Pacemaker Malfunctioning - Symptoms, Causes, and Diagnosis

Introduction

The pacemaker was invented in 1958, and since then, doctors have reported a drastic decrease in cardiac output. A pacemaker is a device that is placed inside the body to aid in controlling the heart. It is set for a temporary time frame as suggested by the healthcare provider. A pacemaker is implanted under the skin of the chest. This is not a very invasive surgery and does not require opening the heart. The principal function of the pacemaker is to send electrical signals to the heart in order to stabilize the heart rate and also bring down the contraction of the lower chambers of the heart to standard limits.

Pacemakers have established themselves as a long-term treatment modality for life-threatening arrhythmias and can also improve the patient's quality of life. The heart is divided into four chambers. The above two chambers are the left and right atrium, and the lower two are called the left and right ventricles. Generally, a pacemaker contracts the ventricles alone. If the pacemaker fails in the functions mentioned above, the patient is diagnosed with a malfunctioned pacemaker.

What Are the Signs of a Malfunctioning Pacemaker?

A pacemaker is implanted inside the patient who has problems with the rhythm of the heart. When a pacemaker is placed in the chest or abdomen, it sends electrical impulses that help in the beating of the heart at a normal rhythm. It is estimated that approximately more than 2.5 million people have a pacemaker implanted within them. A pacemaker becomes a part of the body and a part of the cardiovascular system as well. So it is vital to know the signs if the pacemaker stops working or performing its functions.

Below are some of the signs that may alert the patient of a malfunctioned pacemaker.

• Chest pain or chest discomfort.

• Irregular heart rhythm.

• Difficulty in breathing.

• Lightheadedness.

• Tachycardia.

• Dizziness.

• Irritation or itch around the site of surgery.

• High-grade fever.

• Swelling or pus discharge at the site of surgery.

• Alterations in blood pressure.

• Feeling worse after pacemaker surgery.

• Continuous hiccups.

• Twitching of the muscles.

• Irritation and twitching in the chest or abdomen.

• Bradycardia.

• A feeling of constant fluttering in the heart.

• Feeling of a portable device under the skin that is loose.

• Drainage at the site of pacemaker implantation.

• Swelling and redness at the site of surgery.

What Are the Causes of Pacemaker Malfunctioning?

It generally becomes elementary for the patient to tell if they feel there is an issue with their pacemaker. Additionally, there are multiple reasons why a pacemaker may not function properly or may stop working at all.

These include the following causes:

• The underlying cardiovascular disease has changed.

• The pacemaker is now not suitable for underlying cardiovascular conditions.

• The pacemaker needs to be adjusted as per the new electrical activity going on in the patient’s heart.

• There is an interference in the magnetic field of the pacemaker due to strong magnets in the surrounding.

• The patient regularly works near power generators.

• There is a broken part of the pacemaker that needs to be fixed.

• The battery is out of date for the pacemaker.

• The wire that leads to the communication between the pacemaker and the heart is impaired.

• Pacing problems that may have developed over time.

• Cardiac output failure.

• Failure to capture any irregular heart rhythms.

• The pacemaker is not able to sense any changes.

• Pseudo functioning of the pacemaker.

• Underlying tachycardia.

• Over-sensing of the pacemaker.

• Pacemaker crosstalk when there is the presence of two pacemakers.

• Runaway pacemakers, due to depletion of battery life, may pose a threat to the patient's life if not immediately evaluated.

How to Diagnose a Pacemaker Malfunctioning?

Prompt diagnosis is essential in the case of a pacemaker malfunctioning. The healthcare provider should be alert to the clinical manifestations as well as the symptoms presented by the patient. Symptoms such as syncope, palpitations, fast heart rate, or slow heart rate should not be ignored. The patient should always have their vitals under the monitor. After the complete medical history is given, the healthcare provider should notice extracardiac signs such as hiccups or coughs. Physical symptoms to look for during the diagnosis of pacemaker malfunctioning are the following:

• Erosion of the pacemaker pocket.

• Stimulation of the diaphragm.

• Hypotension.

• Atrioventricular waves are not in harmony on the electrocardiogram.

• Stimulation of pocket.

Along with the above, the interprofessional team of doctors must search all details of the pacemaker, such as the manufacturer, model number, programming features, pacing systems, etc.

What to Do While the Pacemaker Is Failing?

If the patient is sure that the pacemaker is failing, they need to immediately rush to the nearby hospital. If this is not possible, it should be made sure that the patient does not touch, pull, push or physically disturb the pacemaker. On reaching the medical setup, make sure to give a detailed medical history regarding the cardiovascular condition and that pacemaker to the healthcare provider. It is usually wise to consult a cardiologist or an electrophysiologist instead of a general practitioner. Malfunctioning pacemakers generally call for timely rectification of the problem as well as correct assessment.

Conclusion

A pacemaker is a device that is surgically inserted into the body to help in the smooth functioning of the heart. When this device does not work correctly, it leads to multiple complications and, thus, a pacemaker malfunctioning. This should be immediately corrected after prompt diagnosis. The majority of pacemaker malfunctions get corrected with suitable programming as well as correction of the underlying cardiovascular disease. Patient education is critical in such cases. They should seek medical attention for any uncommon symptoms. They should also stay away from touching or pressing the site of the implanted pacemaker. It is also suggested that they stay away from high magnetic resources, which do not include telephone or television remotes; nevertheless, limiting the uses of such tiny devices can also be appropriate.