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What is a pacemaker?

A pacemaker is a small device that sends electrical impulses to the cardiac muscle. This helps to regulate a normal heart rate and rhythm.

Insertion of a pacemaker is known as implantation. A pacemaker is placed just below the skin near your heart to help regulate the heart beat.

 

Who needs it?

A pacemaker is used to treat patients with:

  • Slow Atrial Fibrillation
  • Bradycardia (slow heart rate)
  • Heart Block (electrical impulses not continuing throughout pathway correctly)
  • Sick sinus syndrome (alternating slow and fast rhythms of the heart)
  • Congestive heart failure

 

How a normal heart beats:

In a normal heart, the muscles and chambers within the heart synchronize in a regulated type of harmony together. This occurs only when the electrical impulses are conducted properly through the heart.

If the heart is beating too slow or too fast, a sufficient amount of blood is unable to flow throughout the body. When this happens, patients may get symptoms of arrhythmia. These symptoms include fatigue, shortness of breath, fainting, or loss of consciousness.

The electrical signals of the heart follow through a conduction pathway. The origin of this pathway is from the Sinoatrial node, the natural pacemaker of the heart. The impulses are transmitted throughout the heart keeping it beating in sync in rate and rhythm.

What does a pacemaker do?

When the Sinoatrial node is not functioning properly, a pacemaker is needed to help initiate the correct electrical impulses. The pacemaker acts by mimicking the Sinoatrial node, generating a normal heart rate and rhythm.

  • Battery: the pacemaker battery supplies the power to the pacemaker. This is a small, sealed, lithium battery that can lasts for years. Battery life usually lasts 5-10 years depending on how active your pacemaker is.A pacemaker consists of:
  • Computerized generator: this is a miniature computer inside the pacemaker. The battery transmits electrical impulses that go through this generator to stimulate the heart to beat.
  • Case: the battery and computer generator are sealed inside a metal casing.

  • Leads: are flexible wires connecting the generator to the walls of the heart.

Pacemakers not only monitor your heartbeat but also your body motion and breathing pattern. This can signal the pacemaker to increase during times of exercise.

 

What are the different types of pacemakers?

Depending on the condition of the heart, Dr. Jamnadas or Dr. Kelly will determine the number of chambers in your heart that need to be placed.
Pacemakers can be implanted temporarily or permanently.

The different types of pacemakers are:

  • Single Chamber Pacemakers: this uses one lead which connects either to the right atrium or ventricle.
  • Dual Chamber Pacemakers: this uses two leads with one connecting to the right atrium and the second connecting to the right ventricle to make the heart beat more efficiently.
  • Biventricular pacemakers: this uses 3 leads, one in the right atrium, and one in each ventricle. This treatment resets the ventricular pumping system and is referred to as Cardiac Resynchronization Therapy (CRT).

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.

These complications include:

  • Allergy: may produce an allergic reaction to the dye.
  • Swelling, bruising or bleeding at or around the implantation site.
  • Formation of a clot (hematoma).
  • Infection: can occur where their pacemaker was implanted.
  • Damage to blood vessels or nerves around pacemaker site
  • Collapsed lung

How is this diagnosed?

Dr. Jamnadas or Dr. Kelly will discuss with you about your history and symptoms.

Following this, a physical examination will be performed to get a better idea of your condition.

A number of different tests can be done to find out the cause of irregular heartbeats including:

  • Electrocardiogram (EKG) – a simple,non-invasive test that records the electrical activity of the heart and its beating pattern.
  • Holter monitor- records the electrical events of the heart during your normal daily activities. It is important to accurately record your activities and symptoms so Dr. Jamnadas or Dr. Kelly can compare them to the Holter monitor findings. If symptoms do not occur within 24 hours, an event recorder may be ordered for you for up to 30 days.
  • Echocardiogram (ECHO) – shows images of the heart determining the size and shape of the heart, and shows whether the heart walls and pumping activity are normal or performing weakly.
  • Stress test- helps access the blood flow to the heart at rest and during stress. Will detect if any areas receiving less blood flow.

What to expect:
Before the procedure:

Today pacemaker devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

A pacemaker is usually implanted just beneath the skin of your chest, below the collarbone.

Pacemakers are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay overnight in the hospital.

You will need to arrange for someone to pick you up and drop you off.

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an I.V. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the pacemaker will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the pacemaker leads will be threaded through the vein and fixed to the wall of the right atrium or ventricle or both, depending on your pacemaker.

The other end of the lead will be secured to the generator box.

The pacemaker settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the pacemaker underneath the skin of the chest.

After the pacemaker is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

After the procedure:

After the procedure, you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks.

On the side of the incision, Do NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.

Do not drive until you know how your pacemaker affects you.

Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you and when it is best to start.

Make sure to:

  • Change your dressing as often as instructed and avoid getting the area wet for about a week.
  • Take your temperature and check the incision every day for signs of infection like redness, discharge, or a local rise in temperature.
  • Learn how to take your own pulse and keep a record of it.
  • Avoid putting direct pressure on your pacemaker. For example, do not lie on your chest while sleeping at night.
  • Let your primary health care provider or any other healthcare providers, as well as the dentist, know about your pacemaker before receiving any treatment.
  • Carry an ID card that contains information about your pacemaker. Your pacemaker may set off a metal detector while going through security. You may need to show this card to security personnel.
  • Keep your cellular phone away from your pacemaker. Do not carry your phone in your shirt pocket, even when it is turned off.
  • Avoid strong magnets including MRI scans and hand-held security wands.
  • Avoid strong electrical fields such as those made by radio transmitting towers, ham radios, and heavy duty electrical equipment.
  • Avoid leaning over the open hood of a running car. A running engine creates an electrical field.

Keep all follow-up appointments to check your pacemaker and lead. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

Follow-up appointments will be scheduled for you in the initial one month, and then the following 2 months, then every 3 months to get your device checked.

What can I use?

The following items are all ok to use:

  • Microwave ovens
  • Computers
  • Hair dryers
  • Power tools
  • Radios
  • Televisions
  • Stereos
  • Electric blankets
  • Vacuum cleaners
  • Heating pads
  • Cars

Call Dr. Jamnadas if you experience any symptoms of:

  • Dizziness
  • Palpitations
  • Shortness of breath
  • Fatigue
  • Fainting spells
  • Twitching chest muscles
  • Chest pain or pain at pacemaker site
  • Fever
  • Hiccups that won’t stop

What is it?

A biventricular pacemaker a small device used for cardiac resynchronization therapy for patients with heart failure. This delivers small electrical impulses to both the left and right ventricles to help them contract at the same time. This helps the heart to pump blood more efficiently with each beat.

Who needs it?

A biventricular pacemaker is used to treat patients with:

  • Moderate to severe heart failure
  • Ejection fraction <35% (the amount of blood pumped out of the heart with each beat)
  • Ventricular dysynchrony
  • Interventricular conduction delay or bundle branch block
  • Symptoms of heart failure not corrected with medication at maximum dosage

How a normal heart beats:

In a normal heart, the muscles and chambers of the heart contract and relax in a synchronized regulated type of harmony together. This timed synchronization or rhythm allows the ventricles to relax and fill with sufficient amount of blood then contract, pumping out a sufficient amount of blood throughout the body.

How does it work?

In a patient with heart failure, the chambers of the heart are not in sync with each other. This leads to an inadequate blood supply throughout the body and can lead to symptoms of heart failure. These symptoms include shortness of breath, dry cough, swelling of the legs, irregular heart beats, or fatigue.

A biventricular pacemaker sends a steady pattern of electrical impulses first to the right atrium then to both the right and left ventricles of the heart.

These small impulses help by keeping the contractions in sync and in a regular rhythm to provide adequate blood flow throughout the body.

This treatment resets the ventricular pumping system and is referred to as Cardiac Resynchronization Therapy (CRT).

What are the parts of a biventricular pacemaker?

A biventricular pacemaker consists of:

  • Battery: the pacemaker battery supplies the power to the pacemaker. This is a small, sealed, lithium battery that can lasts for years. Battery life usually lasts 5-10 years depending on how active your pacemaker is.
  • Computerized generator: this is a miniature computer inside the pacemaker. The battery transmits electrical impulses that go through this generator to stimulate the heart to beat.
  • Case: the battery and computer generator are sealed inside a metal casing.
  • Leads: 3 flexible wires connect the generator to the walls of the heart.

Biventricular Pacemakers not only monitor your heart beat, but also your body motion and breathing pattern. This can signal the pacemaker to increase during times of exercise.

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.

These complications include:

  • Allergy: may produce an allergic reaction to the dye.
  • Swelling, bruising, or bleeding at or around the implantation site.
  • Formation of a clot (hematoma).
  • Infection: can occur where there pacemaker was implanted.
  • Damage to blood vessels or nerves around pacemaker site
  • Collapse lung
  • Device may move out of place from the heart.
  • Device might not detect or appropriately treat your heart rhythm.

How is this diagnosed?

Dr. Jamnadas or Dr. Kelly will discuss with you about your history and symptoms.

Following this a physical examination will be performed to get a better idea of your condition.

A number of different tests can be done including:

  • Electrocardiogram (EKG) – a simple,non-invasive test that records the electrical activity of the heart and its beating pattern.
  • Holter monitor- records the electrical events of the heart during your normal daily activities. It is important to accurately record your activities and symptoms so Dr. Jamnadas or Dr. Kelly can compare them to the Holter monitor findings. If symptoms do not occur within 24 hours, an event recorder may be ordered for you for up to 30 days. 
  • Echocardiogram (ECHO) – shows images of the heart determining the size and shape of the heart, and shows whether the heart walls and pumping activity are normal or performing weakly.
  • Stress test- helps access the blood flow to the heart at rest and during stress. Will detect if any areas receiving less blood flow.

What to expect:
Before the procedure:

Today pacemaker devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

A biventricular pacemaker is usually implanted just beneath the skin of your chest, below the collarbone.

Biventricular pacemakers are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay over night in the hospital. Pack an overnight bag just in case.

You will need to arrange for someone to pick you up and drop you off.

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an I.V. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the pacemaker will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the pacemaker leads will be threaded through the vein and fixed to the wall of the right atrium and both right and left ventricles. The other end of the leads will be secured to the generator box.

The pacemaker settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the pacemaker underneath the skin of the chest.

After the pacemaker is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

After the procedure:

After the procedure you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks.

On the side of incision, DO NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.

Do not drive until you know how your pacemaker affects you.

Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you and when it is best to start.

Make sure to:

  • Change your dressing as often as instructed and avoid getting the area wet for about a week.
  • Take your temperature and check the incision everyday for signs of infection like redness, discharge, or a local rise in temperature.
  • Learn how to take your own pulse and keep record of it.
  • Avoid putting direct pressure on your pacemaker. For example, do not lie on your chest while sleeping at night.
  • Let your primary health care provider or any other healthcare providers as well as dentist know about your pacemaker before receiving any treatment.
  • Carry an ID card that contains information about your pacemaker. Your pacemaker may set off a metal detector while going through security. You may need to show this card to security personnel.
  • Keep your cellular phone away from your pacemaker. Do not carry your phone in your shirt pocket, even when it is turned off.
  • Avoid strong magnets including MRI scans and hand held security wands.
  • Avoid strong electrical fields such as those made by radio transmitting towers, ham radios, and heavy duty electrical equipment.
  • Avoid leaning over the open hood of a running car. A running engine creates am electrical field.

Keep all follow up appointments to check your pacemaker and leads. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

What can I use?

The following items are all ok to use:

  • Microwave ovens
  • Computers
  • Hair dryers
  • Power tools
  • Radios
  • Televisions
  • Stereos
  • Electric blankets
  • Vacuum cleaners
  • Heating pads
  • Cars

Call Dr. Jamnadas if you experience any symptoms of:

  • Dizziness
  • Palpitations
  • Shortness of breath
  • Fatigue
  • Fainting spells
  • Twitching chest muscles
  • Chest pain or pain at pacemaker site
  • Fever
  • Hiccups that won’t stop

What is an ICD?

An ICD is a small device that monitors the electrical activity of the heart. This not only evaluates the hearts activity, but can also store the electrical events so Dr. Jamnadas can assess them.

In the event a dangerously fast heart rhythm is detected, the ICD quickly delivers therapy in the form of electrical energy.

This helps to regulate a normal heart rate and rhythm.

 

Who needs it?

An ICD is used to treat patients with:

  • Ventricular Fibrillation
  • Ventricular Tachycardia
  • Congestive Heart Failure
  • Cardiomyopathy
  • Long QT syndrome

How a normal heart beats:

In a normal heart, the muscles and chambers within the heart synchronize in a regulated type of harmony together. This occurs only when there is a normal rate and rhythm of the heart.

If the heart is beating too slow or too fast, sufficient amount of blood is unable to flow throughout the body. When this happens patients may get symptoms of arrhythmia. These symptoms include fatigue, shortness of breath, fainting, or loss of consciousness.

The electrical signals of the heart follow through a conduction pathway. The origin of this pathway is from the Sinoatrial node that is known as the natural pacemaker of the heart. The impulses are transmitted throughout the heart keeping it beating in sync in rate and rhythm.

What does an ICD do?

An ICD is needed when the heart has the potential to develop a dangerously fast heart rhythm due to the improper activity of the hearts electrical system.

As soon as this occurs, the ICD will send a shock to the heart muscle to defibrillate it or stop the cycle of rapid twitching to normalize the hearts rhythm.

The shock sensation varies amongst people. Some may not even be aware of the shock, where as others may be uncomfortable after responding to such a dangerous rhythm.

An ICD consists of:

  • Battery: the ICD battery supplies the power to the ICD. This is a small, sealed, lithium battery that can lasts for years. Battery life usually lasts 5-10 years depending on how active your ICD is.
  • Computerized generator: this is a miniature computer to evaluate the heart rate, store it in memory, and help the device know when to deliver therapy. The battery transmits electrical impulses that go through this generator to stimulate the heart to beat.
  • Case: the battery and computer generator are sealed inside a metal casing.
  • Leads: are flexible wires connecting the generator to the walls of the heart.

What are the different types of ICDs?

Depending on the condition of the heart, Dr. Jamnadas or Dr. Kelly will determine the right ICD for you.

The different types of ICDs are categorized by the type of pacemaker they contain:

  • ICD with a single chamber pacemaker: this paces in one chamber of the heart. This uses one lead which connects either to the right atrium or ventricle.
  • Dual chamber ICD with dual chamber pacemaker: this uses two leads with one connecting to the right atrium and the second connecting to the right ventricle to make the heart beat more efficiently.
  • Bi ventricular ICDs: pace in three chambers of the heart including the right atrium and the left and right ventricles.

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.

These complications include:

  • Allergy: may produce an allergic reaction to the dye.
  • Swelling, bruising, or bleeding at or around the implantation site.
  • Formation of a clot (hematoma).
  • Infection: can occur where there ICD was implanted.
  • Damage to blood vessels or nerves around ICD site.
  • Collapse lung

How is this diagnosed?

Dr. Jamnadas or Dr. Kelly will discuss with you about your history and symptoms.

Following this a physical examination will be performed to get a better idea of your condition.

A number of different tests can be done to find out the cause of irregular heartbeats including:

  • Electrocardiogram (EKG) – a simple,non-invasive test that records the electrical activity of the heart and its beating pattern.
  • Holter monitor- records the electrical events of the heart during your normal daily activities. It is important to accurately record your activities and symptoms so Dr. Jamnadas or Dr. Kelly can compare them to the Holter monitor findings. If symptoms do not occur within 24 hours, an event recorder may be ordered for you for up to 30 days.
  • Echocardiogram (ECHO) – shows images of the heart determining the size and shape of the heart, and shows whether the heart walls and pumping activity are normal or performing weakly.
  • Stress test- helps access the blood flow to the heart at rest and during stress. Will detect if any areas are receiving less blood flow.

What to expect:
Before the procedure:

Today ICDs devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

An ICD is usually implanted just beneath the skin of your chest, below the collarbone.

ICDs are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay over night in the hospital.

You will need to arrange for someone to pick you up and drop you off.

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an i.v. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the ICD will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the ICD leads will be threaded through the vein and fixed to the wall of the right atrium or ventricle or both, depending on your ICD. The other end of the lead will be secured to the generator box.

The ICD settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the ICD underneath the skin of the chest.

After the ICD is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

After the procedure:

After the procedure you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks.

On the side of incision, Do NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.

Do not drive until you know how your ICD affects you.

Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you.

Make sure to:

  • Change your dressing as often as instructed and avoid getting the area wet for about a week.
  • Take your temperature and check the incision everyday for signs of infection like redness, discharge, or a local rise in temperature.
  • Learn how to take your own pulse and keep record of it.
  • Avoid putting direct pressure on your ICD. For example, do not lie on your chest while sleeping at night.
  • Let your primary health care provider or any other healthcare providers as well as dentist know about your ICD before receiving any treatment.
  • Carry an ID card that contains information about your ICD. Your ICD may set off a metal detector while going through security. You may need to show this card to security personnel.
  • Keep your cellular phone away from your ICD. Do not carry your phone in your shirt pocket, even when it is turned off.
  • Avoid strong magnets including MRI scans and hand held security wands.
  • Avoid strong electrical fields such as those made by radio transmitting towers, ham radios, and heavy duty electrical equipment.
  • Avoid leaning over the open hood of a running car. A running engine creates am electrical field.

Keep all follow up appointments to check your ICD and lead. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

Follow up appointments will be scheduled for you in the initial one month, and then the following 2 months, then every 3 months to get your device checked.

What can I use?

The following items are all ok to use:

  • Microwave ovens
  • Computers
  • Hair dryers
  • Power tools
  • Radios
  • Televisions
  • Stereo
  • Electric blankets
  • Vacuum cleaners
  • Heating pads
  • Cars

Call Dr. Jamnadas if you experience any symptoms of:

  • Dizziness
  • Palpitations
  • Shortness of breath
  • Fatigue
  • Fainting spells
  • Twitching chest muscles
  • Chest pain or pain at ICD site
  • Fever
  • Hiccups that won’t stop

What is it?

A biventricular ICD a small device used for cardiac resynchronization therapy for patients with heart failure. This constantly monitors your heart rate and rhythm and delivers small electrical impulses to both the left and right ventricles to help them contract at the same time.

This helps the heart to pump blood more efficiently with each beat. If any abnormal rhythm is detected, the ICD will deliver a shock to the heart back into a normal rhythm again.

This helps in treating dangerously fast rhythms that can lead to a sudden cardiac arrest.

Who needs it?

A biventricular ICD is used to treat patients with:

  • Moderate to severe heart failure with high risk of sudden cardiac death.
  • Ejection fraction <35% (the amount of blood pumped out of the heart with each beat)
  • Ventricular fibrillation
  • Sustained ventricular tachycardia
  • Interventricular conduction delay or bundle branch block
  • Cardiomyopathy

 

How a normal heart beats:

In a normal heart, the muscles and chambers of the heart contract and relax in a synchronized regulated type of harmony together.

This timed synchronization or rhythm allows the ventricles to relax and fill with sufficient amount of blood then contract, pumping out a sufficient amount of blood throughout the body.

 

How does it work?

In a patient with heart failure, the chambers of the heart are not in sync with each other. This leads to an inadequate blood supply throughout the body and can lead to symptoms of heart failure.

Symptoms include shortness of breath, dry cough, swelling of the legs, irregular heart beats, or fatigue.

A biventricular ICD not only monitors the heart rate and rhythm but also senses dangerously fast heartbeats that can lead to cardiac arrest. If the device senses a life threatening heart beat, it will deliver a shock to the heart. This shock or defibrillation stops the abnormal rhythm and sets the heart into a regular rhythm again. This shock helps keep the contractions of the heart in sync and in a regular rhythm to provide adequate blood flow throughout the body.

This treatment resets the ventricular pumping system and is referred to as Cardiac Resynchronization Therapy (CRT).

 

 

What are the parts of a biventricular ICD?

A biventricular ICD consists of:biv icd

  • Battery: the ICD battery supplies the power to the ICD. This is a small, sealed, lithium battery that can lasts for years. Battery life usually lasts 5-10 years depending on how active your ICD is.
  • Computerized generator: this is a miniature computer inside the ICD. The battery transmits electrical impulses that go through this generator to stimulate the heart to beat.
  • Case: the battery and computer generator are sealed inside a metal casing.
  • Leads: 3 flexible wires connect the generator to the walls of the heart.

Biventricular ICDs not only monitor your heart beat, but also your body motion and breathing pattern. This can signal the ICD to increase during times of exercise.

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.

These complications include:

  • Allergy: may produce an allergic reaction to the dye.
  • Swelling, bruising, or bleeding at or around the implantation site.
  • Formation of a clot (hematoma).
  • Infection: can occur where there ICD was implanted.
  • Damage to blood vessels or nerves around ICD site
  • Collapse lung
  • Device may move out of place from the heart.
  • Device might not detect or appropriately treat your heart rhythm.

 

 

 

How is this diagnosed?

Dr. Jamnadas or Dr. Kelly will discuss with you about your history and symptoms.

Following this a physical examination will be performed to get a better idea of your condition.

A number of different tests can be done including:

  • Electrocardiogram (EKG) – a simple,non-invasive test that records the electrical activity of the heart and its beating pattern.
  • Holter monitor- records the electrical events of the heart during your normal daily activities. It is important to accurately record your activities and symptoms so Dr. Jamnadas or Dr. Kelly can compare them to the Holter monitor findings. If symptoms do not occur within 24 hours, an event recorder may be ordered for you for up to 30 days.
  • Echocardiogram (ECHO) – shows images of the heart determining the size and shape of the heart, and shows whether the heart walls and pumping activity are normal or performing weakly.
  • Stress test- helps access the blood flow to the heart at rest and during stress. Will detect if any areas receiving less blood flow.

 

What to expect:
Before the procedure:

Today ICD devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

A biventricular ICD is usually implanted just beneath the skin of your chest, below the collarbone.

Biventricular ICDs are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay over night in the hospital. Pack an overnight bag just in case.

You will need to arrange for someone to pick you up and drop you off.

 

 

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an I.V. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the ICD will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the ICD leads will be threaded through the vein and fixed to the wall of the right icdleadsatrium and both right and left ventricles. The other end of the leads will be secured to the generator box.

The ICD settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the ICD underneath the skin of the chest.

After the ICD is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

 

 

After the procedure:

After the procedure you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks.

On the side of incision, DO NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.

Do not drive until you know how your ICD affects you.

Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you and when it is best to start.

Make sure to:

  • Change your dressing as often as instructed and avoid getting the area wet for about a week.
  • Take your temperature and check the incision everyday for signs of infection like redness, discharge, or a local rise in temperature.
  • Learn how to take your own pulse and keep record of it.
  • Avoid putting direct pressure on your ICD. For example, do not lie on your chest while sleeping at night.
  • Let your primary health care provider or any other healthcare providers as well as dentist know about your ICD before receiving any treatment.
  • Carry an ID card that contains information about your ICD. Your ICD may set off a metal detector while going through security. You may need to show this card to security personnel.
  • Keep your cellular phone away from your ICD. Do not carry your phone in your shirt pocket, even when it is turned off.
  • Avoid strong magnets including MRI scans and hand held security wands.noMRI
  • Avoid strong electrical fields such as those made by radio transmitting towers, ham radios, and heavy duty electrical equipment.
  • Avoid leaning over the open hood of a running car. A running engine creates am electrical field.

Keep all follow up appointments to check your ICD and leads. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

What can I use?

Thefollowing items are all ok to use:

  • Microwave ovens
  • Computers
  • Hair dryers
  • Power tools
  • Radios
  • Televisions
  • Stereos
  • Electric blankets
  • Vacuum cleaners
  • Heating pads
  • Cars

Call Dr. Jamnadas if you experience any symptoms of:

  • Dizziness
  • Palpitations
  • Shortness of breath
  • Fatigue
  • Fainting spells
  • Twitching chest muscles
  • Chest pain or pain at ICD site
  • Fever
  • Hiccups that won’t stop

What is it?

A Holter monitor is a small portable device used to record the electrical activity of the heart. A Holter monitor is typically worn for 24 hours to record each heart beat during your normal daily activity. This is performed to detect any irregular heart rhythms that may not be picked up on a routine electrocardiogram (EKG) during your office visit.holter monitor

Who needs it?

A Holter monitor may be ordered in a patient for a number of reasons. Some indications for a Holter monitor include:

  • Arrhythmia (irregular heartbeat)
  • Atrial Fibrillation/ Flutter
  • Atrial tachycardia
  • Palpitations
  • Supraventricular tachycardia
  • Syncope
  • Bradycardia (slow heart rate)
  • Ventricular Tachycardia
  • After a heart attack
  • New cardiac medication usage

How do I prepare for the test?

There is no specific preparation before having a Holter monitor put on. Make sure to shower before the test as you will not be permitted to while wearing the monitor.

The test is a painless test. Most people do not notice they even have the monitor on.

There is no risk associated with this test. It is important to avoid getting the device wet, as it is an electrical device. Some things to avoid during the 24 hours include electric blankets, high-voltage areas, magnets, and metal detectors.

How is it performed?

Several small sticky electrodes will be placed on the chest and attached to the Holter monitor. These can easily be hidden under your clothes. The Holter monitor is small enough to attach to your belt or may be worn around the neck or waist. The Holter monitor will be worn for 24 hours throughout your normal daily activities including exercise, eating, sleeping, and even when you take your daily medications. It is important to make a diary of your activities. Make sure to include the time of day of each activity. Any symptoms you might feel should be accurately recorded. After 24 hours, the monitor and diary must be returned to our clinic.

Front view male figure torso with holter monitor and ekg/heart rhythm inset; SOURCE: body3D.psd; cardio_holter-monitor_proc_1_layers.psd

How are results interpreted?

The events recorded from the Holter monitor will be compared to your daily activity diary as well as any symptoms you may have noted. The results of the test may reveal normal cardiac activity.normalEKG

If your symptoms are so infrequent that a 24 hour monitor does not reveal any abnormal activity, an event monitor may be issued for the next 30 days. The events recorded in a 24 hour monitor may help reveal a present heart condition. Further management can be done following this.

Call our office:

If any of the following occur, be sure to call our office:

  • Holter monitor makes a noise
  • If an electrode comes off

What is it?

A cardiac event monitor is a small portable device worn by patients during their normal activity forevent_monitor up to 30 days. This device is capable of recording the electrical activity of the heart in the form of an electrocardiogram (EKG) for up to several minutes. This is intended to record arrhythmias (abnormal heart rhythm) that would not be found on a routine EKG or to record an arrhythmia that is so infrequent, it is not detected on a 24 hour Holter monitor.

Who needs it?

  • Patients with palpitations with or without arrhythmias
  • Patients with symptoms of:
    • Intermittent palpitations
    • New syncope
    • Dizziness
    • Intermittent lightheadedness
  • Patients requiring monitoring of the effects of drugs given to them to control atrial fibrillation
  • Patients recovering from cardiac surgery who need arrhythmia monitoring
  • Patients with obstructive sleep apnea who may have possible arrhythmias

Can anyone use it?

An event monitor is not intended for patients with life-threatening arrhythmias.

How does it work?

eventleadplacement
eventEKG2

A package with the event monitor will be delivered to you. You will need to apply 3 sticky patches (electrodes) to your chest. These electrodes will be attached to wires called leads which connect to the monitor that is worn around your neck.This will be given to you up to a period of 30 days. If you feel any symptoms, push the button on the monitor to begin recording. This will allow Dr. Jamnadas to know what was happening with your heart at that point of time.

What are the benefits?

  • This is capable of detecting asymptomatic events and transmitting them immediately to Dr. Jamnadas.
  • Useful in recording arrhythmias that would not be found on a routine EKG or a 24 hour Holter monitor.
  • The extended memory allows Dr. Jamnadas to examine the hearts electrical activity over an entire day.
  • Useful in diagnosis of previously unrecognized arrhythmias and cause of symptoms.
  • Allows confirmation or exclusion of a probable arrhythmic cause of symptoms.
  • Useful in monitoring anti-arrhythmic medication.

Implantable Loop Recorders are surgically placed just beneath the skin on the chest and are left for periods up to a year.  These are small devices that range in size from a small pocket lighter to slightly larger than a matchstick and are designed to catch the rare periods of palpitations and arrhythmias that may be present.  By identifying the specific event your physician can recommend the most appropriate treatment for your condition.  Upon conclusion of monitoring period, this device is surgically removed.