Pacemaker Precautions - Signs of Malfunctioning and Diagnosis

Introduction

A pacemaker is a cardiovascular device placed inside the body to aid in controlling the heart. It is set for a temporary time frame, or 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 primary function of the pacemaker is to send electrical signals to the heart to stabilize the heart rate and bring down the contraction of the heart's lower chambers to standard limits.

Pacemakers have established themselves as a long-term treatment modality for life-threatening arrhythmias and can improve the patient's quality of life. The heart has four chambers and 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, resulting in lousy coordination between the atrium and the ventricles. Therefore, to avoid this, certain precautions need to be taken to increase the effectiveness and life of a pacemaker.

What Are the Various Types of Pacemakers?

• Dual Chamber Pacemakers - This type of pacemaker helps carry electrical impulses to the right atrium and right ventricle of the heart and controls the contraction timing of these chambers.

• Single Chamber Pacemakers - This pacemaker carries electrical impulses to the right ventricle of the heart.

• Biventricular Pacemakers - This one is used in people who have cardiac failure or heartbeat problems. It is also called cardiac resynchronization therapy.

What Precautions Are to Be Taken With a Pacemaker?

A pacemaker is a medical device surgically inserted into the body to help the heart's smooth functioning. When this device does not work correctly, it leads to multiple complications and, thus, a pacemaker malfunctioning. Therefore, the defects should be corrected immediately after prompt diagnosis. Most pacemaker malfunctions get corrected with suitable programming and correction of the underlying cardiovascular disease. Patient education is critical in such cases. They should seek medical attention for any uncommon symptoms.

Mentioned below are a few of the important pacemaker precautions to be kept under consideration:

• Stay away from touching or pressing the site of the implanted pacemaker.

• It is also suggested that people should also avoid high magnetic resources, which do not include telephone or television remotes.

• A person should avoid activities such as bowling, swimming, and golf.

• Weightlifting and heavy workouts must be highly discouraged.

• A mobile phone can be used but on the opposite side of the opposite ear of the cardiac implant.

• A person should avoid leaning forward for a longer duration.

• Avoid staying near electrical appliances for an extended period.

• Keep away from large magnetic fields.

• Always carry an identity card for the inserted pacemaker.

• Avoid close contact with electronic appliances.

• Avoid strenuous actions such as vacuuming, moving the lawn mower, and floor mopping.

• Avoid raising the left hand.

• Limiting the use of tiny electronic devices can also be appropriate.

What Are the Signs of a Malfunctioning Pacemaker?

A pacemaker is implanted inside the patient who has problems with the heart's rhythm. A pacemaker in the chest or abdomen sends electrical impulses that help beat 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. So it is vital to know the signs if the pacemaker stops working or performing its functions.

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

• Chest pain or chest discomfort.

• Irregular heart rhythm.

• Difficulty in breathing.

• Lightheadedness.

• Tachycardia (fast heart rate).

• Dizziness.

• Irritation or itching 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 (slow heart rate).

• A feeling of constant fluttering in the heart.

• A feeling of a portable device under the loose skin.

• Drainage at the site of pacemaker implantation.

• Swelling and redness at the site of surgery.

What Are the Causes of a Malfunctioning Pacemaker?

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

These include the following causes:

• The underlying cardiovascular disease has changed.

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

• The pacemaker should be adjusted as per the new electrical activity 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.

• Due to the depletion of battery life, runaway pacemakers may threaten the patient's life if not immediately evaluated.

How to Diagnose a Malfunctioning Pacemaker?

Prompt diagnosis is essential in the case of a pacemaker malfunctioning. The healthcare provider should be alert to the clinical manifestations and symptoms presented by the patient. Along with the above, the interprofessional team of doctors must search all details of the pacemaker, such as the manufacturer, model number, programming features, and pacing systems. Symptoms such as syncope, palpitations, and fast or slow heart rate should not be ignored. The patient should always have their vitals under the monitor. After the complete medical history, 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 or low blood pressure.

• Atrioventricular waves are not in harmony on the electrocardiogram.

• Stimulation of pocket.

Conclusion

Pacemakers are cardiovascular devices widely used as a treatment option to correct the heart's abnormal rhythms. Modern-day pacemakers do not get affected by electrical appliances. Going ahead with a pacemaker is a decision of the patient and the professional, generally a cardiovascular surgeon and team. It is an invasive procedure with a positive outlook to regulate heartbeat. If necessary, precautions are strictly followed.