Pacemaker / heart failure

[Jowasace]

I’m hoping someone can give me an explanation to pass on to my dad.

He is mid 80s.

He has had a pacemaker for about 12- 15 years. He was fitted with this following a couple of bouts where we thought he had tripped up but the GP did some hearth rhythm test on him and referred him and he was told he had a slow heart beat.

He goes for checks regularly and a few weeks ago had his battery changed.

AF has been mentioned in his letters, and we think this refers to the condition he has requiring the pacemaker.

Separately to this, towards the start of lock down he had slightly swollen ankles and breathlessness. Had X-ray etc and consultant advised he had mild heart failure.

He was given meds and it seemed ok.

Until 3/4 months ago where he would complain of breathlessness. Not all of the time but probably every day or so. Sometimes it’s more obvious when he has climbed the stairs and other times he could be just sitting there.

He has had another X-ray; clear lungs but GP has said possible slightly enlarged heart. He had a consultants app for end of June. I realise that in all likelihood the heart failure has got worse.

This is where I need the help please. He is wholly convinced that the pacemaker team have “turned his pace maker down” thus causing him breathlessness. He has said this since getting the breathlessness 3/4 months ago and continues to say it since the change of battery a few weeks ago (I don’t even know how pacemakers really work but when they called us to let us know how the procedure had gone, I asked if the settings remained the same and they said it had.

I know enough to know there are 2 different functions at play; the electrical function which the pace maker is helping and the muscle function that firms the heart failure and I think causes the breathlessness.

However getting him to understand and accept this is difficult. I don’t know enough to explain it. My dad is understanding of machinery/engines/electrical as there was rarely a job he wouldn’t undertake on his car/build/extend the house.

So I’m wondering if anyone has any suggestions for me to try and explain/diagrams I can draw.

As I said he sees cardiologist in three weeks but I would like to have a better attempt at reassuring him that at least the pacemaker is doing it’s job before then. And the hopefully the cardiologist can reinforce! Thank you.

He is getting older and the heart failure is progressing. The pace maker isn’t going to prevent the progression of the heart failure.

And I understand this.

What I’m asking for is how to explain the workings of the heart. To explain there are two different issues and the pacemaker helps the one but why it can’t help the other.

Can you take his pulse, if he has a pacemaker it will be set to a number of beats per minute and it may say on his card what it is set at

www.bhf.org.uk/informationsupport/publications/treatments-for-heart-conditions/pacemakers
www.bhf.org.uk/informationsupport/conditions/heart-failure

In engineering terms, the heart is simply a pump. Much like a central heating boiler.
It needs an electrical control system - that’s what the pacemaker is doing, rather like the timer/thermostat.
But it also has to physically pump liquid round the system - that’s what the heart muscle is doing to the blood, equivalent to the boiler’s circulator pump with hot water.
In heart failure, the pump is getting flabby or damaged and can’t push so well. No amount of fiddling with the pacemaker, or the boiler’s timer, will help that.
Fortunately for your father, there are drugs that improve the pumping action of the heart. ACE inhibitors, or in the old days digoxin, can be beneficial, and his cardiologist will probably discuss these with him.

He has AF which essentially is an irregular heart beat. So the pacemaker keeps his heart beating in a regular rhythm.
The heart failure is a separate issue which means part of his heart is not pumping effectively causing fluid build up. The pacemaker can help somewhat with this (in terms of helping the heart keep a good pumping rhythm) but unfortunately heart failure is a progressive problem and gets worse over time. If he had an enlarged heart it's likely that there is fluid sitting around his heart and this will make him breathless.
Does he have any fluid anywhere else eg legs? is he prescribed diuretics (water tablets)? It may be that these need increasing which will help offload some of the water and help his breathing.

Unfortunately the term heart failure can be a bit misleading, and it strikes fear into people who are suddenly left thinking that they’re about to die.

In truth heart failure just means the heart isn’t pumping as well as it should, the normal heart pumps between 55/75% efficiency.
Anything below that is considered to be heart failure.

The pacemaker on the other hand is often installed either because of a low heart rate, or an arrhythmia which means the heart skips beats.
Or in some instances with a cardiomyopathy the risk of sudden cardiac death.
But it’s possible to have a pacemaker and not be in heart failure, and similar you can be in heart failure and not require a pacemaker.

The swelling relates to the heart failure and will be fluid retention. And that also contributes to his breathlessness. Is he on diuretics?
His cardiologist may need to increase these, and may also give him a fluid restriction.

In terms of other medications, nobody can really say what kind of meds he should be on as we don’t know the exact details, and there are so many.
But he needs to ask about the condition, the causes etc, and what medications are likely to help.

Knowledge is power, and the more he finds out, the more questions he asks, the more answers he will get.

FWIW I am in heart failure and I have an ICD/pacemaker.

My future lies in ultimate heart transplant, but we’re not there yet, and while I’m in heart failure,my heart isn’t yet failing. Iyswim.