Case Study On Pacemakers

CASE STUDY ON PACEMAKERS
INTRODUCTION:
A Pacemaker is an electrically-charged medical device. It is implanted

under the skin to help manage irregular heartbeats called arrhythmias.
Pacemaker regulates body’s electrical system, which controls the heart rhythm.
With each heartbeat, an electrical impulse travels from the top of the heart to the
bottom, signalling the heart’s muscles to contract. Pacemaker can also track
and record your heartbeat. A record can help the doctor better understand
arrhythmia.
Pacemakers generally treat two types of arrhythmias:
 Tachycardia, a heartbeat that’s too fast
 Bradycardia, a heartbeat that’s too slow
Some people need a special type of pacemaker called a biventricular

pacemaker, or bivent. A bivent makes the two sides of the heart beat in sync.
This is known as cardiac resynchronization therapy (CRT).
NEED FOR PACEMAKERS
Pacemaker is needed if heart is pumping too quickly or slowly. In either

case, body doesn’t get enough blood. This can cause:
 fatigue
 fainting or light headedness
 shortness of breath
 damage to vital organs
 eventual death
Not all pacemakers are permanent. Temporary pacemakers can control certain
types of problems. You may need a temporary pacemaker after a heart attack or
heart surgery. You may also need one if a medication overdose temporarily
slowed your heart.
PRINCIPLE
A pacemaker helps monitor and control your heartbeat. The electrodes

detect your heart's electrical activity and send data through the wires to the
computer in the generator. If your heart rhythm is abnormal, the computer will
direct the generator to send electrical pulses to your heart.
COMPONENTS USED:
 A pulse generator which has a sealed lithium battery and an electronic

circuitry package. The pulse generator produces the electrical signals that
make the heart beat. Most pulse generators also have the capability to
receive and respond to signals that are sent by the heart itself.
 One or more wires (also called leads). Leads are insulated flexible wires
that conduct electrical signals to the heart from the pulse generator. The
leads also relay signals from the heart to the pulse generator. One end of
the lead is attached to the pulse generator and the electrode end of the
lead is positioned in the atrium (the upper chamber of the heart) or in the
right ventricle (the lower chamber of the heart). In the case of a
biventricular pacemaker, leads are placed in both ventricles.
 Electrodes, which are found on each lead.

BLOCK DIAGRAM OF PACEMAKER:
PREPARATION FOR PACEMAKER:
Before receiving a pacemaker, the patient undergoes several tests.

These tests can ensure that a pacemaker is the right choice for the patient.
 An echocardiogram uses sound waves to measure the size and thickness

of your heart muscle.
 For an electrocardiogram, a nurse or doctor places sensors on your skin

that measure your heart’s electrical signals.
 For Holter monitoring, you wear a device that tracks your heart rhythm
for 24 hours.
 A stress test monitors your heart rate while you exercise.
If a pacemaker is right for the patient, he will need to plan for the surgery.
The doctor will give him/her complete instructions on how to prepare.
 Don’t drink or eat anything after midnight the night before the surgery.
 The patient is advised to follow the doctor’s instructions about which
medicines to stop taking and to take the prescribed medicines before the
surgery.
HOW IS PACEMAKER SURGERY PERFORMED?
Implanting a pacemaker typically takes 1 to 2 hours. Patient

receive a sedative to relax and a local anaesthetic to numb the incision
site. Patient is awake during the procedure.The surgeon will make a small
incision near the shoulder. They’ll guide a small wire through the incision
into a major vein near the collarbone. Then the surgeon will lead the wire
through the vein to your heart. An X-ray machine will help guide surgeon
through the process.
Using the wire, Surgeon will attach an electrode to your heart’s

right ventricle. The ventricle is the lower chamber of the heart. The other
end of the wire attaches to a pulse generator. This contains the battery and
electrical circuits. Typically, the surgeon will implant the generator under
your skin near the collarbone.If the patient getting a biventricular
pacemaker, surgeon will attach a second lead to the heart’s right atrium.
The atrium is the upper chamber of the heart.At the end, surgeon will
close incision with stitches.
WHAT ARE THE COMPLICATIONS ASSOCIATED WITH A

PACEMAKER?
Every medical procedure has some risks. Most risks associated with a
pacemaker are from the surgical installation. They include:
 an allergic reaction to anaesthesia
 bleeding
 bruising
 damaged nerves or blood vessels
 an infection at the site of the incision
 a collapsed lung, which is rare
 a punctured heart, which is also rare. Most complications are temporary.

Life-altering complications are rare.
WHAT HAPPENS AFTER PACEMAKER SURGERY?
The patient may go home that evening, or could stay in the hospital
overnight. Before he/she go home, doctor will make sure the pacemaker
is programmed properly for the heart’s needs. The doctor can reprogram
the device as needed at follow-up appointments.Over the next month, the
patient should avoid rigorous exercise and heavy lifting. He/she may also
need to take over-the-counter medications for any discomfort. Ask the
doctors what pain relievers are safest for the patient.
Every few months, hook the pacemaker up to a phone line using

special equipment provided by the doctor. It allows the doctor to receive
information from the pacemaker without the need for an office
visit.Modern pacemakers are not as sensitive to electrical devices as the
old ones, but certain devices could cause interference with your
pacemaker. For example, you should avoid:
 keeping a cell phone or MP3 player in the pocket over your pacemaker
 standing for too long near certain appliances, such as microwaves
 long exposures to metal detectors
 high-voltage transformers
The doctor will give you more detailed instructions about how to
minimize your risks.
WORKING OF PACEMAKER :
The heart’s sinus node is the natural pacemaker (located in the

upper right chamber of the heart). It sends an electrical impulse to make
heart beat. The job of a pacemaker is to artificially take over the role of
sinus node if it isn’t working properly.
Electrical impulses are sent by the pacemaker to stimulate the heart

to contract and produce a heartbeat. Most pacemakers work just when
they’re needed – on demand. Some pacemakers send out impulses all of
the time. This is called fixed rate.Pacemakers do not give an electrical
shock to the heart.
TYPES OF PACEMAKER:
 Single-chamber pacemakers use one lead in the upper chamber

(atria) or lower chamber (ventricles) of the right side of the heart.
 Dual-chamber pacemakers use one lead in the right atrium and one
lead in the right ventricle of your heart.
 Biventricular pacemakers use three leads: one placed in the right
atrium, one placed in the right ventricle, and one placed in the left
ventricle (via the coronary sinus vein).
CONCLUSION:
Pacemaker implantations are extremely successful, with rates greater than

99 percent. For a 3-lead pacemaker system, the success rates are about 97
percent. The risks of major complications from a pacemaker implant are low. It
included 1,517 patients who received their first pacemaker for bradycardia
(slow or irregular heart rhythm) between 2003 and 2007. Patients were followed
for an average of 5.8 years. The researchers found survival rates of 93%, 81%,
69% and 61% after 1, 3, 5 and 7 years respectively.

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CASE STUDY ON PACEMAKERS

A Pacemaker is an electrically-charged medical device. It is implanted

Pacemakers generally treat two types of arrhythmias:

 Tachycardia, a heartbeat that’s too fast

 Bradycardia, a heartbeat that’s too slow

Some people need a special type of pacemaker called a biventricular

NEED FOR PACEMAKERS

Pacemaker is needed if heart is pumping too quickly or slowly. In either

 fainting or light headedness

 damage to vital organs

A pacemaker helps monitor and control your heartbeat. The electrodes

 A pulse generator which has a sealed lithium battery and an electronic

 Electrodes, which are found on each lead.

PREPARATION FOR PACEMAKER:

Before receiving a pacemaker, the patient undergoes several tests.

 An echocardiogram uses sound waves to measure the size and thickness

 For an electrocardiogram, a nurse or doctor places sensors on your skin

 A stress test monitors your heart rate while you exercise.

HOW IS PACEMAKER SURGERY PERFORMED?

Implanting a pacemaker typically takes 1 to 2 hours. Patient

Using the wire, Surgeon will attach an electrode to your heart’s

WHAT ARE THE COMPLICATIONS ASSOCIATED WITH A

 an allergic reaction to anaesthesia

 damaged nerves or blood vessels

 an infection at the site of the incision

 a collapsed lung, which is rare

 a punctured heart, which is also rare. Most complications are temporary.

Every few months, hook the pacemaker up to a phone line using

 standing for too long near certain appliances, such as microwaves

 long exposures to metal detectors

The heart’s sinus node is the natural pacemaker (located in the

Electrical impulses are sent by the pacemaker to stimulate the heart

 Single-chamber pacemakers use one lead in the upper chamber

Pacemaker implantations are extremely successful, with rates greater than

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