BajaNomad - By popular request....Pacemakers!!

By popular request....Pacemakers!!

EnsenadaDr - 7-30-2014 at 08:00 AM

Why do we need a Pacemaker?

Doctors recommend pacemakers for many reasons. The most common reasons are bradycardia and heart block.

Bradycardia is a heartbeat that is slower than normal. Heart block is a disorder that occurs if an electrical signal is slowed or disrupted as it moves through the heart.

Heart block can happen as a result of aging, damage to the heart from a heart attack, or other conditions that disrupt the heart's electrical activity. Some nerve and muscle disorders also can cause heart block, including muscular dystrophy.

Your doctor also may recommend a pacemaker if:

Aging or heart disease damages your sinus node's ability to set the correct pace for your heartbeat. Such damage can cause slower than normal heartbeats or long pauses between heartbeats. The damage also can cause your heart to switch between slow and fast rhythms. This condition is called sick sinus syndrome.
You've had a medical procedure to treat an arrhythmia called atrial fibrillation. A pacemaker can help regulate your heartbeat after the procedure.
You need to take certain heart medicines, such as beta blockers. These medicines can slow your heartbeat too much.
You faint or have other symptoms of a slow heartbeat. For example, this may happen if the main artery in your neck that supplies your brain with blood is sensitive to pressure. Just quickly turning your neck can cause your heart to beat slower than normal. As a result, your brain might not get enough blood flow, causing you to feel faint or collapse.
You have heart muscle problems that cause electrical signals to travel too slowly through your heart muscle. Your pacemaker may provide cardiac resynchronization therapy (CRT) for this problem. CRT devices coordinate electrical signaling between the heart's lower chambers.
You have long QT syndrome, which puts you at risk for dangerous arrhythmias.
Doctors also may recommend pacemakers for people who have certain types of congenital heart disease or for people who have had heart transplants. Children, teens, and adults can use pacemakers.

Before recommending a pacemaker, your doctor will consider any arrhythmia symptoms you have, such as dizziness, unexplained fainting, or shortness of breath. He or she also will consider whether you have a history of heart disease, what medicines you're currently taking, and the results of heart tests.

Diagnostic Tests

Many tests are used to detect arrhythmias. You may have one or more of the following tests.

EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular).

An EKG also records the strength and timing of electrical signals as they pass through your heart. The test can help diagnose bradycardia and heart block (the most common reasons for needing a pacemaker).

A standard EKG only records the heartbeat for a few seconds. It won't detect arrhythmias that don't happen during the test.

To diagnose heart rhythm problems that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors.

Holter and Event Monitors
A Holter monitor records the heart's electrical activity for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG.

An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.

For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.

You can wear an event monitor for weeks or until symptoms occur.

Echocardiography
Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves are working.

Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and injury to the heart muscle caused by poor blood flow.

Electrophysiology Study
For this test, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records the heart's electrical signals.

Your doctor uses the wire to electrically stimulate your heart. This allows him or her to see how your heart's electrical system responds. This test helps pinpoint where the heart's electrical system is damaged.

Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast.

During stress testing, you exercise to make your heart work hard and beat fast while heart tests, such as an EKG or echo, are done. If you can't exercise, you may be given medicine to raise your heart rate.

http://www.nhlbi.nih.gov/health/health-topics/topics/pace/wh...

The ABC's of Pacemakers.

5 Minutes on pacemakers
The ABCs of pacemakers
by Gregory P. Curnew, MD
Who gets what kind, and why
Vol.19, No.03, April 2011
Several readers have asked about pacemakers lately. What are the different kinds, how are they categorized by letter codes, and how do cardiologists decide which type to give to whom? To start with the last question, the bottom line is if the patient has very few episodes of pauses, then a simple backup VVI pacemaker is a logical choice. If the patient is spending the vast majority of their time in complete heart block, then a dual chamber pacemaker (DDI or DDD) that paces both the atrium and ventricle makes sense.

THE 3-LETTER SYSTEM EXPLAINED:

Letter #1, tells what chamber is paced, i.e. V stands for pacing the ventricle. Other options are A (atrium), O (none) and D (dual).

Letter #2, tells us what the pacemaker will sense. In this case, the second V means the pacemaker’s sensors are in the ventricle. Other options are A, O, and D.

Letter #3, response to event, tells us what will make the pacemaker discharge. This is where most confusion arises. In the case of a VVI, ‘I’ stands for inhibited — the device will pulse to the designated chamber unless it detects intrinsic electrical activity. Other options are O (none), T (triggered mode, generally used for device testing), and D (dual — inhibited and triggered).

These three letter codes are also the first three of the longer 5- and 6-letter coding systems. The fourth letter in such codes refers to rate modulation, if any. This is an adjustment in the pacemaker’s target rate based on the patient’s changing cardiovascular demands. It may be programmable, or based on metabolic or other sensors that detect exercise. The fifth letter generally refers to anti-tachycardia function, if any.

A number following the 3-letter code (i.e. VVI 60) tells us the programmed heart rate the pacemaker will pulse at. With inhibited response pacemakers, this is also usually the heart rate below which the device will start discharging. In other words, a VVI 60 will be inhibited from firing if spontaneous heart rate is over 60 bpm.

So, fixed-rate or asynchronous pacemakers, which need no sensors or triggering events, are coded AOO, VOO or DOO, and discharge at a preset rate that’s independent of the inherent heart rate.

Single-chamber synchronous or demand pacemakers are coded AAI or VVI. They discharge at a preset rate if the heart drops below that rate.

Dual-chamber AV sequential pacemakers are coded VDD, DVI or DDD. They discharge in the atrium first (except the VDD), then in the ventricle after waiting through a pre-programmed PR interval.

Finally there are programmable pacemakers with various complex adjustable functions that can’t really be described with letter codes.

A very crude list matching conditions to appropriate pacemakers might look like this:

Uncomplicated sinus-node dysfunction: AAI
Sinus-node dysfunction with AV-node disease: DDD
AV block: DDD
AV block with no organized atrial activity: VVI
Cardiomyopathy: DDD
Any of the above conditions if chronotropic response (increase in heart rate with exercise) is lacking: DDDR or VVIR, with the R referring to rate modulation, a higher pulsing rate during exercise.
Neurogenic syncope: DDD or DDI.

micah202 - 7-30-2014 at 08:27 AM

.

.........yes

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motoged - 7-30-2014 at 09:55 AM

Quote:

Originally posted by EnsenadaDr

By Popular Request.....

Doc, I have a general discomfort in the vicinity of my left shoulder. I know I have injured it crashing motorcycles over the years and have a rotator cuff chronic problem. A few months ago I got up from laying on the couch and felt an immediate sharp pain/spasm under my collar bone and in the front of my chest (again, left side)....and the chiropractor diagnosed a first rib strain issue....and I felt better for three days, when the whole right side shoulder and upper arm area became the new trouble spot....two months of chiro and massage seemed to fix it up.

Now, the left shoulder-chest area is feeling tight and like the first rib is about to migrate again.

Is this a precursor to heart problems (mine has been broken numerous times) or just a structural issue with skeletal and musculature dynamics at play?

BajaBlanca - 7-30-2014 at 10:02 AM

thanks, lots of info.

norte - 7-30-2014 at 11:22 AM

popular request? by all means. everyone should get one while they are camping in baja due to the stress of bandits and mayhem.

EnsenadaDr - 7-30-2014 at 12:40 PM

I think you need a full workup Motoged to rule out cardiac problems.

Quote:

Originally posted by motoged

Quote:

Originally posted by EnsenadaDr

By Popular Request.....

motoged - 7-30-2014 at 01:10 PM

Doc,
Thanks...I am getting some ultrasounds done....stress test I guess is around the corner...

EnsenadaDr - 7-31-2014 at 12:29 PM

Motoged, the key thing here is that you are taking steps to treat your problem. Maintenance will be easier once you know exactly what you are dealing with. Good luck!

Tioloco - 8-1-2014 at 09:29 AM

Good info, Doc. Gracias

redmesa - 8-1-2014 at 12:49 PM

What I do not understand is ...when do they decide for a pacemaker rather than medications, cardioversions and heart ablations? It was never clear to me why my husband did not get a pacemaker.

Lee - 8-1-2014 at 01:11 PM

Quote:

Originally posted by redmesa
What I do not understand is ...when do they decide for a pacemaker rather than medications, cardioversions and heart ablations? It was never clear to me why my husband did not get a pacemaker.

A cardiologist will advise you on when this stuff should be done. YOU decide if it's the direction you want to go in. Do the research and get educated.

2 of 3 cardios I saw last year advised me to see a cardiophysiologist about ablation (at their clinic). I told them I wasn't interested in that procedure at this time and wasn't seeing another doctor.

I believe doctors over prescribe meds and procedures for many reasons. Maybe some doctors are in bed with drug companies.

If you don't understand this stuff find an ''advocate'' who will help you make these important decisions. Don't trust doctors will always make correct decisions!

bacquito - 8-2-2014 at 05:29 PM

On July 28th. I had a pacemaker installed at Sharp Medical. I have had a slow heartbeat for years and I noticed it was continuing to slow down. My resting heart beat prior to the operation was in the high 20's to 30's. The Doctor said I needed it so in I went-somewhat nervous.
After the operation my resting heart beat in now 60-65. Too early to provide information on the future affects but will keep all Nomads informed of my experience.
I was told I could return to "normal activities" and in fact I took a walk today.