Dr. Fett Pacemaker?

[Kim]

Dr. Fett,

I have been having problems with my hearts rhythm. I wore a holtier monitor and it shows that I am having lots of spells of Superventricular Tachyicardia and spells of my heart rate going down into the low 40's when I am awake and into the low 20's at night. I saw my regular cardiologist who thinks I need a pacemaker because when I am on low doses of medicines to treat the tachycardia my heart goes to slow(coreg, toporol xl, the short acting for of toperol, atacand, atenol, ). My problem is today I saw the electrophysiologist, he feels like I am over reacting to a small problem and he and the cardiologist are not agreeing. He wants to wait another few months to see if it gets better with me wearing a event loop monitor agian to record symptoms. I have wore both loop mointors 3 times for a month and holter monitors 4 times in the last year. They all show that I am still having small pauses and my heart rate is both to slow and to fast. What should I do I have had a few passing out spells, I am tired constantly, and have spells of chest pain. What do I do ?? After the electrophysiologist told me that he wanted to wait on a pacemaker he then told me that he thought if I got a second opion they would give me a pacemaker.. The dr. is supposed to be very good but he seemed to think that I was being overly sensitive to this issue. I am just frustrated and not sure what to do? I don't even want a pacemaker but I keep ending up in the ER. My EF has improved greatly from 15% a year ago today to 50% now.

Sorry this is so long I just don't know what else to do.
Kim
EF @dx 15%
EF currently 50%

[JAMESFETT]

Kim, it is great to hear from you. The most encouraging thing is that you are approaching this from a position of strength because your EF is 50 percent. That is great! Doesn't it seem pretty clear that when you are receiving different advice from the cardiologist and the electrophysiologist that another opinion of an expert who can help the other two get together would be indicated? You are located in KY, and I just don't know any of my own trusted cardiologists in that area, but maybe someone else does. So I suggest that you receive another opinion and then have the 3 come to a best conclusion and give you clear advice. Congratulations on all the great progress you have made. What do you think is the best course? What medications are you now on , and what dosage? If you do need a pacemaker it can be a temporary thing as a bridge to complete healing.

JD

[Kim]

It was suggested by the nurse practicioner to get another opinion but she is for a pacemaker. The heart electrical expert wants to exaust the possibilty of hyper sensitivity to beta blockers and has re-prescribed toporalXL in 25mg to be split and taken 12.5mg in the AM to minimise the potential drop in resting heart rate that has been occuring mainly at night but also somewhat at random during the day during like, walking through the grocery store, the other day, took it at a BP machiene after recovering from a dizzy spell, it was 50bpm a few minutes after the dizzy spell, so it was probably lower.

This time a non-looping event HRM/ECG was sent home with that records about 20seconds at a time to be uploaded by phone after an event.

The Nurse Practitioner says to use it a lot after the toperolxl has come back up in a couple of days. Meds have been switched several times over the last 3months to try to alleviate the swings in pulse rate.

Is there a chance that the heart can relearn to find its own rhythm after being affected by the regulating meds? Like it can get a bit lazy?

[Kim]

If I get another opionion and decided to get a pacemaker would i need to switch to that hospital for my care. I really like the nurse practioner that i see at UK. She told me before I left yesterday to get another opionion but I would have to go to another hospital. I'm just frustrated this hospital has been really good so far in my care. I didn't know you could get a temporary pacemaker I had not ever heard of that.

I am currently taking 12.5 mg. of toperol xl, asprin, and lipitor.

Thanks Dr. Fett I guess I will get a another opionion.

Kim

[JAMESFETT]

It seems to me that all the possible options offered to you are good, because once again you are at a position of strength with an EF of 50 percent; and none of what is being offered to you will bring you harm. So weigh carefully what you like and want to keep and go with that.

JD