Pacemaker & Heart Sounds

I am th RN who posted last week with what I thought was a physiological block...turned out the EPS showed 2:1 AV Block, infra-nodal(?), below(or at?) the Bundle of HIS(I was stil groggy) and I had a Dual Chamber Meditronic Pacer implanted 10/01/07. I am no Cardiac nurse, my specialty lies in wound care, but I have just enough cardiac knowledge to make me "dangerous".  Anyway, my question is 1) Does a pacemaker change the heart sounds in any way?  I swear that when I listen w stethoscope at about the level of the sternal notch (where I think the RT ventricle would be) it almost sounds like a murmur-not a rub- but I don't think I've ever heard this in my heart before.  My first f/u appt is Wed. the 10th of this month. I would appreciate your opinion on this as it will influence whether or not I request an earlier appt.  Question #2) Can one still experience multiple PAC's w pacer?(I had an episode yesterday-scared me, but pulse didn't drop...thanks I guess to Pacer.  Thankyou, Carol

[Michael J. McWilliams, M.D.]

1) Does a pacemaker change the heart sounds in any way?  I swear that when I listen w stethoscope at about the level of the sternal notch (where I think the RT ventricle would be) it almost sounds like a murmur-not a rub- but I don't think I've ever heard this in my heart before.  

There is change that a pacemaker can cause a murmur, but this would be very rare. Occasionally, the tricuspid valve can leak if the pacemaker lead is against it.  You pacemaker should be programmed to only pace the ventricle when needed and you didn't need the pacemaker for bradycardia before the procedure, it can usually be programmed ot minimize ventricular pacing.


#2) Can one still experience multiple PAC's w pacer?(I had an episode yesterday-scared me, but pulse didn't drop...thanks I guess to Pacer.

PACs are usually not decreased by the pacemaker unless the pacemaker rate is set faster than the rate that PACs occur.  This is usually not effective for decreasing PVCs.

I hope this helps and thanks for posting.