slow heart rate

[pausan]

I am turning 32 this March. Since i was 14 years old, i have experienced more than 25 times of syncope, each incident is a result of either too much hot weather, starving or hunger, pain intolerance or claustrophobia
i was told by two electrophysiologist to put a pacemaker, having hb of 49-57,
per minute.
thing is, i think its too early for me to put a pacemaker. moreso, the cost is high, ive got two kids now,
can i just delay the implantation?
what's the worst case scenarion if im not gonna put it in?
please advise

[MichelleP_3811]

I would suggest if you decide against the pacemaker at this point to do your best to drink more water and get more sodium in your diet.  I don't usually recommend sports drinks because they are generally too high in sodium for casual drinking but maybe check into them.  Consult with your cardiologist about your options and risk factors in regards to the pacemaker and get their thoughts on what I suggested.  Best of luck and keep us posted on how you are.

[achillea]

If you feel well and live actively without weakness, shortness of breath and so on, that argues against an absolute need for a pacemaker.

On the other hand, a pause of five seconds is fairly long for a person who is not an athlete.  Was there only one five-second interval in the 14 hours you wore the monitor?  If so, and if it happened only during sleep, that also argues against the need for a pacemaker.

On the third hand, if you had many such intervals during sleep, that could indeed point to a possible need for the pacemaker.

Personally, I think it would be a good idea to request a longer period of monitoring, to see if you are doing a lot of these five-second delays or not, plus a frank discussion with your doctors about whether or not you really need a pacemaker--and if so, exactly why.

At this point, from what you have described, it does not sound as though you have been given enough information or reasons to make the choice.

[pausan]

thanks for your response..
1. i have always been hyperactive, yes i feel good most of the time, and i can do activities that are usually heavy for a woman. i can shop with ease, take care of my kids, do all multitasking at home and i feel okay
2. yes there are thigns, situations that can cause me to faint.
3. i did had a holter test for 24hours only, I had 5seconds of no beat and that was when i was sleeping, about 1 to 2secs when im awake
4. 2d echo results were fine, though there is mild dialtion of the left atrium

[achillea]

Although your BP is low, it is not terribly, horribly out of line, and even though your heart rate is quite slow, I have several friends with your heart rate, and they lead perfectly normal lives.

So here are two or three questions:

1. Except when you are about to faint, how do you usually feel?  Are you tired, weak, and short of breath much of the time?  If so, that argues for a pacemaker.  Or can you do normal stuff like shopping, playing, or chasing your kids around without any problems at all?  If this is the case, it implies that under ordinary circumstances, you have enough blood circulating to live a normal life and perhaps less need for a pacemaker just now.

2. Do you really only faint when you get overheated, are frightened or starving or in pain, or have claustrophobia?  If so, that sounds a lot like the standard 'vasovagal faint,' which is not rare.  People with this problem do have to keep a sharp eye out for situations that are tricky for them, but vasovagal fainters without other problems are not treated with pacemakers.  

However, if you have Sick Sinus Syndrome, that can change the picture.  Your already slow heartbeat and low BP do not give you much 'reserve' or wiggle room, so you might faint much more easily than ordinary fainters.  The big deal, as Michelle says, is that fainting puts you (and probably your kids) at great risk for injury.   But if you truly can always, always, *never-fail,* sense a faint coming on and have time to prepare, then under the circumstances, it sounds to me as though you might have one more reason to delay the pacemaker.  Still, it is worth noting that Sick Sinus Syndrome just tends to get worse with age, and it is one common reason that older folks--way older than you--do get pacemakers.

There are two more factors I can think of:

1. You don't mention having worn a Holter monitor for a long period, and I wonder if that has been done?  It gives a better picture of your day to day heart function over a longer period of time than something that is checked briefly in the doctor's office.  Personally, I would not be thinking about a pacemaker if I had not worn a monitor a couple of times to get the big picture.

2. Have your electrophysiologists told you that you have anything like 'sinoatrial block,' a situation where the electrical charge just doesn't get through at the right time or speed?  If so, that IS an argument in favor of a pacemaker.

I think it boils down to whether or not you need a pacemaker to function normally and safely at THIS point in your life.  In terms of delaying the surgery--judging from what you have posted--the worst case scenario would be that your heart rate would just get slower and slower, you'd faint more often with less control over it, and you'd be so tired that it would be hard to do much of anything.

So, major things to think about are 1) how well you feel and function every day, 2) the serious risks involved in fainting, and 3) medically speaking, whether or not you have any kind of "heart block'?

It's a lot to think about.  If you have a doctor you can talk with, it would be good to have a LONG conversation with him/her about how much of a medical need you have right now for a pacemaker.

[pausan]

hi michelle! thanks for your advise.. my BP is typically 90/60 and yes, i am not fond of drinking water and i don't prefer salty foods. i was advised to take meds to bridge the slow heart rate. i was told about the sick sinus, that causes slow heart rate. lowest rate is 49beats/minute highest i got was 63. i don't have a heart failure. and yes i believe this is one of the greatest decision i will make in my life.. i know once i put this, i will be needing a replacement in 10 years or if needed as per doctor's advise. i can say that i can avoid having syncope, and thank God for the past 18 years i have been safe, since i anticipate of having syncope and i usually go to a safe place, where i can sit or lay down.

i just think that it is too early for me to put the thing... but im scared a bit.. but im confused.. me and husband are now trying to gather funds for the operation and its not easy..

thanks so much for your time.. i appreciate it so much.. bless your heart michelle and take care always.. :)

[MichelleP_3811]

It sounds to me like you have episodes of low blood pressure in response to your environment.  What is your blood pressure typically?  If it runs low adding extra water and sodium to your diet may help alleviate your syncope.  As for the heart rate are you on any meds?  Does the slow rate cause you any problems in general?  Are you that slow all the time?  Do you have heart failure?  Putting in a pacemaker is a big deal so it would seem wise to me to seek a second opinion.  As well if you are tolerating the low rate without much symptoms and your syncope is indeed solely in response to environment then really follow what your gut is telling you.  If you feel super uncomfortable about having a pacemaker put in then take some time to really think it through.  As well compare that option with how not getting a pacemaker makes you feel and follow the path that feels most right.  

This said, passing out is a big deal and can be very dangerous if it happens while driving or operating heavy equipment so just be as objective and realistic about the situation as you can.  Are you being totally honest with yourself about when you are passing out (no need to justify that on here it is something for you to think about for yourself).  If you can honestly say that external extreme circumstances led to the syncope then so be it but do keep in mind that a pacemaker though a big deal if it helps keep you safe and sound may be a wise choice.  But it is a big decision and no one would fault you for seeking a second opinion about the situation.  Best of luck.  Do keep us posted on how you are doing.