Heart disease
January 17, 2012 | 15,00 EUR | answered by Dr. med. Ralf Berg
Hello,
I have the following problem.
I am worried about my father. He is 62 years old and has a resting heart rate of about 40 beats per minute.
He has already been to the doctor about this issue, and a long-term ECG was done.
The result is that he has an enlarged heart, which has occasional pauses.
His blood pressure is not too high. It is mostly normal, and when it deviates, it is slightly low.
He does not have shortness of breath and occasionally engages in sports such as volleyball and jogging. His heart rate does not exceed 147 beats during these activities.
A doctor has suggested a pacemaker for the pauses in his heart.
However, we are very unsure. The low blood pressure should be a sign against the risk of a heart attack. Also, he does not have any circulation problems. He feels good.
However, there are still other signs.
My father is estimated to be about 10kg overweight.
It would be great if I could get an assessment/tip from you.
What are the risks of getting a pacemaker inserted? Is it even necessary?
Are there lifestyle changes with a pacemaker? How long does it last?
To what extent can one positively influence the problem by changing diet (what is good?) and lifestyle?
What is your opinion on long-term use of medications such as aspirin?
Thank you in advance.
Dear Questioner,
A frequency of 40 and below, especially if longer duration "pauses" were found in the long-term ECG, justifies the consideration, or suggestion, of implanting a pacemaker in order to prevent syncope (circulatory collapse with a fall due to prolonged heart rate pauses). The risks of inserting a pacemaker are low. It is usually implanted under local anesthesia into the chest skin, and connected with the leads (usually 2 pieces) which are advanced through the subclavian vein/superior vena cava to the heart and anchored there. The risks are similar to wound care and complications that may arise with the placement of a central venous access. Additionally, there is the possibility, but usually manageable, of triggering heart rhythm disturbances when placing the leads. The battery life depends on usage, but modern pacemaker batteries usually last over 10 years. The only limitation is that the function, settings, and battery reserve need to be externally checked half-yearly or yearly intervals, for which you need to schedule appointments at the hospital or with a cardiologist. In this case, I believe that the problem cannot be solved or alleviated with a diet. The use of aspirin (ASS) cannot be assessed from here. Knowledge of a long-term ECG and further investigations is necessary. If it has been suggested, please ask the treating doctors on what basis they see an advantage in this. As you mentioned yourself, in this case it is not so much about coronary heart disease/heart attack risk, but about a bradycardic heart rhythm disorder possibly with early signs of heart failure (heart failure). In case of a risk due to calcifications in the coronary arteries, aspirin is of course necessary, and I support this. However, based on the described symptoms, this cannot necessarily be inferred. In summary: The risks of placing a pacemaker are low. If longer pauses occur in the long-term ECG justifying the use of a pacemaker, your father, still maintaining good performance, should consider having one implanted. Pacemaker recipients do not have to fear significant reductions in quality of life. Whether the use of aspirin is appropriate, you should discuss with the local doctors. This is always advisable if you have rhythm disturbances and heart weakness in addition to concerns about coronary artery calcification. I hope my assessment is understandable and helpful in your decision-making process, or your father's decision-making process.
Best regards, Dr. R. Berg
