Who Needs a Pacemaker?
Doctors recommend pacemakers to patients for a
number of reasons. The most common reason is when a patient's heart is beating
too slow or there are long pauses between heartbeats.
A pacemaker may be helpful if:
- Aging or heart disease damages your sinus node's
ability to set the correct pace for your heartbeat. Such damage can make your
heart beat too slow, or it can cause long pauses between heartbeats. The damage
also can cause your heart rhythm to alternate between slow and fast.
- You need to take certain heart medicines (such as
beta blockers), but these medicines slow down your heartbeat too much.
- The electrical signals between your heart's upper
and lower chambers are partially or completely blocked or slowed down (this is
called heart block). Aging, damage to the heart from a
heart
attack, or other heart conditions can prevent electrical signals from
reaching all the heart's chambers.
- You often faint due to a slow heartbeat. For
example, this may happen if the main artery in your neck that supplies your
brain with blood is sensitive to pressure. In you have this condition, just
quickly turning your neck can cause your heart to beat slower than normal. When
that happens, not enough blood may flow to your brain, causing you to faint.
- You have had a medical procedure to treat an
arrhythmia
called atrial fibrillation. A pacemaker can help regulate your heartbeat after
the procedure.
- You have heart muscle problems that cause
electrical signals to travel through your heart muscle too slow. (Your
pacemaker will provide cardiac resynchronization therapy for this problem.)
To decide whether a pacemaker will benefit you, your
doctor will consider any symptoms you have of an irregular heartbeat, such as
dizziness, unexplained fainting, or shortness of breath. He or she also will
consider whether you have a history of heart disease, what medicines you're
currently taking, and the results of heart tests.
A pacemaker won't be recommended unless your heart
tests show that you have irregular heartbeats.
Tests That Help Determine Whether You Need a
Pacemaker
A number of tests are used to detect an arrhythmia.
Your doctor may recommend some or all of these tests.
EKG (Electrocardiogram)
This simple and painless test detects and records
the electrical activity of the heart. An
EKG
shows how fast the heart is beating and the heart's rhythm (steady or
irregular). It also records the strength and timing of electrical signals as
they pass through each part of the heart.
Holter Monitor
A
Holter monitor, also called an ambulatory EKG, records the
electrical signals of your heart for a full 24- or 48-hour period. You wear
small patches called electrodes on your chest that are connected by wires to a
small, portable recorder. The recorder can be clipped to a belt, kept in a
pocket, or hung around your neck.
During the 24 or 48 hours, you do your usual daily
activities and keep a notebook, noting any symptoms you have and the time they
occur. You then return both the recorder and the notebook to your doctor to
read the results. Your doctor can see how your heart was beating at the time
you had symptoms.
The purpose of a Holter monitor is to record heart
signals during typical daily activities and while sleeping, and to find heart
problems that may occur for only a few minutes out of the day.
Echocardiogram
This test uses sound waves to create a moving
picture of your heart. An
echocardiogram
shows the size and shape of your heart and how well your heart is pumping
blood. The test can identify areas of heart muscle that aren't contracting
normally or getting enough blood flow.
Electrophysiology Study
For an
electrophysiology study, your doctor threads a small, flexible
wire from a blood vessel in your arm or leg to your heart. The wire
electrically stimulates your heart to see how your heart's electrical system
responds. The electrical stimulation helps to find where the heart 's
electrical system is damaged.
Stress Test
Some heart problems are easier to diagnose when your
heart is working harder and beating faster than when it's at rest. During
stress
testing, you exercise to make your heart work harder and beat faster while
heart tests, such as an EKG or echocardiogram, are performed.
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