When is it time for a pacemaker?

[Sherylancmom]

Hello,
   My mother is 74 years old and has a history of strokes.  We suspect she may have had one of them as recently as two months ago (a minor one?).  She has had a problem with high blood pressure and  wide pulse pressure (at least 160's/40's or 50's) with her top number as high as 200 once but usually in the 160's without her Norvasc 2.5mg and her bottom number usually in the 50's with or without Norvasc.  Her bottom number dips as low as the 40's, even the high 30's and she has mild episodes of shortness of breath, dizziness, and a self described "whoosh" feeling of a rush of blood originating around her left rib cage going upwards.  She has an irregular heartbeat and she takes Flecainide twice a day. She just got out of the hospital last night after what we thought was a heart attack with chest pain but it turned out to be fine. She was previously tested a few months back and her Echo, Carotid Ultrasound and Stress Test were ok but other than blood work at the hospital, heart rate monitoring and a chest x-ray, no other tests were done at the hospital.  However, the heart monitor showed several sinus bradycardia episodes in the high 30's.  I worry about how low her rate goes down during sleep if it goes down this far when she is awake. Even when she was stimulated, her rate didn't really go up where it should, per her doctor.  Her stroke(s) has affected her memory which has inexplicably gotten worse recently, making me wonder about hardening of the arteries or some kind of insufficient blood flow to the brain.
    Her cardiologists dismiss all of this and say she is fine and didn't even want her on any medication, Flecainide and Norvasc included, but only did so for her comfort and my insistence when her bp was over 200 because I was afraid of another stroke. The latest cardiologist in this group suggested "Sick Sinus Syndrome" during her hospital visit and the possibility of a pacemaker in the future, but she is the very first in this large group to suggest anything may even need to ever be done.  My question is this- am I just a worried daughter thinking that she is at unnecessary risk for a stroke or heart attack  that could be prevented with a more attentive/ aggressive treatment plan or should I expect more?  I just have trouble seeing her symptoms and the possibilities for problems and then accepting that nothing needs to be done.
   Thanks so much!

[ksig]

I have AFib and several years ago my heart rate dropped to 28-36 and stayed there for several hours.  I was admitted to the hospital and taken off the arrhythmia meds and we waited.  My heart rate returned to normal (60bpm) but AFib returned with a vengeance within a day.  My EP then had a talk with me about my predicament:  I needed the meds to curb the AFib but they were causing my heart rate to dip to dangerous levels for me. So I got my first pacer. I just had my first change out two weeks ago and I am doing well.  I still have AFib but I do not drop below 60 for which I am grateful.  

It may be worth a trip to see an EP (electrophysiologist) rather than a cardiologist to discuss your mom's low heart rate.
ksig.

[is_something_wrong]

This is a typical "ask the doctor" issue I think. It's probably wise to get an opinion from another cardiologist.

I guess, with a pacemaker, it's possible to use beta blockers more aggressively, to reduce blood pressure and tachycardia events. In SSS, I think this is the normal procedure - using high dosage beta blockers and setting lowest heart rate to 50 or 60.

I've almost considered asking for a pacemaker myself - I use a small dosage of beta blockers for my PACs and SVT - and it causes my resting heart rate to drop into the 40s - causing lots of skipped beats. It's really annoying.