Question for GP Maarten: Pacemaker
Maarten Vasbinder is a retired general practitioner, a profession he previously practiced largely in Spain. On Thailandblog he answers questions from readers who live in Thailand.
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Dear Martin,
I have had a low heart rate for years, between 50 and 55 bpm. That causes and caused no problems, not even back then during endurance sports.
In 2000, after severe pneumonia, I developed arrhythmia, for which Tambocor was prescribed in the Netherlands. It worked well, even during long multi-week cycling trips.
Monitoring continued in Thailand, but after a Holter test, the cardiologist suggested stopping the Tambocor, partly due to possible side effects, and starting warfarin instead. That worked fine too, even with the same low heart rate. No dizziness, fatigue, or anything like that. I just feel good. During the recent check-up, another ECG was performed, and the heart rate was again found to be low and sometimes below 50 bpm. The cardiologist suggested implanting a pacemaker. Because I feel good, I have postponed that and shortened the check-up interval to 2 months. My questions:
- Is a good feeling and the absence of the usual indicators at low frequency a contraindication for a pacemaker?
- What happens in the body when, after years of low frequencies, the frequency goes to 60 pm?
- What influence on daily functioning?
- If I decide to implement, what are the relevant points to consider?
I am enclosing the blood pressure readings.
Details: 84 years, 188 cm, no smoking or alcohol, only Wafarin medication.
Best Regards,
K.
******
Specifications,
A difficult question. What is wisdom?
According to protocol, you have been due for a pacemaker for years, but in reality, you have no symptoms.
Unfortunately, protocols are based on averages, and there are only a few that meet them.
If you get a pacemaker, in my opinion, it won't change much, except that you will be wearing a second little machine that can malfunction. Together with your heart, you will then have two.
My advice is: don't do it. Your pulse goes up during power training, and that is good. If you experience symptoms such as fatigue, dizziness, and/or shortness of breath, you can always reconsider your decision.
Your blood pressure is perfect, except for the occasional outlier.
Continue taking the warfarin, an anticoagulant (blood thinner), because of your irregular pulse, which does not go away even with a pacemaker. With a pacemaker, a normal heartbeat breaks through the arrhythmia. This is clearly visible on an ECG.
Yours faithfully,
Dr. Maarten
Do you have a question for Maarten and do you live in Thailand? Send this to the editor: www.thailandblog.nl/contact/ It is important that you provide the correct information (see list at the top of the page).
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