What to expect now???

[angdoren]

My husband 54, just survived his second VTAC situation.  Background - he had his aortic valve replaced in nov 2006 and VTAC late nov 2006 and CHF in Dec 2006.  Apparently back in 1991 - he had a virus that attacked his heart. EF was last shown during nuclear test to be at 24%.  Has been as low as 15.  Sunday for the first time he actually FELT the pain and tightening, and was very very close to passing out.  When paramedics got here he was at 242 bpm.  Having been shocked once before while aware, he heard the doctor mention paddles and said I do not want to be shocked and literally scared himself back to sinus rhythum.  They sent us to Sioux Falls Heart Hospital where finally after 2 years of trying to convince him he agreed to the ICD.  The angiogram showed no more than 20% blockages, which the DR was hoping he would find some blockage to explain away the VTAH and be able to treat.  Dr explains now (as we were told before) that his heart is very week.  THe lower chambers are severly damaged.  He has the ICD in and we have just returned home.  Here are the questions that would help us understand what now?   Dr already told us not to expect a long life from the ICD, because it is having to work almost constantly instead of just as needed randomly.  With the ICD inplace helping him pace his heart ( he is in AFIB most of the time) and with it being there to zap him if it gets out of control, what is the life expectancy.  What other issues from his weak heart will not be helped?  Does the ICD work every time? Can the extremely bad heart still fail with it in?  Is there a risk of it just stopping? I read in one of the forums about the pump just stopping.  Are we looking at years yet for him to be around.  At 54 he has put on 100 lbs since 2006 and is very tired all the time - can not do a flight of stairs without being winded.  All the meds for his heart have damaged his kidney function.  He is not diabetic. Takes Lisinopril, Norvasc, Coreg, Lasix and about 14 other meds daily.  They just swithed him from the amiodorone to Sortol so I do not know what that change will bring.  We were told several times he would not survive another VTAC episode and his CHF would not make it another year and here we are. Living every day to the fullest, but the not knowing if he only has months or if we can really expect another 10 - 20 is hard.Please advise a very scared wife.  

[ireneo]

My Dad's EF was 30. His ICD was also a pacemaker since he had periods of bradycardia as well. Each person needs their own particular blend of cardio meds. It can be frustrating as heck trying this and that but it's the only way to find what works for each person.

I'm not sure what happens if a person's heart gives out with an ICD in place. Usually the ICD is there to correct an abnormal arrhythmia. It's set to sense v-tach (set for a specific rate and length of time) and then administer "therapy", the shock. I don't think it will respond to a still heart unless his is a pacemaker as well. It might try to pace the heart up to 60 or whatever it's set for. These are great questions to ask his doctor. Sometimes if a person has a very bad heart and is near death from heart failure, the patient may opt to turn off the ICD so he/she can pass quietly. The doctors discussed that with my Dad. Then again, he passed quietly from the cancer and the device wasn't a problem. It was still on.

Heart problems aren't always caused by blockages. Sometimes it's an electrical problem (I have various arrhythmias but a healthy heart) or it can be the heart muscle itself. Your husband had a valve problem. So you see it's not always an easy diagnosis.

I do hope the doctors can adjust his meds so he's not feeling so tired and discouraged. He'll never go jogging again or play football (heck, few of us over 50 do those things anyway) but there's still a lot of things in life to enjoy even at a slower pace. I wish I had some words of encouragement that would help. Take care.

[angdoren]

Thank you for your response.  It does help. Do you know what his EF was when he got the ICD.  Confusing part fo rme is his artery are no worse than 20% blocked.  He did have to have his right coarted done same time as replacing his aortic valve.  He has been on the amiodorone for 2 years now and it has taken a huge tole on his kidneys along with the lasizx and spiralactone and lisinopril etc etc.  They just took him off the amiodarone and put him on sortel.  I know nothing about that one.  I just don't see how the heart can end it with an ICD.  Does it just sometimes not work ar the heart just stop??  I am 39 , and well I wasn't prepared for this.  I love my husband dearly and I am just trying to be prepared and know what to look for now.  Again thank you for posting.

[ireneo]

I can only share my Dad's situation. He had 4 heart attacks over a period of years which damaged his heart pretty badly. He was having v-tach quite often and he also ended up with an ICD. After about 5 years with the ICD his heart started to fail pretty badly. The docs even put him on hospice care. Part of the problem was my Dad's reluctance to switch his meds. He was comfortable with the meds he had and didn't want to bother with the side effects of new meds. After doing a face plant in the hospital parking lot one day, he agreed to switch to the Amiodarone. That helped so much in his case that he was able to come off of hospice care. He lived another 19 months after that. The sad part? His heart didn't give out; they found out he had cancer and that took him.