PACEMAKER MYSTERIES UNCOVERED

1.    What exactly is a pacemaker?

A pacemaker is composed of three parts: a pulse generator (generally the size of a matchbox), one or more leads, and an electrode on each lead. A pacemaker signals the heart to beat when the heartbeat is too slow or irregular.

A pulse generator is a small metal case that contains electronic circuitry with a small computer and a battery that regulate the impulses sent to the heart.

The lead (or leads) is an insulated wire that is connected to the pulse generator on one end, with the other end placed inside one of the heart’s chambers. The lead is almost always placed so that it runs through a large vein in the chest leading directly to the heart. The electrode on the end of a lead touches the heart wall. The lead delivers the electrical impulses to the heart. It also senses the heart’s electrical activity and relays this information back to the pulse generator. Pacemaker leads may be positioned in the atrium (upper chamber) or ventricle (lower chamber) or both, depending on the medical condition.

If the heart’s rate is slower than the programmed limit, an electrical impulse is sent through the lead to the electrode and causes the heart to beat at a faster rate.

When the heart beats at a rate faster than the programmed limit, the pacemaker generally monitors the heart rate and will not pace. Modern pacemakers are programmed to work on demand only, so they do not compete with natural heartbeats. Generally, no electrical impulses will be sent to the heart unless the heart’s natural rate falls below the pacemaker’s lower limit.

The pacemaker is typically inserted under the skin, below the collarbone by a surgeon. After the insertion, regularly scheduled appointments will be made to ensure the pacemaker is functioning properly. Your doctorwill use a special computer, called a programmer, to review the pacemaker’s activity and adjust the settings when needed.

2.  How do I know I need a pacemaker?

Problems with the heart rhythm may cause difficulties because the heart is unable to pump enough blood to the body. If the heart rate is too slow, the blood is pumped too slowly. And the opposite – If the heart rate is too fast or too irregular, the heart chambers are unable to fill up with enough blood to pump out with each beat. When the body does not receive enough blood certain physical symptoms will present, like:

You Feel Extremely Fatigued

If your heart cannot effectively pump blood through your body, it may leave you feeling extremely tired or fatigued. Fatigue may cause you to feel sleepy or like you have no energy. In particular, take note of how you feel when you walk up a flight of stairs. If you find it difficult to breathe after walking up a single flight of stairs, there may be reason for concern and you should reach out to your cardiologist to discuss your symptoms.

You Frequently Get Lightheaded or Dizzy

Dizziness or feeling lightheaded can be a sign your heart isn’t beating properly. These signs can also be caused by other conditions such as low blood pressure, low blood sugar and hyperventilation, all which your doctor can review during a medical consultation.

You Fainted, But You Don’t Know Why

Fainting can occur because you’ve not eaten or because you’ve had a sudden shock. It can also be the result of your heart beating too slowly or irregularly. If you faint but otherwise seem normal, call your doctor.

You Have Palpitations or an Intense Pounding in Your Chest

A pounding sensation in your chest could be a sign of a serious irregular heartbeat that might need to be controlled with a pacemaker. Arrhythmias or AFib can occur when you’re physically active, but also when you are quiet, sitting while watching TV, or lying in bed. You might feel your heartbeat unusually fast, or you may just notice it beating when you normally don’t. If you already have a pacemaker, fluttering or pounding sensations can mean that it is malfunctioning. Any of these situations calls for a consultation with your doctor!

You Have Chest Pain

Chest pain could be a sign of a variety of reasons, including a heart attack or heart disease. A treatable solution may include the insertion of a pacemaker after your cardiologist performs a full spectrum investigation and runs tests to determine the reason for the distress.

You Are Short of Breath or Have Difficulty Breathing

Shortness of breath is one of the symptoms of heart disease or an irregular heartbeat. Increasing shortness of breath while doing your usual activities could further point to your heart not working as efficiently as it should.

You Take Medications That Slow Down Your Heartbeat

Some medications are designed to slow down your heartbeat. Your doctor may recommend a pacemaker if you need higher doses of these medications and there is concern that your heart rate will go too low.

If you believe you are suffering from a heart rhythm disorder or have any of the above symptoms, a proper consultation with one of our experts may point you in the right direction of how best to treat it.

Some examples of heart rate and rhythm problems for which a pacemaker might be inserted include:

• Bradycardia. This occurs when the sinus node causes the heart to beat too slowly.
• Tachy-brady syndrome. This is characterized by alternating fast and slow heartbeats.
• Heart block. This occurs when the electrical signal is delayed or blocked 
• Having certain health conditions, such as:
  • pericarditis, an inflammation of the tissue surrounding the heart
  • myocarditis, an inflammation of the heart muscle
  • cardiomyopathy, which involves changes to the heart muscle that affect its ability to pump blood
  • systemic sclerosis, a rare condition that can cause inflammation and scarring of the skin and internal organs
  • sarcoidosis, a rare condition that causes swollen areas of tissue called granulomas to appear in the organs of the body
  • hypothyroidism, in which your thyroid produces too little thyroid hormone

There may be other reasons for your cardiologist to recommend a pacemaker insertion and these will be discussed during your treatment plan.

3.  What are the Risks associated with Pacemaker Insertion?

Every medical procedure has some risks. Most risks associated with a pacemaker are a result of the implantation procedure. The list includes some of the more extreme reactions:

• an allergic reaction to anesthesia
• bleeding or bruising
• blood clots
• damaged nerves or blood vessels
• an infection at the site of the incision or of the leads themselves
• buildup of scar tissue around the pacemaker
• pacemaker syndrome, which is when a pacemaker only stimulates one ventricle, leading to fatigue, shortness of breath, low blood pressure, and pacemaker-related cardiomyopathy
• pneumothorax, or a collapsed lung
• fluid collection around the heart
• a punctured heart, which can be caused by displaced leads

Most complications are temporary and life-altering complications are rare. It’s also possible, although unlikely, for a pacemaker to malfunction, or stop working properly. This can happen if:

• one or more leads move out of position
• the battery in the pulse generator dies
• a strong magnetic field has damaged your pacemaker
• there’s a programming error with your pacemaker

If your pacemaker malfunctions, you may notice that your arrhythmia or heart failure symptoms begin to get worse. Should this occur, it’s important to make an appointment with your cardiologist so that they can check to see if your pacemaker is working properly.

4.  What is the takeaway?

A pacemaker can help alleviate your symptoms and prevent complications, but not everyone with these symptoms needs a pacemaker, though. Our team of expert cardiologists will  review your medical history and perform the required tests to help your cardiologist determine if a pacemaker is a good option for you or not. Why not reach out to our Rhythmology expert (specialist in treating heart arrhythmias) Dr. Ashraf Hussein to discuss your concerns and treatment plan?

Get in touch to book your next consultation!

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information on the topic.