What Does This ECG Report Indicate?
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
Regarding your concern, I would explain that your actual ECG reveals the usual pattern of a single chamber pacemaker with an inserted lead inside the right atrium.
That's why atrial paced complexes are registered.
Also, prolonged PR intervals (>200 ms) means that there exists an atrio-ventricular conductance delay (first degree AV block), which needs to be carefully monitored.
I would recommend discussing with your attending doctor (cardiologist or internist) for the opportunity of performing an ambulatory 24 to 48 hours ECG monitoring to investigate for the presence of a more advance atrio-ventricular conductance disturbance (second or third degree AV block) episodes.
If episodes of second of third degree AV block are present, then switching to a dual chamber atrio-ventricular sequential pacing would be recommended.
This latter strategy would be beneficial also regarding atrial fibrillation recurrences.
Meanwhile, I recommend discussing with your prescribing doctor on the possibility of reducing your daily Bisoprolol dosage.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
I must tell you this, recently, My Cardiol. ws talking Cardio Ablation and I was excited. When he discussed this with the operating doctor, he said NEVER...she could not at 74 live through such a surgery. That is off the table. My honey is coming tonight for the weekend, and I will have him fix my scanner for me. My cardiogram shows I had I small heart-attack...I would like you to read it, and explain it to me.
Thanks for responding...I was not feeling well yesterday, so went to bed by 7 pm.
I do not have a death wish. Out of 5 children in my family, I am the only one still alive. The rest all passed in their 50's, and I question how soon am I going to just drop like everyone else. Cardiologist tells me, I have a long life ahead.
Opinion as follows:
Detailed Answer:
Hello again!
Regarding AV block, I would explain that it happens when there is an abnormal delay or even complete blockage of the electrical impulses travelling from its site of origin in the atria wall down to the ventricles.
AV block is the main reason for pacemaker implantation and the presence of a very low heart rate of around 28 bpm, raised a strong suspicion of AV block presence, or sick sinus syndrome.
These latter are frequently seen in the presence of coronary artery disease.
The fact you may have two wires inside your heart doesn’t necessarily mean you have a dual chamber pacemaker, as you had two pacemakers during this period.
Whether a pacemaker or ICD-pacemaker, it would depend on the presence of significant cardiac performance impairment and the risk of complex life-threatening arrhythmia.
As you have a known coronary artery disease, all the experienced rhythm disorders are quite understandable.
I agree with the EP doctor that electrophysiology study at your circumstances would not be the right choice.
Nevertheless, I would like to directly review your medical reports including ECG, cardiac echo and coronary angiogram, in order to be possible for me giving a concrete and more adequate professional opinion.
I remain at your disposal for further discussions.
Regards,
Dr. Iliri
You are welcome!
Detailed Answer:
Hello again,
I am glad to have relieved your concern. You may ask me directly in case of any further uncertainties.
Regarding Dercum disease, I could explain that it generally affects women around 45-60 years old, mainly obese individuals and is characterized by multiple painful lipomas (fatty tissue masses).
It is a rare and not well-known disease, because no clearly approved causes and specific treatments exist.
It is associated with multiple, painful, fatty masses; persistent fatigue and neuropsychiatric disturbances, including emotional instability, depression, epilepsy, confusion, and dementia.
Rarely, it is complicated by necrosis of fatty masses, septicemia and even septic shock.
Treatment is nonspecific; prednisone has been used in some cases.
Also, pain relief drugs, such as lidocaine, nonsteroidal anti-inflammatory drugs and even opioid analgesics have been successfully applied.
Surgical treatment, such as liposuction and also excision of localized painful lipomas have been effective at relieving the pain.
Hope to have been helpful to you!
Wishing to you all the best,
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello again!
I can understand how you feel.
It is important to care about your body and weight.
But, I would explain that Dercum disease has a good prognosis, which means that you can live as long as other healthy persons.
Unfortunately there is no proven efficacy therapy against this disorder.
But, I would recommend you starting pregabaline for the pain. You can take it 75mg twice daily. It can be really helpful for the pain caused by neuropathy. But as an anticonvulsivant, it can also be helpful in chronic pain.
So, I think it may be helpful to you. You should discuss with your doctor about this issue.
I recommend having a balanced diet and performing a lot of physical activity (walking, aerobics, recreational sports, Yoga), in order to stay fit.
You should feel blessed that you have a beautiful shape and body!
I wish you have a wonderful Holiday with your family too!
Best wishes,
Dr. Iliri