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Dr. Andrew Rynne

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Can pre-surgery echocardiogram detect low heart rate levels?

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Dr. Bhanu Partap

Cardiologist

Practicing since :2010

Answered : 2051 Questions

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Posted on Mon, 10 Sep 2018 in Hypertension and Heart Disease
Question: 85 year old male just had EVAR (endovascular abdominal aneurysm repair). Was kept in hospital overnight for observation. Monitor showed heart rate slowing at intervals to 20 and 30 beats per minute. Then recovers to low 60s (his normal reading). A pacemaker is now recommended.
1. How was this not detected on the pre-surgery echocardiogram? And the pre-surgery substitute treadmill stress test-IV injection?
2. Did the EVAR somehow cause this?
3. He is on bedrest, with catheter and monitor. Would he be able to recover at home and avoid the pacemaker?
doctor
Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:

Need some more information.

Detailed Answer:

Hi,

After going through the medical details provided by you I understand your concern and I would like to know

1. How frequently his heart rate is going that low.

2. Was an ECG taken during that slow heart heart, if yes then kindly upload here for me to review it.

3. Any Holter monitoring was done (24 hrs ecg recording)?

4. Also please upload his Echocardiography report. I want to know his ejection fraction and LV dimensions.

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Bhanu Partap 45 minutes later
1. Heart rate went to 20 and 30 at least twice. However it continues to decline and recover...
2. I have no other information. Pre-op to the EVAR he was given an echocardiogram, and then went for a separate stress test. They didn't use the treadmill however, but an IV with XXXXXXX No abnormality was detected on either test and the EVAR was scheduled.
3. Within hours after the EVAR the lowering heart rate was detected. (He is lying down with catheter.)
4. The cardiologist who recommended the pacemaker said something about a 2-1,2-1 rhythm.
My questions again:
1. How was this not detected on the pre-surgery tests?
2. Did the EVAR somehow cause this?
3. Would he be able to recover at home and avoid the pacemaker?
4. Is the heart stopped at all during pacemaker insertion?
doctor
Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:

Hello Again.

Detailed Answer:

Hi,

With the required information it would have been better anyways

1. Probably because it was not there before.

2. Yes considering the 80+ age group this could have developed as a post op complication of any major interventional procedure.

3. 2-1 rhythm is basically a second degree AV block of conduction system of heart.

And with that if heart rate goes below 40 then a pacemaker is required in place to prevent syncope or other life threatening events.

4. No heart keeps beating during pacemaker insertion.

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Bhanu Partap 4 hours later
Is recovery possible without a pacemaker?
doctor
Answered by Dr. Bhanu Partap 20 minutes later
Brief Answer:

Most Likely NO.

Detailed Answer:

Hi,

Keeping all the current situation in mind and if the AV block is persisting then is unlikely then the patient will return back to normal conduction.

Hope I have answered your query.

Take care

Dr. Bhanu Partap, Cardiologist
Above answer was peer-reviewed by : Dr. Nagamani Ng
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