• Your Heart’s Electrical System
• How a Pacemaker Can Help Your Heart
• Living With Your Pacemaker

The reason for a Pacemaker?
Your doctor may have told you that you need a pacemaker – to understand why you need a pacemaker you must understand the electrical system of the heart and how it regulate your heart beat, it is too slow or irregular. Problems with this electrical system can make your heart’s pace slow or uneven, possible leaving you feeling tired or even faint. A pacemaker is a small electronic device that will regulate your electrical system, keeping the your heart beating at the right pace.

Signs and Symptoms of a Slow Heartbeat
Your heartbeat may be slow all the time or only every so often. When your hearts’ pace is slow or uneven, you may feel one or several of these symptoms:

• Dizziness
• Lightheadedness
• Shortness of breath
• Fatigue
• Confusion
• Fainting spells

These symptoms are usually most noticeable when you are trying to do something physical, such as walking or climbing stairs.

How and Who implants my Pacemaker?
Having a pacemaker implanted is a fairly simple surgical procedure, but it does require a lifelong commitment, working with your Cardiologist. This specially trained physician is called an Electrophysiologist. This specialist’s job is to implant and oversee the function of your pacemaker on a regular basis. With proper care, a pacemaker can help keep you feeling good for many years to come.

How Your Heart’s Electrical system Work
Your hearts’ job is to keep blood moving through your body. To do this, your heart beats many times each minute. Signals from your heart’s electrical system tell it when to beat. If there is a problem with these signals, your heart may not beat when it should. This doesn’t always mean you’ve had a heart attack or have a problem with your blood vessels - it simply means your heart’s not beating often enough.

Signals Tell your Heart to Beat
Your heart is divided into four chambers that hold blood as it moves through the heart. The two upper chambers are the atria and the two lower chambers are the ventricles. When the heart beats, the atrial contract (squeeze) to move blood to the ventricles and the ventricles contract to move blood out to the rest of the body. Certain areas of the hearts’ electrical system, known as nodes, send the signals that tell the chambers when to contract. When you’re active, these signals speed up to move your blood faster. When you’re resting, the signals return to a slower pace.

Problems with Your Signals
Sometimes your heart’s signals don’t work properly. The signals from the SA node may be too slow (sinus bradycardia), may alternate between being too fast and too slow (sick sinus syndrome), or may occasionally stop (sinus pause). Or, signals may not be able to leave the AV node or move along the pathways to the ventricles (heartblock). These problems mean that the atria, the ventricles, or both contract at too slow a pace – fewer times each minute than they should.

What is a Pacemaker?
When there’s a problem with your heart’s electrical system, a pacemaker can help. A pacemaker is a small, lightweight, electronic device that’s placed inside your body. The pacemaker keeps track of your heartbeat and, when necessary, generates electrical signals similar to the heart’s natural signals. These signals keep your heart beating at the right pace.

What a Pacemaker Does
A pacemaker helps to keep your heart from beating too slowly, but it doesn’t stop your heart from beating on its own. The pacemaker “listens” to your heart. When the hearts own electrical system sends a signal and the heartbeats, the pacemaker waits and does nothing. When the hearts’ system misses a signal, the pacemaker sends a signal to replace it.

Types of Pacemakers
Your doctor will choose the type of pacemaker that’s best for you. A pacemaker with one lead is called a single-chamber pacemaker. A Pacemaker with two leads is called a dual-chamber pacemaker.

Implanting Your Pacemaker
Inserting the pacemaker into your body is called implantation. Pacemaker implantation is not open-heart surgery. Rather, it is a minor procedure that is done in an operating room or cardiac catheterization lab. You will be given instructions on how to prepare for the procedure. Pacemakers can be inserted near the right or left shoulder. If you prefer to have it implanted on a particular side, discuss your preference with your doctor.

Preparing for the Pacemaker Implantation
Ask your doctor whether you should stop taking aspirin or other medication before your procedure. Unless instructed otherwise, don’t eat or drink anything for six hours before the procedure. You’ll probably be admitted to the hospital on the day of the procedure. Before the procedure begins, you may be given some medication to help you relax. The skin where the pacemaker is implanted may be washed and shaved.

Understanding Risks and Complications
Implanting a pacemaker is a simple procedure involving little risk. But, as with any other surgical procedure, there can be complications. You will be asked to sign a consent form stating that you understand the procedure, risks of implantation and give your permission to perform the procedure. The possible risks of implanting a pacemaker include the following:

• Bleeding or severe bruising
• Tearing of the vein or artery wall
• Clotting or air bubbles in the vein
• Puncture of the lung or heart muscle
• Infection or nerve damage at the incision site

During the Procedure
The most common method used to insert a pacemaker is call endocardial (“inside the heart”) implantation. In many cases, this procedure takes one to tow hours. You stay awake during the procedure. If so, you’ll probably hear the surgical team talking. You may be asked some questions or be asked to take some deep breaths during the procedures by the your physician or the staff.

Implanting the Pacemaker
This a how endocardial implantation is commonly done:

• A local anesthetic is given by injection to numb the area where the pacemaker will be inserted. This keeps you from feeling pain during the procedure.
• An incision in made in your skin below your collarbone to create a small “pocket”.
• The lead is threaded through the incision into the vein in your upper chest. The lead is then guided into your heat’s chambers using x-ray monitors. Electrical measurements are taken to determine a good position for the lead in the heart. If there is a second lead, this process in repeated.
• The pacemaker generator is attached to the lead or leads. Then, the generator is placed in the pocket under your skin.
• The pacemaker’s settings are programmed to help your heart beat at a rate that is right for you. The incision is then closed and covered with a sterile dressing.

After Your Pacemaker Procedure
After your pacemaker is implanted, you’ll probably stay in the hospital for a day or two to be sure that there are no further heartbeat problems. When you go home you may be given instructions on how to take care of the incision site as it heals. Your doctor may also schedule some follow-up visits.

In the Hospital
During your stay in the hospital, your heart’s signals are monitored to be sure the pacemaker is working correctly. A nurse may take your pulse and blood pressure regularly and check your incision for bleeding or swelling. To give the lead or leads a chance to secure themselves inside the vein and your heart, it will be recommended that you do not lift your arm above your shoulder on the side where the pacemaker was implanted. It’s normal to have some pain and stiffness in the area around your incision for a week or so. Pain medication can help make you more comfortable. Please remember to talk to your nurse if you feel any unusual symptoms like hiccups that won’t go away, dizziness, chest pain, and shortness of breath or difficulty taking deep breaths.

Once You are Home
A few days after leaving the hospital, you can go back to most of your daily activities. But take it easy for a few weeks as to continue the healing process inside your body and to insure that the leads are kept in place once all daily activities resume. Be careful not to hit or rub the insertion site. Also avoid activities like heavy lifting, running, or contact sports. Every day, take your temperature and check your incision for signs of infection. Ina week or two, you may visit the doctor to have your sutures or staples removed, if necessary, and to check how your incision is healing.

The Fist Few Months After your Procedure
Your incision should heal completely within about a month after the procedure. Continue to avoid letting anything rub or hit your pacemaker. Don’t fiddle or play with the pacemaker under your skin. Your may feel numbness or fullness in the area around the pacemaker for a few months after the implantation procedure. which is normal.

When to Call Your Doctor

• You have signs of an infection (a fever, redness, swelling, or warmth at the incision site, drainage from the incision).
• You fell any of the symptoms you had before the pacemaker was implanted.

How to Care for Your Pacemaker
To be sure your pacemaker is working correctly, you will be asked to visit your doctor or pacemaker clinic several times a year. During these visits, the pacemaker’s settings can be adjusted if necessary. Your pacemaker can also be checked from your home. Pacemaker batteries and leads occasionally need to be replaced – your doctor will tell you when this needs to be done.

Follow-up Visits
Regular visits to the doctor’s office, pacemaker clinic, or hospital help make sure your pacemaker is working correctly. During these visits, tests such as an electrocardiogram (EKG or ECG) are performed. Your pacemaker’s battery level is also checked. As the battery begins to run low, the pacemaker send a signal that can be seen during routine tests, There’s still plenty of time to replace the battery when the signal is sent, so you don’t have to worry about the battery running dowm unexpectedly.

Making Pacemaker Adjustments
From time to time, the pacemaker’s setting may need to be readjusted to better help your heart. For most pacemakers, adjustments can be done from outside the body, so surgery is not required. Your doctor will determine whether your pacemaker’s settings need adjusting and can make there adjustments during a follow-up visit. A computer device is used outside the body, and without cutting the skin, to acquire pacemaker function information as well as changing the settings to make your pacemaker function at the best possible level.

Checking Your Pacemaker from Home
You may occasionally be asked to help check your pacemaker by sending signals to your doctor or pacemaker clinic by phone, or by checking your pulse.

• If your doctor recommends that you send signals by phone, your doctor will arrange for the telephone monitoring service. This service allows you to use a special transmitter to send your pacemaker signals over the phone lines. A doctor or specially trained technician will analyze the recorded signals and checks that everything is running smoothly. Your doctor will tell you how often you need to use this service.
• Checking your pulse regularly is not necessary, but you may be asked to check if from time o time. Your nurse or doctor can show you how to do it correctly.

Replacing the Battery and Leads
Pacemaker batteries usually last for about 5 to 10 years before they need to be replaced. Because the battery is sealed inside the generator, replacing a battery requires replacing the entire generator. This procedure is usually simpler and shorter than the initial implantation. To replace the generator, the pacemaker pocket is opened, the old generator, is detached from the leads, the leads are tested, the new generator is attached to the leads, and the pocket is closed. If a new lead is added, the procedure will most likely be similar to your original implantation. Occasionally, the leads wear out and need to be replaced. In this case, replacing the leads may require a more complicated and riskier procedure.

When to Call Your Doctor

• Dizziness, lightheadedness, lack of energy, or fainting spells-symptoms you had before the pacemaker was implanted.
• Fever and chills.
• Rapid or pounding heartbeat or shortness of breath.
• Pain in the area around your pacemaker.
• Swelling on the arm closest to the incision site.

Living With Your Pacemaker
It is not difficult to live with a pacemaker. You can usually do almost everything you did before you got your pacemaker, since you probably feel better, you may even do more. One of the things you might do is exercise, which is a great way to improve your health. Also, see your doctor regularly to help ensure that you remain healthy and feeling good.

Remember to Always Carry Your Pacemaker ID Card
When you first get your pacemaker, you will be given a card to carry. This ID card contains important information about your pacemaker. Show it to any doctor, dentist, or other medical professional you visit. Also, because pacemakers tend to set off security devices like those found in airports, libraries, department and grocery stores, you may need to show your card to security personnel.

Exercise
Exercise is usually good for you and your heart. It can help make you healthier and help you feel your best. Ask your doctor whether exercise is right for you and, if it is, to recommend an exercise program for you. This program may include activities such as swimming, walking, bicycling, jogging, tennis, or another activity you enjoy. Certain activates, like racquetball or contact sports, probably should be avoided because they may cause your pacemaker to get bumped.

Outside Signals
You do not have to worry about most outside signals. Modern pacemakers are well protested from outside signals, so there are very few things that can interfere with your pacemaker. But if you ever feel symptoms that make you think that a device is disrupting your pacemaker’s signals, turn the device off or move away. Your symptoms should stop and your pacemaker should not be damaged. To be safe, check with your doctor should that situation occur.
Microwave ovens and other appliances that are in good repair will not interfere with your pacemaker. Things like computers, hair dryers, power tools, radios, television, stereos, electric blankets, vacuum cleaners, heating pads, and cars are all OK to use.

Remember…….
• Stay In touch with your Doctor
• Follow all recommendations about caring for your pacemaker
• Take medications as prescribed
• Call your physician should you have any symptoms as described in this information.
• Discuss any concerns you may have regarding your health.