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User question:
How is possible, having third degree atrioventricular block and being 70 years old, to row the distance of 5K in one hour at a heart rate of 60 beats per minute and 20 seconds after stopping to row the heart rate going down to 40 beats per minute, all without any symptoms at all?
CohereAI:
Engaging in rowing at a moderate intensity, as described in your scenario, is indeed possible for some individuals with a third-degree atrioventricular (AV) block, even at an advanced age of 70 years. Here's how this could be feasible:
Asymptomatic Condition: If a person with a third-degree AV block remains asymptomatic, meaning they don't experience any symptoms like dizziness, fatigue, or chest discomfort, they might be able to undertake moderate physical activities. Some individuals with this condition can have well-functioning compensatory mechanisms that allow them to tolerate a certain level of physical exertion.
Heart Rate and Rhythm: A heart rate of around 60 beats per minute during exercise is within a manageable range for many individuals, including some with certain cardiac conditions. Additionally, a slow decrease in heart rate after exercise, such as dropping to 40 beats per minute, might be a relatively normal response, especially in older athletes.
Compensatory Mechanisms: Effective compensatory mechanisms, as mentioned earlier, can help some individuals with third-degree AV block maintain adequate cardiac output and blood pressure, even during moderate exercise. These mechanisms can involve the autonomic nervous system and cardiac reserve.
Regular Physical Activity: The individual could be a long-time rower who has maintained a regular exercise routine, making them physically fit and well-acclimated to the sport. Regular exercise can help improve cardiovascular fitness and enhance the body's ability to compensate for cardiac abnormalities.
Rate Responsive Pacing: If the individual has a pacemaker, it might be equipped with rate-responsive technology. This means that the pacemaker can increase its pacing rate in response to physical activity, providing the heart with the necessary support during exercise.
Good Overall Health: The individual's general health and absence of other significant comorbidities could be a favorable factor. Some older adults maintain good cardiovascular health and fitness levels, allowing them to undertake moderate endurance exercises like rowing.
Gradual Exercise Onset: Starting the rowing activity gradually and monitoring heart rate throughout can help ensure that the individual remains within a safe range. As their heart rate reaches moderate levels, they might be able to sustain rowing without symptoms.
Clinical Evaluation: Prior to engaging in regular rowing or any exercise routine, the individual would have undergone a comprehensive clinical evaluation by a cardiologist. This evaluation would have determined their fitness for exercise and potentially adjusted their medication or pacemaker settings accordingly.
However, it's essential to emphasize that while this scenario is possible, it's relatively rare and depends on multiple favorable factors. Most individuals with third-degree AV block would require more intensive cardiac management and might not be able to exercise to this extent. Engaging in regular physical activity, especially at an advanced age and with cardiac conditions, should always be done under medical supervision and with the approval of a healthcare professional.
Should this patient be implanted with a pacemaker?
Determining whether a patient with a third-degree atrioventricular (AV) block should receive a pacemaker implantation requires a thorough clinical evaluation and consideration of several factors. While I cannot provide a definitive recommendation, as it should be tailored to each individual by a cardiologist, here are some key points to aid in the decision-making process:
Symptomatic Status: The presence or absence of symptoms is a significant consideration. If the patient is asymptomatic, meaning they don't experience any discomfort, dizziness, or other cardiovascular symptoms associated with their third-degree AV block, the need for immediate pacemaker implantation might be less urgent.
Age and Overall Health: The patient's age and general health status matter. Older adults, especially those with multiple comorbidities, might benefit more from pacemaker implantation to reduce the risks associated with bradycardia.
Heart Rate and Rhythm: The patient's resting heart rate and its variability might be crucial factors. A consistently low heart rate, especially if accompanied by symptoms like fatigue or dizziness, would strongly indicate the need for pacemaker therapy.
Exercise Tolerance: How well the patient tolerates physical activity is essential. If their heart rate remains stable and within a reasonable range during exercise, and they don't experience symptoms, the need for a pacemaker might be less pressing.
Compensatory Mechanisms: The presence of effective compensatory mechanisms that allow the patient to maintain adequate cardiac output and blood pressure, even at rest and during exercise, could mean that pacemaker implantation could be deferred or might not be necessary.
Risk Assessment: Conduct a comprehensive risk assessment, considering the potential risks of both having and not having a pacemaker. The benefits of implantation should outweigh these risks.
Guidance from Cardiologists: The expertise of cardiologists or electrophysiologists is invaluable in these decisions. They can provide a detailed evaluation, interpret tests, and offer personalized recommendations.
Patient Preferences: The patient's preferences and quality of life considerations are important. Some patients might prioritize their independence and active lifestyle, making them more inclined toward pacemaker implantation.
Availability of Follow-up Care: Access to regular and timely medical follow-up care is crucial. Pacemaker implantation and subsequent monitoring require specialized care.
Device Technology: The availability of advanced pacemaker devices, including those with rate responsiveness and the ability to sense and pace both atria and ventricles, could be a significant factor. These devices can improve the patient's quality of life and potentially allow for a broader range of activities.
Prognosis: The long-term prognosis with and without pacemaker implantation should be considered. The presence of other cardiac conditions or comorbidities might influence this prognosis.
Ultimately, the decision should be made on a case-by-case basis, with a thorough evaluation of the patient's medical history, current health status, and future expectations. Implanting a pacemaker is a significant procedure with potential risks, so it must be carefully considered and discussed between the patient and their healthcare team.
