Dear Dr. Roach: My husband had a stress test done several years ago, and at the time, it was discovered that he had a bundle branch block in his heart. No one mentioned it until recently, after he had an episode with a fast heartbeat, sweating and trouble breathing. He was taken to the emergency room, and the cardiologist indicated that there are three bundle branches, and he has two blocked.
Since he has had this heart problem, the doctor has recommended that we focus on it. He mentioned that he could put in a pacemaker, but also suggested a LUX-Dx Insertable Cardiac Monitor (ICM) System. This way, they insert the ICM (which is about the length of a paper clip and runs on a battery that is safely sealed within the device) just under the skin. It then has a monitor to keep track of and send information to the doctor’s office. Then they could determine when, or if, a pacemaker will be necessary.
We had never heard of this. Are you familiar with them? We’ve never heard of a heart bundle branch block either. Any information you could provide would be appreciated.
T.B.
Your husband has two separate issues, the first being that his bundle branch block is an electrical problem within the heart. The heart has an electrical system, starting up in the right atrium with the natural pacemaker of the heart. Special conduction tissue leads to another structure — the atrioventricular node, which regulates conduction down to the ventricles.
There, three bundle branches continue conducting the electrical impulse to the muscle of the heart. Once the electrical impulse hits the muscle cells, they contract. The branches ensure that they all contract at the same time for coordinated muscle contraction.
The bundle branches can degenerate over time or get damaged in a heart attack. Most of the time, this does not require specific treatment, but with two of the three blocked, he is at risk for a complete heart block, which absolutely requires a pacemaker.
His second issue is the fast heart rate. There are many possible causes behind this. An implantable cardiac monitor keeps track of every beat for up to months or even years. This can help provide a diagnosis as to why he had a fast heartbeat. It can also determine whether he is developing intermittent heart block.
Your husband’s electrophysiologist has more expertise of your husband’s condition than I do. If he recommends the ICM instead of a pacemaker for now, I would really consider that. It’s a much easier and less-invasive procedure than a permanent pacemaker.
Dear Dr. Roach: I’m a 75-year-old healthy woman with extensive body tattoos. I got a mammogram that came back with good results, but the technician and my doctor mentioned the tattoo ink in my lymph nodes. Both said that there was no danger, and we all chuckled. But is this really dangerous or not?
J.S.
Probably not. But tattoo inks in the United States are not regulated, and some of the chemicals used in the inks are carcinogenic. So, there is at least a theoretical risk of developing cancer. The ink has been proven by biopsy to go into the lymph nodes. Current evidence suggests that there is very little risk of cancer associated with tattoos.
There is not a definitive answer, but I suspect that if there is a risk, it’s very small.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
