I had a patient who was young about 20 years old and had a normal resting pulse of 37-44. She has had previous open heart surgery to repair an ADS at age 11. She underwent a cardiac cath to for suspected PAH but PA pressure was 23/9 mean 17. The lowest her pulse went was 33 while laying down. She has a normal stress test with her highest pulse at 140. She is frequently tired, and sometimes light headed. She has frequent headaches and some nausea. She feels better when she sleeps preferably 8-11 hours. She has controlled hypothyroidism and is on 75mcg of synthroid. Her most frequent echo showed RV 33-43 mmHg, Mildly decreased LV function. She also has occasional PAC and PVC.
The electroyphysiologist said that a pacemaker is not necessary but he will put one in if the patient requests one. He said that the patient borderline meets his criteria for a pacemaker. The patients regular cardiologist thinks if she doesn't get a pacemaker she should at least get an internal cardiac event monitor.
The patient is concerned that the pacemaker will not make her feel better and that even if she gets one it may not help her with her tiredness and fatigue.
Should the patient get a pacemaker?
Will the pacemaker make her feel better?
If the patient doesn't get a pacemaker now will she need one later?
If the patient decides to have children will she need a pacemaker then?