Pacing 100% of time? Silent heart attack?

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New Member

Date Joined Aug 2010
Total Posts : 3
   Posted 8/9/2010 2:32 PM (GMT -6)   
HI, I'm looking for some hands-on (hearts-on?) advice to help with making treatment decisions for my dad and formulating questions for his cardiologist appointment next week. Dad has dementia and diabetes.

Two stress tests showed that Dad had probably had a silent heart attack. This was confirmed by a heart ultrasound; we were told the damage is on the front of the heart, near the left artery. When we went in for a cardiac CT scan, we discovered he is pacing 100% of the time. The pacemaker was implanted five years ago after a third degree heart block. (He passed out while driving, hit a tow truck head on. The airbag did not deploy, and the resulting jerk across the chest from his seatbelt restarted his heart. An ambulance was right behind him and they kept him going until an emergency pacemaker could be placed.)

The next step the doc wants to do is a heart cath and I suppose angioplasty if warranted. With his other health problems, I am not too sure about this.

What pros/cons or questions spring to your mind?

Thanks for your help!

Elite Member

Date Joined Apr 2007
Total Posts : 32602
   Posted 8/9/2010 4:22 PM (GMT -6)   
If your Dad has 3rd degree heartblock then it would make sense that he is pacing 100% of the time. Complete, or third degree, heart block is a condition whereby no electrical signals from the top part of the heart, the atria, reach the bottom chambers of the heart, the ventricles. Thus, the ventricles must generate their own electrical pacemaker impulse. However, the electrical impulse is much slower than the regular heartbeat.  This can lead to a failure of the heart to pump blood to the organs of the body and sudden cardiac death thus the pacemaker is doing it's job. 
Chest pain is a common heart attack symptom. Since diabetes can impact the nerves, some people with diabetes have heart attacks without experiencing any pain whatsoever. These so-called silent heart attacks are not usually diagnosed until a routine medical exam.

Anyone who has experienced a silent heart attack is at greater risk for another, more serious heart attack and should be closely monitored by a cardiologist.

You do not mention how bad your Dad's dementia or Diabetes, is also what age is he, and does he live at home ?

The gold standard for coronary artery disease is coronary angiogram, used to identify the exact location of disease, anatomical details and the severity of disease. I would discuss with your Dad's cardiologist if doing further tests will improve his quality of life and if you feel it will after talking with the Dr. then you may have your answer.



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New Member

Date Joined Aug 2010
Total Posts : 3
   Posted 8/9/2010 5:54 PM (GMT -6)   
Thanks, Kitt. One reason I am concerned is that he was not pacing 100% of time when pacemaker was installed. So that is a new development, it seems.

When his first pacemaker was installed, it became infected. He had to be hospitalized for a week after the pacemaker was removed from the infected area. They put him on an external pacemaker which rarely fired and on IV antibiotics. Then a new pacemaker was installed on the other side of his chest.

Dad's diabetes is now very stable, controlled by metformin. However, in the past, it was apparently not as well controlled, because he has neuropathy from his feet up to mid-calf. He is very unsteady on his feet and has fallen several times recently; his PCP attributes this to the neuropathy -- if you can't feel your feet, it's harder to keep your balance.

The dementia is Stage 4, if you are familiar with those stages (that is out of 7 -- 4 is a solid mid-stage). He can no longer handle his finances, manage his medications, or drive safely. My mother died in May (of Stage 7 dementia), and he has forgotten that at least twice since then. His dementia has accelerated greatly since Mom died, and he now lives in an Assisted Living Facility.

New Member

Date Joined Aug 2010
Total Posts : 3
   Posted 8/9/2010 5:56 PM (GMT -6)   
BTW the nurse told me the complete stoppage of the heart was a third-degree heart block. I apologize if I am using the wrong terminology -- I know all about dementia but this is new territory for me!
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