But among the most terrifying of that trio can be the experience that comes when something goes wrong with your heart. It may be simple fatigue, or you may faint. You may have puffy ankles, weight gain or other fluid retention. You may have a heartbeat that’s out of synch, as your natural functions fail to regulate the heartbeat.
That’s when you may need a pacemaker, a small device that can help regulate the beats of your heart when it experiences something called arrhythmia, an irregular heartbeat.
The pacemaker offers electronic stimulation that helps the heart get back on a regular beat. For most people, it’s a surgical implantation that’s just under your chest skin and near your collarbone. The surgeon then hooks the device to your heart with small wires. The implant may not be permanent – some people just need a little extra help after a traumatic event like a heart attack.
Some cases are even more minor, and the patient wears the stimulation device on the outside of the skin, carrying a battery unit in their belt area to keep the device powered.
Pacemakers are becoming more popular as treatment. A Journal of the American College of Cardiology report found approximately 121,300 pacemakers were implanted in the U.S. in 1993. That figure rose to 188,700 by 2009, a 56 percent increase. The pacemaker frenzy peaked in 2001 and since has leveled off.
The average patient age for a pacemaker has increased during that period as well, rising from 73 to 75 years of age. Of course, that also meant the recipients were likely to have multiple maladies, including kidney problems or diabetes. That makes it more risky for the patient, who are older and sicker. The rates of infection have risen along with the number of operations.
TWO IS BETTER THAN ONE
Pacemakers are increasingly becoming used to stimulate two chambers of the heart, and thus are known as “dual-chamber” pacemakers. As of 2009, they comprised more than 80 percent of all implants, making them by far the most dominant device in the realm, particularly in the U.S. Of course, that comes at a price – the dual model pacemaker is more expensive than the single-chamber model, rising to $78,000 by 2009, and that doesn’t include the added hospital charges or medications.
But the American College of Cardiology has made the dual-chamber model its recommended choice, noting that it seems more effective than the single-chamber device.
SHOULD I GET ONE?
It’s obviously a doctor’s call as to whether you need a pacemaker. Candidates with irregular heartbeats are the most likely candidates.
As the heart ages, certain changes occur, and some medications you may take for other problems in the body can affect the heart. Some people may have genetic conditions that manifest as they age, resulting in a heartbeat disruption.
The two conditions most common to pacemaker candidates are bradycardia and heart block. A slowed heartbeat is known as bradycardia. A heart block is a disruption of the electrical signal of your heart. Some nerve or muscle damage may cause either, as will a previous heart attack. But the most common cause is aging.
TESTING BEFORE INSERTION
Your doctor may recommend some diagnostic tests before committing to inserting a pacemaker. An EKG, the abbreviation for electrocardiogram test, is designed to detect the heart’s electrical activity. Once you are hooked up to monitors, the painless test will show the speed of your heartbeat, plus the strength and timing of electrical signals.
You can do the test in your doctor’s office, or you may have to wear a portable EKG to test the strength in the course of daily activity. These devices are known as Holter and event monitors.
A Holter monitor will record electrical activity in the heart from 24 to 48 hours, keeping a record of your cardiovascular activity while you go about your day. It’s usually recommended for busy individuals because a heart arrhythmia may not show up during a brief office test.
The event monitor will also be worn during daily activities but will only record sporadic activity while wearing it. Many event monitors are activated by the patient, who pushes a button to turn it on when they feel heart rhythms start to go out of synch.
An echocardiograph is a sound wave that creates a picture of your heart. The sound waves create a moving image that can tell your doctor how well the heart, its valves and chambers are working. It also can pinpoint areas where the blood flow is weak and areas that aren’t contracting as they should. It also allows previous injuries to the muscle to be examined.
Some doctors use an Electrophysiology Study to determine whether an implant is needed. This test requires a thin wire to be passed through your upper thigh area or arm to your heart. The wire will record your heart’s electrical signals, and the doctor can electrically stimulate the heart, helping him or her determine whether any areas are damaged.
In other cases, a stress test may be required. As the name indicates, this will require you to walk on a treadmill and be monitored to see that your heart is working well when exposed to exercise. Heart problems usually will manifest themselves when the heart is being exercised, affording your doctor the opportunity to see your muscle engaged at its maximum.
YOUR ROLE IN GETTING A PACEMAKER
Having a pacemaker implanted requires some commitment – you have to monitor your pulse once the device is implanted and keep good records for your doctor on when the device is working. An implant typically will be checked every three to six months, and the devices will last eight years or longer. When the battery runs out, you’ll need a new pacemaker implanted.
Patients with a device need to be proactive and follow all doctor instructions. They may be required to carry identification that they are an implant wearer and to advise dentists and other doctors of the device because certain equipment can affect the pacemaker function. It’s wise to avoid wild amusement park rides or horror films if you’re easily startled, and you have to let airport tra know of your pacemaker, or risk the alarm going off and additional hassles. Some older microwaves may affect devices, so be wary of nuking that convenience store burrito.
Overall, be aware that getting a pacemaker is something that hundreds of thousands of Americans have experienced. It can add many productive years to your life and sustain your quality of life. Speak to your medical professional and talk about your symptoms to see if you’re a good candidate for an implant.