Pacemakers

Summary

Designed for patients preparing to have a pacemaker implanted and their families, this video explains the physiology of the heart, arrhythmias, and what the pacemaker will do to control them. It covers the steps leading to surgery and what the patient can expect before being discharged. Recovery guidelines, temporary restrictions, and incision care in the first few weeks following discharge are reviewed. The video provides safety guidelines for living a full life with a pacemaker.

Details

Introduction

This program is designed to help relieve your concerns about the device and the procedure to implant it. It will also review guidelines for living with the device, so you can enjoy a healthy, productive life.

Understanding the Heart

• The heart is one of the body's most vital organs:
  • It is a muscle that continuously pumps blood carrying oxygen and nutrients throughout the body.
  • The heart is divided into four chambers that beat in a steady rhythm:
  1. First, the upper two chambers of the heart, called the atria, contract.
  2. Then the two lower chambers of the heart, called the ventricles, contract.
• The heart's contractions are controlled by electrical impulses that travel through the heart at a steady rhythm.

• Sometimes, the heart's normal rhythm is disrupted by abnormal rhythms called arrhythmias:

• Physiology:
  • The heart's natural pacemaker may send signals too slowly.
  • Some of the signals may be blocked from reaching the heart's lower chambers.
• These cause the heart to beat too slowly and the body can't receive the blood and oxygen it needs.
• Symptoms:
  • Dizzy spells
  • Fatigue
  • Shortness of breath
  • Fainting
• The heart may beat so slowly that it becomes life threatening.
• Causes:
  • Heart attack
  • Heart damage
  • Another heart related condition
  • Genetic defects

Understanding Your Pacemaker

• A pacemaker helps the heart beat at an effective rate:
  • A Pacemaker consists of two parts:
    • The main component is called the pulse generator which contains a computer chip and battery.
    • Connected to it are thin wires called leads.
  • The pulse generator is implanted in the chest, below the collarbone.
  • The leads are then threaded through a vein, and attached to the walls of the heart's chambers. Depending on your condition, leads may be attached to one or two chambers of your heart.
  • When the pulse generator senses an abnormally slow heart rhythm, it sends electrical impulses through the lead to the heart.
    • These impulses stimulate the heart, helping it pump blood at a normal pre-determined rate.
    • A Pacemaker produces electrical impulses only when it senses the heart needs assistance.
• There are several different types of pacemakers:
  • Your condition will determine the type of Pacemaker that is best for you.
  • Biventricular Pacemakers:
    • For some patients with Congestive Heart Failure, whose hearts have considerably weaker pumping abilities.
    • This special, three lead pacemaker can provide electrical impulses that strengthen the heart beats, helping the heart pump more blood.

What To Expect The Day Of Surgery

• Pre-operative guidelines to follow:
  • Your doctor will provide specific instructions regarding eating and drinking prior to your procedure.
  • They may also recommend that you stop taking certain medications, like aspirin, which can thin the blood, several hours or days in advance.
• There are risks associated with implanting a Pacemaker:
  • These include:
    • Infection
    • Severe bleeding
    • A collapsed lung
  • Prior to the procedure you will be required to sign a consent form.
  • Be sure to discuss these risks or any concerns you may have with your healthcare team.
• At the hospital:
  • You will dress in a hospital gown.
  • You will be asked to remove any jewelry or accessories such as contact lenses or dentures.
• Pacemakers are implanted on either the left or right side of the chest. You will have input as to where it will be best suited for you.
• Preparation for the procedure:
  • You will be given medications to help relax you.
  • Your chest will be shaved, cleaned, and prepared near the collarbone where the incision will be made.
  • The procedure may be performed in an operating room or in a cardiac catheterization lab.
  • A local anesthetic will be administered so you will not feel any discomfort.
  • An IV will be started and electrodes will be attached to monitor your heart rhythms during the procedure.
• The Procedure:
  • The doctor will make an incision about 2-4 inches long, right below the collarbone to create a small pocket.
  • The pacing lead will be threaded through a vein and into your heart.
  • X-ray monitors will guide your physician through the procedure.
  • If a second lead is used, the doctor will repeat the process.
  • Leads will be tested for sensing and stimulation, and then sewn into the small pocket under the skin.
  • The electrical pacing for your device is then programmed, and the incision closed.

Recovering From Your Procedure

• After your procedure you may feel a slight discomfort where the incision was made. If so, ask your nurse for pain medication.
• The length of your hospital stay varies from facility to facility:
  • You may recover in the hospital for a few hours, overnight, or even two nights.
  • Your stay will depend upon the type of pacemaker you receive, and your general overall health.
• Discharge:
  • Your pacemaker will be tested and the electrical pacing will be adjusted if necessary.
  • Your health care team will also review individual discharge instructions, including:
    • Incision care
    • Medications
    • Physical activity
    • A schedule to follow for regular check-ups
  • Someone will be required to pick you up, and drive you home.

Recovering At Home

• You may feel a little tired or sore, so take things slowly in the beginning, especially during the first one to two weeks.
• Temporary Restrictions:
  • Refrain from lifting heavy objects.
  • Limit movements of the arm closest to your incision, to protect it from opening up.
  • Do not let anything hit, or rub against your pacemaker.
  • You should not engage in contact sports.
  • Your doctor may also ask you not to drive your car for one or two weeks.
• You will be able to return to the majority of your activities almost immediately.
• Incision Care:
  • Keep the area clean and dry:
    • Do not use soap and water on your incision for at least 2 days after arriving home.
    • Do not apply any lotion or powder until the incision has healed completely.
  • If swelling occurs ice should be applied to help keep the swelling down.
  • Talk with your physician regarding how to care for your incision.

Living With A Pacemaker

• An ID card with information about your heart rhythms and your particular device will be issued after your Pacemaker is implanted.
  • Always carry it with you, and make sure all your healthcare providers are aware that you have a Pacemaker.
  • Medic alert bracelets indicating you have a Pacemaker are also an option.
• You may use common household appliances in good working order:
  • Microwave ovens
  • TVs
  • Computers
  • Hair dryers
• Some devices may interfere with your device and should be used carefully, or even avoided:
  • When using a cell phone, be sure to hold the phone on the opposite side of your Pacemaker.
  • At security checkpoints present your Pacemaker id card and request a hand search.
  • Your health care team can provide you with more detailed information on what is safe and what is not safe.
• Other information:
  • Always consult your physician before buying over-the-counter medications.
  • Keep emergency and physician numbers, close to the telephone.
  • You may be asked to take their pulse rate for one full minute each day and call your doctor if it is below a certain rate.
  • Notify your doctor if you have any of these symptoms:
    • Dizziness
    • Lightheadedness
    • Increased lack of energy
    • Chest pain
    • Tenderness
    • Redness
    • Prolonged hiccoughing
    • Difficulty breathing
    • Swelling
• You may find adjusting to life with a Pacemaker a little difficult at first:
  • You may experience feelings of sadness or depression.
  • If these feelings persist, contact your healthcare team.
• Maintenance:
  • Checkups take only a few minutes and allow your doctor to tell if your pacemaker is working properly, how often it has delivered therapy, and how much energy is left in the battery.
  • Pacemakers can be expected to last from five to ten years:
    • When the battery gets weak, the pulse generator needs to be replaced.
    • The lead wires usually are not changed, just tested to make sure that they're working properly.

Conclusion

Remember, the whole purpose of a pacemaker is to help your heart pump more effectively, so you can enjoy an improved quality of life and do even more than before.