The human heart works in most cases imperceptibly for him. It contracts in a certain rhythm. At the same time, a normal heart rate is maintained by a special part of the heart called a pacemaker. He regulates the work of this body, is responsible for increasing or decreasing the pulse, depending on the situation. But in some cases, the functions of the pacemaker are disrupted. Arrhythmia occurs, which can threaten the patient's life. Some heart diseases cannot be stopped with medication, often only a pacemaker can help such patients. This is a special device that replaces the functions of a pacemaker. It normalizes the heart rate and restores human performance. But patients who are recommended such treatment often first try to find out how the installation of a pacemaker occurs. Many are afraid of the operation, believing that it will make them disabled. But in fact, this device helps the patient to live a full life again.
What is a pacemaker
The heart can be compared to a pump that distills blood throughout the body. Therefore, the general condition of a person and the functioning of all organs depend on his work. The heart works in a certain rhythm, which can sometimes be disturbed. Most often this is due to malfunctions of the sinus node - the so-called heart pacemaker. In mild cases, they can be corrected with drugs, but not always. Sometimes, to normalize the rhythm, additional stimulation of the heart from the outside is required.
A pacemaker, or pacemaker, is an electrical device that is implanted in the chest cavity near the heart. It is needed in order to regulate the rhythm of this organ. A pacemaker replaces the natural pacemaker, whose functions have been impaired. This often happens due to disruption of the processes of formation of electrical impulses in the sinus node. Because of this, interruptions in the work of the heart occur - arrhythmia appears. It is in these cases that a device is installed that sets the heart to the correct rhythm. Such a procedure is needed mainly by elderly people who, due to age-related changes, disrupt the work of the pacemaker. But they install such devices, if necessary, at any age, even for children with congenital heart pathologies.
The pacemaker consists of a battery that can maintain its performance for a long time, an electronic circuit that creates pulses in a certain rhythm, and wires of electrodes connected to the heart muscle. The body of the device is made of a hypoallergenic titanium alloy. The pacemaker circuitry can synchronize its work with the rhythm of the heart, controlling the heart rate depending on the situation.
Types of devices
Medical equipment is constantly being improved, new models of pacemakers are released, more reliable and effective. Now there are three varieties of such devices: one-, two- and three-chamber. Their choice depends on the severity of the problems with the heart rate of the patient and is determined individually by the doctor.
- Single-chamber devices are needed to stimulate the operation of a single heart chamber. They are usually prescribed for atrial fibrillation or sinus node weakness syndrome to improve the functioning of the right ventricle of the heart. Such devices can have a constant rhythm of work or regulate it depending on the physical load of the patient.
- Bicameral pacemakers stimulate both the atrium and ventricle of the heart. They are needed for more serious pathologies of the sinus node. These devices help the heart to work in a certain rhythm.
- Three-chamber pacemakers have a more complex structure and are installed mainly to relieve symptoms of severe heart failure. They synchronize the work of the ventricles of the heart and increase the strength of its contractions.
- There are also special devices - cardioverter defibrillators. They are needed to slow down the work of the heart in severe tachycardia, which threatens the life of the patient. Such devices suppress too frequent rhythms and normalize the condition during atrial fibrillation.
Indications for the installation of a pacemaker
Typically, such an operation is not immediately decided. At first, conservative therapy is performed, but if it is ineffective, the doctor explains to the patient how the installation of a pacemaker occurs. This procedure is prescribed when the rhythm disturbance cannot be stabilized, and this condition threatens the patient's life. Usually this happens with a prolonged course of heart disease, most often in old age. Indications for the installation of a pacemaker may be as follows:
- persistent bradycardia below 60 beats per minute, which is accompanied by a worsening of the patient's condition;
- bradyarrhythmia with Morgagni-Adams-Stokes syndrome;
- atrioventricular heart block;
- asystole lasting more than 3 seconds;
- atrial fibrillation;
- sick sinus syndrome;
- pronounced tachycardia;
- severe heart failure;
- cardiomyopathy;
- ventricular fibrillation;
- myocardial infarction.
Despite the fact that this operation is considered safe and minimally invasive, it is still a gross interference with the body. Therefore, the installation of this device is carried out only in those cases when you can not do without it.
Possible limitations
The installation of a cardiac pacemaker in the elderly is carried out in conditions that threaten their life. In this case, other chronic pathologies are usually not taken into account, since this device can save the patient from death. Therefore, the vital necessity of the operation is important. But still, sometimes there are certain contraindications to the installation of a pacemaker. This can be a stomach ulcer, especially in the stage of its exacerbation, or other inflammatory diseases of the digestive system. This is important because after the operation it will be necessary to take preparations with acetylsalicylic acid to prevent thrombosis, and they severely damage the mucosa of the digestive tract. In addition, an operation is not performed for severe neurological pathologies and mental disorders.
In most cases, the installation of a pacemaker has no limitations. The operation is easily tolerated by patients; in almost all patients, the state of health after it improves. The device itself is made of a special titanium alloy, which is inert and not torn away by body tissues, does not cause allergic reactions. But there are conditions in which the installation of a pacemaker will be harmless, but not necessary. These are cases of bradycardia in athletes, when during exercise, the heart rate increases. This condition is normal and does not require adjustment. In addition, do not set a pacemaker with atrioventricular block, which is not accompanied by any negative symptoms. If there is no danger to life, surgery can be postponed in cases where the patient has exacerbated chronic diseases, there are infections in the body or inflammatory processes.
Preparation for surgery
The installation of a pacemaker is a serious surgical intervention in the work of the main organ of a person. Therefore, it is carried out only after a full examination in the presence of evidence. It is especially important to conduct a thorough examination before installing a cardiac pacemaker for older people. In this case, ultrasound of the heart, computed tomography of the chest and Dopplerography are done. In addition, various types of electrocardiograms of the heart are necessarily performed. This is a normal ECG, but in 12 leads, ECHO-KG, stress ECG, Holter monitoring for 1-2 days. General and biochemical blood tests, urine tests are also performed. After this, you need to consult a cardiologist, arrhythmologist and, if necessary, other doctors. A full examination is necessary to prevent complications.
Preparation is also needed from the patient himself. In addition to the fact that he must prepare for such an intervention psychologically, it is important how to spend the last day in front of her. In the evening, it is advisable to take a shower, dinner should be light, after which you can no longer eat anything. Medications are only taken by the doctor.
How is the installation of a pacemaker
This operation can be carried out under general anesthesia, but most often the patient is given a sedative and local anesthesia is performed. At the same time, he may feel slight discomfort, for example, burning or pressure at the place of installation of the cardiac pacemaker. It is to control such sensations that the patient must be conscious.
How is a heart pacemaker installed? This question is often of interest to the patients themselves and their loved ones. The device is usually installed on the left side under the collarbone or on the ribs in the region of the pectoralis major muscle. Do this through an incision in the skin, which is parallel to the clavicle. Only in some cases, for example, if the patient is left-handed or there are some scars on the left, installation is done on the right. Further, under the control of x-ray radiation, it is necessary to conduct electrodes into the heart muscle. This is done through the subclavian vein.
After installing the pacemaker, you must configure it. It depends on the features of the heart. Usually it transmits to the heart muscle the impulses necessary for its reduction in a certain rhythm. When the heart starts to work normally, the device may turn off. But after the signals about normal work cease to come from the heart from it, it turns on again. In the most severe cases, the pacemaker is tuned for continuous operation.
Features of the procedure
The operation of installing a cardiac pacemaker is quite complicated. Its outcome and effectiveness depends on the qualifications of the surgeon. The model and cost of the device usually do not matter. For most patients, such operations are free.
The operation of installing a pacemaker may be different in complexity. It depends on the condition of the patient, his age and model of the device. The single-chamber pacemaker is the easiest to install; this procedure lasts only half an hour. Other models require more complex attachment to the heart and customization. Therefore, such operations can last up to 2.5 hours.
Recovery period
After the operation to install a pacemaker, the patient will be in the hospital under the supervision of doctors from 1 to 3 days. A longer stay in the hospital is not required, the main thing is to properly configure the device, and the incision in the subcutaneous tissue heals quickly. But sometimes in severe cases, this period can increase up to 10 days.
At home, the patient needs to continue rehabilitation for a month. At this time, you need to avoid physical exertion, so it is freed from work. A more serious condition and prolonged recovery is necessary when the operation is performed after myocardial infarction.
The most important thing is to properly care for the postoperative wound in the first days to prevent infection. You can take a shower no earlier than 5 days after the procedure. In order not to seam apart, it is necessary at first to avoid lifting weights of more than 5 kg, physical work, running. Even with ordinary household chores, the patient may become worse, so you don’t need to do anything by force, it’s better to postpone work and rest.
Possible complications
Usually, pain after installing a pacemaker is mild and can be easily relieved by painkillers. The patient may feel a slight tingling sensation or a sensation as if a weak electric current was running through the vessels. But these feelings are not strong and pass quickly.
Various complications after surgery are also possible. Their risk is small, no more than 7%, mainly they develop in old age due to a slowdown in tissue regeneration processes and a general weakening of the body. Among the most common complications are:
- internal bleeding;
- damage to blood vessels;
- the appearance of edema or hematoma at the installation site of the device;
- thromboembolism;
- infection development, purulent processes, sepsis;
- pneumothorax;
- tachycardia.
Various complications appear even fewer months after surgery. This may be a displacement of the pacemaker, inflammatory processes in the heart muscle at the location of the electrodes. Sometimes there is severe swelling of the left hand, and if the device does not work correctly, discomfort may occur when electrical impulses are applied. They can be felt in the chest and even in the diaphragm. Some patients with established pacemakers, even after normalizing their rhythm, cannot lead a normal life. Their endurance decreases, even the usual loads are given to them with difficulty. In this case, the so-called ECS syndrome develops: shortness of breath, frequent dizziness until loss of consciousness, weakness, lowering of blood pressure, tachycardia.
In addition, malfunctions can be from the side of the device itself. The warranty for pacemakers is usually 5 years, but sometimes they break earlier. In this case, replacement is free. Usually only the pulse generator changes, since the electrodes in the heart muscle last longer. But most often it is only necessary to change the batteries on time, since in most cases pacemakers last longer than 10 years.
Life with a pacemaker
Usually, after such an operation, the patient quickly returns to normal life. His heart rate is improving, which allows him to forget about heart diseases. But there are some limitations and contraindications after installing a pacemaker. First of all, this applies to various medical research and procedures. Doctors must be warned if it is necessary to conduct electrocoagulation, diathermy, radiation therapy or other manipulations associated with electromagnetic exposure. Often, MRI is considered a contraindication after installing a pacemaker due to the high level of exposure. But in each case, it is necessary to resolve the issue with the doctor individually. Ultrasound can be performed, but not in the installation area of the device.
Many patients are interested in what contraindications are waiting for them after installing a pacemaker. Usually allowed to lead a normal lifestyle, avoiding increased physical exertion. But still there are certain limitations that will help extend the life of the device. It is necessary to protect it from shock, displacement and squeezing. It is advisable not to store the cell phone in the breast pocket, although the harmful effects of its radiation on the pacemaker have not been proven, but doctors recommend being safe. The patient can do the usual work and household chores. Work on a personal plot is allowed. It is recommended only to refuse to use serious electrical appliances: a lawn mower, an electric saw, a drill. In addition, direct sunlight should be avoided at the installation site of the EX.
A patient with a pacemaker installed must always carry a card with him. It describes its settings and characteristics. This may be required by doctors in an emergency. Also, a passport may be necessary when an alarm is triggered on a metal detector. After installing a pacemaker, be sure to regularly undergo a medical examination. The first time this is done 3 months after the operation, then - six months later. Further medical examinations are prescribed individually if necessary, but at least once a year.
Pacemaker and Electrical Appliances
Usually modern models of pacemakers are protected from various electromagnetic influences. But it’s worth it to be safe and avoid them. The patient can use conventional electrical appliances, mobile phones, computers and conventional microwave ovens do not act on the pacemaker. The main thing is that the devices are located further than 15 cm from the EX. But it is advisable for such patients to avoid communication with strong electrical appliances: industrial microwave ovens, welding equipment, radars, and not to stand near high-voltage power lines. Therefore, there are still small restrictions when choosing an activity for a patient with a pacemaker installed.
Even when using conventional equipment, you need to follow some rules.This will help extend the life of the pacemaker and increase its efficiency. It is recommended that all operating devices be held with the hand opposite to the installation location of the EX, not leaning against sockets or microwave ovens. Also, it is undesirable to carry the phone on your chest, try to talk through the headset. In general, wherever contact with electrical appliances can be avoided, it is best to avoid it.
Key recommendations
, . . . , , , , .
, . , , . , .
, , . . , . , . . , 4 . . .
Disability during the installation of a pacemaker is given only when the patient is in a serious condition, as well as if his profession involves difficult working conditions or communication with strong electrical appliances. But this happens infrequently, since such operations are performed mainly by elderly people, and after installing a pacemaker, on the contrary, their general condition improves. As a result, increased efficiency.
How is the installation of a pacemaker: reviews
The effectiveness of such an operation is usually more than 80%. Most patients after it feel much better. This is a less traumatic operation, rarely causing side effects and almost no contraindications. But many patients did not have very pleasant memories of the procedure itself, although it is carried out under local anesthesia and no pain is felt. But there may be feelings of pressure or even a slight burning sensation. Discomfort may also occur when connecting electrodes. But usually the operation takes place without complications, the patient's recovery does not last long, and after that he can lead a normal life.