Rick erb
- Thread starter Rickerb
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Do you have congestive heart failure, Rick? If so, I am sorry to learn of it.
Hi Rick,
I'm sorry to hear this. You've come to a good place. People here are informative, experienced, and supportive.
What, may i ask, are your symptoms? swollen ankles? trouble breathing? Do you take any diuretics? My father, 85, is in congestive heart failure but it is controlled by lasix (diuretic) on a daily basis. He is on a no (as low as possible) salt diet. He has had bypass, valve replacement and repair and has pacemaker as well. Takes coumadin. He monitors himself closely and seems to keep it somewhat at ease. I'm sure others will chime in here shortly to add to what i've already said. Would you mind telling us a bit about your history?
I'm sorry to hear this. You've come to a good place. People here are informative, experienced, and supportive.
What, may i ask, are your symptoms? swollen ankles? trouble breathing? Do you take any diuretics? My father, 85, is in congestive heart failure but it is controlled by lasix (diuretic) on a daily basis. He is on a no (as low as possible) salt diet. He has had bypass, valve replacement and repair and has pacemaker as well. Takes coumadin. He monitors himself closely and seems to keep it somewhat at ease. I'm sure others will chime in here shortly to add to what i've already said. Would you mind telling us a bit about your history?
pellicle
Professional Dingbat, Guru and Merkintologist
... or maybe science and medicine, which is what is helping. Praise God
gerrychuck
Well-known member
If the pacemaker is responsible (it can happen with right ventricular pacing), going to biventricular pacing, sometimes referred to as cardiac resynchronization, can make a huge difference; ejection fraction can be increased by over 20%. Might be something to ask about.
I developed 3rd degree heart block after my 3rd open heart. The last being for a large aortic aneurysm. A pacer was placed with a single right ventricular lead. Over several years my ejection fraction started a gradual slow decline to around 45% when it had been around 55%. I did some research and discovered that in a few places a left ventricular lead was placed along with the right lead even in patients who were not in failure. Cardiac resynchronization still is used primarily for those in failure but probably EVERYONE who just has a single right lead and is being paced nearly 100% of the time would benefit from dual chamber pacing. So even if things improve with medical treatment dual pacing should be considered. My ejection fraction improved about 20% back to 50-55%. Generally the left lead is a bit more tricky to place and often only electrophysiologists place them. There may be political reasons why dual lead pacers are not more widely used. Since I am a physician and I had a good relationship with my electrophysiologist I was able to have this done 7 years ago. Good luck
So glad things worked out well for you. Did you find out being a Dr., made things worse since you new what all could go wrong with the surgery? Could you please share with me how much more dangerous the dual chamber and with defibrillator also is compared to regular pacemaker surgery. My husband has had his one sided pacemaker since 2007. Thanks so much for your help.
As far as I am aware dual chamber pacing is not more risky than single (right) chamber pacing. I am paced 100% with 3rd degree block. If someone is paced due to an irregularly slow heart rate and the degree of pacing is say 20-30% then dual pacing may not be a significant issue. There has been discussions about chronic right sided pacing leading to a sort of cardiomyopathy. The tricky part in left sided pacing is placement of the lead. It is usually placed in a region of the heart known as the coronary sinus which is basically a large venous channel. Standard cardiologists as least in the US usually don't place these leads since they can be a bit more tricky (I have been told) to place than the standard right sided leads but once placed they are not particularly worrisome. Electrophysiologists tend to place these leads at least in my part of the world. If there are issues with frequent abnormal ventricular beats that might lead to ventricular tachycardia then the pacer may also have a defibrillator added. But a defibrillator is not necessary just because there is biventricular pacing. I don't have a defibrillator. Having my pacer placed in 2012 when not in failure was a bit ahead of the standard for that time but for me it has worked out well. I just had the second biventricular pacer placed due to the battery running down at about seven years. Maybe these will be placed by cardiologists more frequently in the future.
https://consultqd.clevelandclinic.o...myopathy-patients-heart-block-normal-ef-know/https://academic.oup.com/europace/article/19/2/165/2952442A few discussions of single sided pacing.
Finally in cardiology many of the studies use gross indicators such as death rate, congestive heart failure and developing atrial fibrillation as points of comparison. Daily patient functionality is more difficult to measure. So for example in treating A. Fib one can go the medical approach using anticoagulants and rate meds vs. ablation treatment. In many studies there is equivalence in longevity (death rate) but the life style of an individual in A. fib may be significantly altered from one who is not. I have been in and out of A. fib.. But the cardiac studies usually don't measure things like this. I would rather be more normal whether or not I gain longevity. Talk to the cardiologist about these issues to get an understanding of where he or she is coming from. If the answers are not helpful get a second opinion. As a physician (Retinal surgeon) I try very hard to educate my patients about why I am suggesting certain treatments and the alternatives. Any physician who comes across as dogmatic and not informative probably should be discarded. There are a few things in medicine that are no brainers that everyone agrees with but there are far more that are not as well defined.
https://consultqd.clevelandclinic.o...myopathy-patients-heart-block-normal-ef-know/https://academic.oup.com/europace/article/19/2/165/2952442A few discussions of single sided pacing.
Finally in cardiology many of the studies use gross indicators such as death rate, congestive heart failure and developing atrial fibrillation as points of comparison. Daily patient functionality is more difficult to measure. So for example in treating A. Fib one can go the medical approach using anticoagulants and rate meds vs. ablation treatment. In many studies there is equivalence in longevity (death rate) but the life style of an individual in A. fib may be significantly altered from one who is not. I have been in and out of A. fib.. But the cardiac studies usually don't measure things like this. I would rather be more normal whether or not I gain longevity. Talk to the cardiologist about these issues to get an understanding of where he or she is coming from. If the answers are not helpful get a second opinion. As a physician (Retinal surgeon) I try very hard to educate my patients about why I am suggesting certain treatments and the alternatives. Any physician who comes across as dogmatic and not informative probably should be discarded. There are a few things in medicine that are no brainers that everyone agrees with but there are far more that are not as well defined.
AnnieP
Member
Absolutely agree true informed consent in any procedure the client must understand the pros and cons what is likely to happen if they elect not to proceed, what alternatives ( if any) are available.
gerrychuck
Well-known member
Thank you for those links vitdoc; very informative. Previously I had seen studies that indicated that decreased lvef was primarily associated with right ventricular pacing where the patient was paced at greater than 80%. The Cleveland Clinic study showed significant effects at a threshold of 20% and again at 40%. This is important for me as I am paced around 50%, mainly at rest, and supports my contention that my pacemaker is largely responsible for the change. Currently in my area, they don't want to consider biventricular pacing unless lvef is below 30%. I have been referred to a heart failure team to look at my drop in ef in the past year (50 to low 40s). I am going to come armed with this study!
charlottekaye
Well-known member
Debster
Well-known member
Biventricular pacing has brought my momther's EF from low 20s to 50-55 percent. Has done wonders!
carolinemc
Well-known member
Did you ever find out the cause of CHF? Mine was from my heart murmur. Thank goodness after the Aortic Valve replacement and being patient for three years, it was over. But it was hell, trying to clean a small apartment, walking to bus stops, working, etc. I was glad when I got my valve replaced with a St; Judes' aortic leaflet. You will be fine. You are a young one at 64. The doctors will get you fixed up soon. Time and waiting is the hardest part of figuring it all out what will work. Hang in there. Hugs for today.Thanks, I guess this isn’t a very promising thing to have, I’m only 64
