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Do I need a pacemaker?

34yr old male, MI 1 and 1/2yrs ago. Follow up cath after 1yr showed no blockages. For the past 6 months have had dizziness during the day no matter the activity. On 30day monitor that has shown night-time sinus pauses of 3to5 secs. and sinus-tach during the day of 154bpm. Went for a tilt table test, bp dropped alittle while standing but hr did not go up. They laid me down and prepared to give something to raise the hr. Before they could I started tachy and felt like my heart would explode. hr went to 176bpm. Lots of dizziness during the day but the pauses dont seem to bother me and oh yea I was also diaged with sleep apnea and yes I wear my mask. Im very stressed and scared and have been since the MI. Do I need a pacemaker and if not what meds will help. Cardio says no pace but cannot so far tell me why this is happening or what I can do to fix it.


This discussion is related to Do I really need a pacemaker?.
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Avatar universal
noticed yesterday that during the dizziness my blood pressure had also dropped to 90/60 doesnt do this every time. I visited my GP on Monday, she was baffled and said also to remain on holter for the 30 days ( ends in two weeks). If the Electro Doc doesn't come with an idea, she wants me to get a second opinion. This is scary because the Electro Doc and my Cardio Doc are in the same office. Any advice.

Thanks again.
Helpful - 0
967168 tn?1477584489
Now VT or Vtach as my dr calls it not sure why and I understand - I've had  sustained & nonsustained too many times and one of the reasons I have a PM/ICD

so SVT is still in the ventricles just above them?  I'm just trying to figure out all this and why I developed PAC's the day of my ablation when I had none previously; now I'm 28% atrial paced...can arrythmia's just move to another place when they're ablated?
Helpful - 0
995271 tn?1463924259
Hi Lisa, yes SVT's origin is above the ventricles.  SVT or SUPRA ventricular tach mean "above" the ventricles.

SVT's can have a sinoatrial source (meaning from the SA node pacer), an atrial source (like a-fib), or atrioventricular source (from the AV node).

VT (without the S) means the tach is originating in the ventricles.  They're PVCs basically, > 3 in a row.

If the VT is under 30 seconds, and here's where acronyms get confusing, it's called NSVT or none sustained ventricular tach.  it sorta looks like it's similar to SVT with just an N in front of it, but that's not the case.

Greater than 30 seconds is called Sustained Ventricular Tach, so now we have more confusion on hands because this "SVT" is noting like SVT of the "supra" variety.

VT is a bit more conerning than SVT (supra VT).   VT if not self correcting needs to be converted through a shock.

From wikipedia:  "The shock may be delivered to the outside of the chest using an external defibrillator, or internally to the heart by an implantable cardioverter-defibrillator (ICD) if one has previously been inserted."


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967168 tn?1477584489
itdood thanks, I did some more reading and found this interesting - pacemakers can be temp or permanent; I think I just always thought it was a permanent kind of thing.)

Is the source above the ventricles where the atrial are? or is that something else? sometimes drs dont explain too much and told me I now have PAC's

Panic or anxiety is normal - I know I've suffered my bouts during these crazy pvc's & pac's & surgeries - ssri's are good to help with that even if you only need them for a short period of time

chuck_5112 your tilt test said negative? there's a few on the dysautonomia forum here who have had negative TTT then later positive ones; depends on which protocol your dr used and if you've passed out fully before - if you dont have your results of testing, I would get them all, that may yield some answers.  Problems with dizziness/fainting sometimes are hard to dx
Helpful - 0
995271 tn?1463924259
P.S., VT doesn't apply to chuck_5112, he's already confirmed with only sinus tach.

and chuck, anxiety is a sneaky nasty beast.  I have it.  Though I hardly ever feel anxious, I've become so tuned in with my heart rate that if I sense an issues it will get tachy on me at the same time I feel anxiety or panic over it.  I was diagnosed with SVT so far, but SVT just means the tach is coming from a source above my ventricles.  SVT can be a bunch of different causes, including sinus tach.  Sinus tach is benign and a pacer cannot do anything about it because the signal is coming from the hearts on pacer, the SA node.
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995271 tn?1463924259
Hi Lisa, I'm almost positve that's the ICD part of the device that handles VT or VF.

The pacer part handles only bracycardia.  I did a bit of research on the Telegen unit.

The ICD handles VT through ventricle stim, cardioversion, or defib.

There are certain types of pacers that can be programmed a certain way to handle VT, but that's either stim or cardioversion.  It's basically using the pacer in a non-pacer way to convert the VT.  But it's not as robust as an ICD at handling VT.  And, this would only apply to someone who is not at risk of going into v-fib.

I don't think there's any way to convert VT with basic pacing signals.

I had to bear down today for a short SVT, I didn't try coughing, I did the valsalva.  haven't had one in a while.  It was exercise enduced.
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967168 tn?1477584489
itdood - interesting; I didn't know that about pacemakers.

I'm interested in knowing - I know I read something about my Teligen and the way it converts VT; but I didn't understand it fully.

So when mine converts VT; it's actually the ICD part of it working? or is it because I have a DDDR [I believe it's called] dual lead PM/ICD?  I thought it was the PM part pacing low & high HB; until it shows I go into Vfib then the icd part works.

Oh btw, yes the coughing trick works, I had to use it a couple of nights ago
Helpful - 0
Avatar universal
Thank you more than you'll know for your reply. I have been told by several that it could be anxiety. It seems the ones who tell me this are the ones who don't want to believe that anything else could happen to me. For it to come from someone I dont know, crazy as it sounds, is more comforting.   Thank You
Helpful - 0
995271 tn?1463924259
sounds like anxiety to me.  could be wrong.  I say this because the tach they found was sinus tach.  which if you've got tach that's the one to have.  causes of sinus tach are many but can be dealt with.

A pacemaker only helps with chronic symptomatic bradycardia, i.e. too slow for too long.  It cannot correct tach nor can it control arrhythmia's other than bradycardia.

For the daytime tach try some coping strategies.  Things like coughing, valsalva maneuver, there are others so research them.  Sometimes these methods can correct the tach.

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