Pacemaker is a very small device which measures about size of a half dollar piece which is designed to place under skin near heart so as to regulate heartbeat. Pacemaker is normally implanted as part of a ‘Cardiac Resynchronization Therapy’. There are a variety of reasons as to why people may need pacemakers. Most common among them is one of a group of conditions known as arrhythmias where rhythm of the heart is abnormal. Normal aging of heart may also be a good cause to disrupt heart rate & make it beat much slower. Another common cause of disruption of heartbeat is heart attack which can eventually damage heart muscle as a result. Some medications are also found to affect heart rate. However, pacemaker can effectively fix this problem regardless of underlying causes of abnormal rate of heartbeats. Pacemaker device is most often implanted in chest through a minor surgical procedure. Patients may subsequently be required to take certain precautions in daily life after installation of the pacemaker.
Normally implanted so as to control heartbeat, Pacemaker can be temporarily implanted in order to treat problem of slow heartbeat following heart surgery, attack or overdose of medications. Pacemaker can also be permanently implanted to correct slowing of heartbeat which is medically termed as Bradycardia or in special cases help treat heart failure. It would therefore be ideal to know how heart beats so as to understand working of a pacemaker.
Heart is a fist-sized muscular pump with four chambers; two to the left & two on the right side. Upper chambers are known as the left & right atria while the lower chambers are the left & right ventricles. Heart chambers must work in synchronized coordination so as to properly function. It must also beat at an appropriate rate which is normally 60 – 90 beats every minute in resting adults. In case heart beats too slow or too fast, it will lead to fatigue, confusion, fainting & shortness of breath; that create other signs & symptoms with not enough of blood flowing through the body. Electric system of the heart controls the pumping action of heart chambers. Normal heartbeat starts within the right atrium in the sinus node. These cluster of cells act as a natural pacemaker with a spark-like plug generating regular electrical impulses traveling through specialized muscle fibers. Whenever electrical impulses reach both the left & right atria they contract so as to squeeze blood into ventricles. Subsequently, after a split-second delay which allow ventricles to fill, impulses reach ventricles & make them contract so as to pump blood to rest of the body.
This implanted electronic device mimics action of the natural human pacemaker. Artificial implanted pacemakers consist of 2 parts.
Pacemakers are designed to monitor heartbeat. In case heartbeat is slow, pacemaker will speed up heart rate by sending electrical signals to heart. Additionally, most pacemakers also have sensors which detect breathing rate or body motion & which will eventually signal pacemaker to increase heart rate during exercise so as to meet increased need of blood & oxygen to tissue & muscles.
Patients will have to undergo several tests to find out cause for irregular heartbeat in order to determine as a good candidate for pacemaker implant surgery. Some of these tests could include the following.
Surgery to implant pacemaker typically takes a few hours & is normally performed while patients are awake under influence of a sedative to relax. However, area where the pacemaker is to be inserted will be numbed. One or more than one flexible insulated wires or leads or electrodes will be inserted into a major vein near or under collarbone & which will be guided to the heart with help of X-ray images. While one end of each wire is secured to appropriate position in heart, the other end is attached to pulse generator which is normally implanted under skin beneath the collarbone.
Patients will generally stay in hospital for one day following pacemaker implant surgery. Pacemaker is also programmed to specific pacing needs of patients before they leave. Return visit is also often scheduled so as to make any corrections required in pacemaker settings. Following this, pacemakers can most often be remotely checked using wireless technology through cell-phone or radiofrequency signals. Pacemakers are designed to receive & transmit information between the patient & the doctor through which doctors can access data like rhythm & heart rate & how pacemaker is functioning including amount of remaining battery life. These remote transmissions can be made at scheduled intervals or at unscheduled points of time whenever pacemaker sends an alert or when patients send a transmission in case they have any concern. This remote technology means to translate into fewer trips to the doctors; but patients will however still need to meet doctors in person for scheduled check-ups. Doctors most often recommend patients avoid heavy lifting or vigorous exercise for about a month following pacemaker implant surgery procedure. Patients may also have some pain & aches near the area where pacemaker is implanted. However, most of these pains are effectively relieved by over-the-counter medications like ibuprofen or acetaminophen, but would be a sensible idea to talk to the doctor before taking any pain relievers.
It is quite unlikely that electrical interference will stop proper working of the pacemaker machinery. Devices like electric drills, electric shavers, electric blankets, radios, toasters, remote controls, television & microwave ovens are generally safe & unlikely to interfere with functioning of pacemaker.
Complications resulting from pacemaker implant surgery are uncommon. Moreover, life-threatening complications resulting from pacemaker implantation procedure are rare. However, some complications in some cases may include the following.
Average battery life of pacemaker device lasts between 5 – 10 years. Entire pacemaker pulse generator is replaced when pacemaker batteries wear out. Another procedure is required so as to fix & replace pacemaker device. However, leads of pacemaker may either be left in place or eventually be needed to replace; procedure to change pacemaker battery is much quicker & requires much less recovery time than the first pacemaker implant surgery procedure. Pacemaker is the most suitable standard treatment for many conditions affecting the electric system of heart. Apart from preventing slow heart rates, pacemakers can effectively treat symptoms like fainting, lightheadedness & fatigue due to the fact that presently available pacemakers can automatically adjust heart rate to match level of physical activity & allow patients resume more active lifestyles.
Pacemaker patients who have become terminally ill with conditions unrelated to heart like cancer, it is quite possible that pacemaker could prolong period of life. However, researchers & doctors have varied opinions upon turning off pacemakers during end-of-life situations. It would therefore be sensible for pacemaker patients to talk to doctors concerning turning off pacemaker device in such situations. It would also be ideal to talk to family members & other designated persons making medical decisions for pacemaker patients about what they should be doing in such end-of-life care situations.
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