Thanks for asking. It hasn't been 100% root caused yet. That will take a hotter and another stress test. Outside chance that its ischemic which would be easier to remedy. Per the cardiologist it can only be ameliorated via a pacemaker. The usual things can help slow deterioration, like weight loss and exercise. I am struggling with the notion of a pacemaker, more than I did with cancer, probably because the symptoms I have are sudden onset and have a clear impact, plain old worn out. Pacemaker implantation is routine these days but if there are complications, like infection, they need to go in. Like everything else at this stage, its a hangman's choice.

Here is a prognosis breakdown:
http://emedicine.medscape.com/article/158064-overview#a6
The thing that I was trying to bring out by posting this topic is that the onset of symptoms can be sudden and easily mistaken for other issues. Apparently the node wears but functions until it reaches a tipping point. The process is driven by the natural pacemaker tissue becoming fibrotic.

I went for the checkup expecting bad news about my aortic stenosis or aneurysm. Both are fine but my left ventricular diastolic function is significantly compromised, Mayo grade 2/4, and then there's this sick sinus deal. Goes to show, you won't hear the one that get's you. :). I had 2 echocardiograms in Portland at a major clinic and both missed the left ventricular issues. Mayo caught it. Why? Probably better equipment and a better doctor reading the results. Regional clinics? No thanks.

Jim