requirement of pacemaker

[sivanagi]

Sir,
My father is 85.He has been a chronic Bronchitis patient. As advised by Docter his heart got examined recently.Report is given below. Doctor suggested implatation of Pacemaker.I want to know whether it can be substituted by Medication or if it is a must whether there is urgency.
Left Atrium:3.7cm,left ventricle:3.6*2.4cms,EF:62%
Right Atrium and right ventricle are dilated.IVS:1.1cm,PW:1.2cm,Arota:2.8cm.
Pulmonary Artery is dilated. Pericardium: No E/o Free Fluid.
Doppler results:AJV:1.1m/sec,MVF:E>A,TVF:TR2+,PJV:1.0m/sec,MRJA:2sq cm, RVSP:40mmhg
Conclusion:
Mild concentric LVH, No regional wall motion abnormality, Good LV function, Mild MR,Moderate TR,Mild PAH,
No PE

[kenkeith]

It appears your father's left ventricle and atrium is normal as well as the contractility of an EF of 62%.  Normal EF is 50 to 70% and that is the percentage of blood pumped into circulation with each heart rate. Mild concentric LVH is somewhat inconsistent with a good EF, but possible.

The medical problem as presented by report is the right side of the heart has an increased right ventricle enlargement as well as the upper right chamber and is consistant with a high (marginally) of right ventricle systole (pumping phase) pressure (RVSP).  Moderate tricuspid valve regurgitation should be watched...mitral valve's mild leakeage is considered medically insignificant.

To evaluate for a pacemaker:  Does the heart pump too slowly? Does the heart rate increase 2 to 3 fold during stress or exercise? Symptoms associated with need for a pacemaker: Fainting, near fainting, dizziness, lack of energy, fatigue, shortness of breath and exercise intolerance.

Extreme slowing or complete stopping of the heartbeat can be fatal. In other cases, people may have no symptoms but are at high risk for dangerously slow heart rates because of disturbances of the electrical system of the heart. A pacemaker may be recommended for these people before symptoms occur. There are no electrical disturbance shown with your post?!

Because a wrong decision can be very serious I would hesitate to second quess a doctor's assessment.  From what you have posted, I don't see any compelling reason for a pacemaker, and there is medication to treat slow, fast irregular heartbeats.  You may want to get a second opinion or get an answer whether or not there is any arrhythmia of concern or is the suggested pacemaker assurance in the event of a rhythm disorder?!