bit.

The catheter up the pelvis is probably an EP study. They can thread little wires into the heart and check the electrical workings in there. I've had 3 EP studies with ablations. It sounds a lot scarier than it is. Ask the cardio if he suspects something more is going on in there besides the slow heart rate.