You might think that you’d never be a candidate for a pacemaker. Perhaps your doctor has told you that your cholesterol levels are good. Maybe your blood pressure readings are normal, too. But these facts don’t mean that the electrical components of your heart, which control the speed and rhythm of your heartbeats, are firing on all cylinders.
Common misconceptions: Many people assume that pacemakers are needed only by individuals who have serious cardiovascular disease or are approaching the end of their lives. Neither assumption is true.
It can be common for someone who needs a pacemaker to be otherwise healthy—in these cases, the heart just needs help to generate the signals that make it pump efficiently. And even though people who get pacemakers usually are over age 60, a person of any age may need the device, which is about the size of two poker chips stacked on top of one another. Those with cardiovascular disease also are more likely to need a pacemaker.
The heart normally beats 60 to 100 times a minute. The rate and rhythm of the heart are set by a natural pacemaker—a cluster of cells known as the sinoatrial, or SA, node. What can go wrong: Electrical signals that are delayed or interrupted, due to conditions such as those described later in this article, cause the heart to beat too slowly (a condition known as bradycardia)…or to pump insufficient amounts of blood (a condition known as heart failure).
These problems can lead to unexplained symptoms, such as dizziness, shortness of breath, fatigue and/or episodes of syncope (a sudden loss of consciousness). More subtle symptoms include chest pain, swelling, coughing, difficulty walking and weight gain.
When such symptoms occur, doctors routinely recommend an EKG and/or use of a Holter monitor, a device that’s worn at home to record the heart’s electrical activity over 24 to 48 hours. An echocardiogram (an ultrasound test that shows how well the heart is working) and/or an intracardiac electrophysiology study (to pinpoint where the heart’s electrical system is damaged) also may be needed.
Note: Many heart failure patients need defibrillators, which are different from pacemakers. If a potentially fatal arrhythmia is detected by the device, it can give the patient a lifesaving shock. Pacemakers do not have this ability.
After certain problems are ruled out, you may be advised to get a pacemaker for these conditions…*
What doctors check before suggesting a pacemaker: Patients with angina (chest pain caused by reduced blood flow to the heart) may be advised to take a beta-blocker drug, such as atenolol (Tenormin), to reduce the heart’s demand for oxygen. But this type of medication may slow the heart too much and cause bradycardia. Calcium channel blockers, such as diltiazem (Cardizem), or other anti-arrhythmics, such as amiodarone (Pacerone), also can slow heart rates.
What to try first: If a drug you’re taking is causing bradycardia, it’s possible that changing the drug and/or dose will help. Be sure to discuss this option with your doctor. If a different drug and/or dose doesn’t help within several weeks, you may need a pacemaker.
What doctors check before suggesting a pacemaker: In some cases, an AV block is temporary—for example, due to Lyme disease or a potassium deficiency.
What to try first: If your doctor says that you are experiencing an AV block, ask about blood tests to check your electrolytes (including potassium) and to ensure that you don’t have Lyme disease, which can lead to forms of AV block that usually resolve on their own when the underlying condition is treated.
A “third-degree” AV block is potentially the most serious. It can occur with aging and may even follow a heart attack because the interruption in circulation from a blood clot can damage the AV node. Important: The AV node usually recovers on its own within a day or two after a heart attack is treated. If the node recovers, you won’t need a pacemaker…if symptoms continue, a pacemaker is almost always needed.
Other conditions that can cause a slow and irregular heartbeat that may require a pacemaker include congestive heart failure, neuromuscular diseases (such as Parkinson’s disease) and carotid sinus hypersensitivity.
If you have a pacemaker, it’s safe to pass through freestanding security systems at airports. But ask security officers to avoid holding a metal-detecting wand near the pacemaker area for more than a second or two because the magnet inside the wand may affect the operation of the pacemaker. Always carry your pacemaker ID card.
*Doctors should follow the American College of Cardiology’s evidence-based guidelines when deciding whether a patient needs a pacemaker. To read these guidelines, go to CardioSource.org.
