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Hello everybody thanks you for joining us today for our chat we are very pleased to have with us cardiologist stevennissen who#39’s chairman of the departmentof cardiovascular medicine and heart surgeon mark Elena who are both authorsof heart 411 the only guy to heart health you will ever need and they will answer your questions about heart health including prevention medical advances myths and treatment just to get some housekeeping done on Betsy Stasis I'lobe moderating the chat today you willtry to answer as many questions as pecan and if you'd like to submit questions you can submit them using the box below we will start with the questions and we#39;ll start with dr.nissen Dr. NISS and our first questions with Donna she says that her son has congenital heart defect that now has him on a dual pacemaker at set at 80beats per minute it#39’s working ninetypercent of the time yet bradycardia andbigeminy and his doctors want him to exercise, and he wants to know aboutraising his blood pressure higher yeahs I pacemakers have become much more sophisticated over the years and thereat now ways to program pacemakers ask me a specific kind of pacemaker to built#39’s called a rate responsivepacemaker what that means is it senses when the patient is active and automatically increases their heart wait to meet the demands of exercise and there are various approaches to doing that, so I would strongly urge that heconsult with an electrophysiologistpreferably the person to put the pacemaker in but if that's not availableyou'’d certainly be happtoto see yourson here and things can be done to make that pacemaker adapt to his need and desired exercisethere'’s one more questioabout pacemakersrs I noticed from Alan and he wanted to know if pacemaker lead placement could have any negative effect on left ventricular ejection fraction well pacemaker lead placement is a minaret and the electrophysiologists that put these things in work very hard to optimize the placement of the leads to enhance the performance of the heart audit is correct that a pacemaker leave that is not in the right location or snot programmed correctly and actually impair rather than enhance the function of the left ventricle main pumping chamber of the heart so again it#39;s avery technical area, but there are issue sit does need to be addressed and I would again urge Alan to see electrophysiologist with experience in this area and of course if there needs to be a consultation one of electrophysiologists is always pleased to see patients and see whether or not anything can be done with their pacemaker by reprogramming it or even on occasion moving a lead or doing this Ina different way in order to improve the heart function it is a very important area that does require some significant thought Dr. Phil enough Alan alsomentions that he had isolated tricuspidvalve repair, and he wants to know how common that is IN#39;m isolated tricuspidregurgitation or a tricuspid valve leaks pretty...
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