HOW DOES IT WORK 

The pacemaker is a small metal cased circuit which is run electronically by a micro computer. This microchip is majorly subdivided into 2 parts which are electrodes on each lead and a pulse generator. Whenever the patient’s heart beats in a non uniform manner or too low than required then improper amount of blood is circulated around the body which is hazardous, hence at these times the pacemaker comes in play where it signals the heart through electrical impulses that brings back the functioning of the heart in it’s appropriate rhythm.

HOW DOES THE PACEMAKER RUN 

Pacemaker runs by a small electronic battery which is placed inside the pacemaker unit. It has a long life which runs anywhere from 7 to 10 years.

TYPES OF PACEMAKER IMPLANTS 

Human heart has 4 chambers i.e 2 on the upper side and 2 on the bottom. Pacemaker units are of 3 types that can be implanted in the patient’s upper chest depending upon the patient’s heart issue. These three types are as follows.

1. Uni/ Single Chamber PPI – This kind of pacemaker is attached to any of the upper or lower chambers of the heart.
2. Dual Chamber PPI – This pacemaker is attached to 2 chambers of the heart i.e one above and one below.
3. Bi-Ventricular Pacemaker PPI – This pacemaker is used for cardiac resynchronization.

HOW IS A PACEMAKER IMPLANTED :

Before the implant, the assigned doctor would know the patient’s medical reports, family history, allergies, procedure & the financials

1. For the surgery, the patient is sedated (Anesthesia) with the help of an IV drip, through a small incision the surgeon would insert a narrow flexible tube under the collarbone. This goes up though the blood veins to the heart. Its position is observed through an imaging process called Fluoroscopy. Once everything is in place, the pacemaker is fitted beneath the skin. Parallelly various forms of heart scans will be running to make sure all vital organs are functioning normally.
2. Post surgery, the patient is kept under critical observation where all his organs are observed for normal functioning and to make sure the implant has got no side effects as such. Once the heart rate and other bodily functions related to the blood is regulated the patient is discharged from the recovery ward and sent home.

BENEFITS OF PACEMAKER IMPLANTATION 

It is to note that a pacemaker does not cure any heart diseases but rather keeps in control with appropriately normal rhythm.

Benefits of having a right heart rhythm according to the body’s activity are as follows:

• To eradicate the problem of Bradycardia.
• Efficient breathing.
• Efficient functioning of the heart.
• Reduced fatigue.

WHO NEEDS ANGIOPLASTY 

Angioplasty is recommended for patients who have faced the following symptoms:

1. Heart stroke.
2. Angina (Extreme heart pain).
3. Blockage in the heart’s artery/ Atherosclerosis.
4. Abnormal results after various heart scans leading to an underlying potential heart disease.
5. Doctor’s recommendation based upon other abnormal heart symptoms.

PROCEDURE

Angioplasty is done under abnormal report conditions of an angiogram which indicates the level of blockage. Initially local anesthesia is given to the patient, then a narrow flexible tube known as catheter is placed from an incision made either in the region of the patient’s groin or on the wrist. This is a special catheter that has the ability to expand in it’s place like a balloon when pumped. Through the X-Ray imaging once the catheter has reached the point of blockage it is pumped to expand the wall of the artery which pushes the fatty plaque through the blood vessels and the blockage is removed. In some cases an external human safe grade metal mesh is placed on the walls of the catheter’s balloon. This mesh acts like a barrier for the arteries to not contract in its place in the future. The catheter is then safely removed.

DURATION OF THE PROCESS 

Angioplasty can take anywhere between 30 minutes to a few hours depending upon the case of the patient.

POST CORONARY ANGIOPLASTY

After the procedure of angioplasty the patient must:

• Follow healthy lifestyle that promotes good heart health.
• Quitting consumption of alcohol, smoking & chewing tobacco.
• Maintaining the LDL cholesterol level to a normal range.
• Exercise advised by the doctor.

TIME TO RECOVER 

If the process of angioplasty is not planned then the recovery time would be around 7 days to return to work for a routine lifestyle but if in case it’s performed under an emergency situation like after a heart stroke then the time of recovery would increase anywhere from a few weeks to months depending upon the severity of the patient.

The conditions that cause heart failure are not all reversible. However, treatments are provided to improve the signs and symptoms of heart failure.

Heart failure is usually related to other condition or disease that may include the following:

1. Coronary artery diseases: This is a condition in which the coronary arteries are narrowed or get blocked
2. Congenital heart defect: A defect that is present from birth can affect walls of the heart
3. Heart attack: When a heart attack occurs, the blood supply to the heart is stopped which may lead to heart failure
4. Cardiomyopathy: This is a condition in which the heart muscles weaken due to reasons like infections, drug or alcohol abuse, genetic issues.
5. Other conditions: Other medical conditions like high blood pressure, diabetes, kidney disease, thyroid problems, heart valve disease may lead to heart failure.

Lifestyle changes like weight management, exercising and avoiding alcohol and drug abuse are vital in avoiding heart failure.

Symptoms of Heart failure:

Heart failure can be a chronic (ongoing) or acute (sudden) condition. The symptoms of heart failure include:

1. Shortness of breath on exertion followed by shortness of breath even at rest
2. Paroxysmal nocturnal dyspnoea or PND, i.e., shortness of breath and coughing that usually occurs in the night
3. Easy fatigue and tiredness
4. Pedal oedema i.e., accumulation of fluid in the feet or lower legs that increases in the evening time
5. Intermittent chest pain
6. Increased frequency of urination at night
7. Stomach pain
8. Loss of appetite
9. Indigestion
10. Dry cough
11. Giddiness

Diagnosis of Heart failure:

A number of clinical symptoms and lab investigations help in the diagnosis of heart failure. The clinical signs of heart failure are:

1. Tachycardia: abnormal rapid heart rate.
2. Pulse murmur(Alternate pulse is weak)
3. Pedal oedema
4. Cold periphery
5. Cardiomegaly: an enlarged heart that may lead to abnormal heart rhythms
6. S3
7. Constrictive defect

Further lab investigations suggested are:

1. 2D Echo: to investigate the left ventricle function, pulmonary arterial hypertension (high blood pressure of lungs) and inferior vena cava plethora (lack of collapsibility)
2. Blood tests: Haemoglobin (to check for anaemia), elevated B-type natriuretic peptide (BNP) or N-terminal pro-b-type natriuretic (NT pro-BNP) to detect, diagnose or evaluate the severity of heart failure.
3. ECG (Electrocardiogram): To give an idea about conduction defect and changes due to a heart attack.
4. Chest X-ray: To view the condition of the heart and lungs.

2D echo provides details about the size of heart chambers, pumping function of the heart, any leakage of valves, lung pressure and presence of fluid. Other tests suggested are CT Scan, MRI, Coronary angiogram, Myocardial biopsy and stress test.

Treatment of Heart failure:

After the diagnosis of heart failure, various non-pharmacological and pharmacological measures are suggested to the patient. A change in lifestyle is recommended to the patients diagnosed with heart failure. Weight management, exercises that do not cause physical strain, drug and alcohol abstinence, reduction in intake of salt and restrictions on fluid intake are suggested. Other methods of treatment include:

1. Medication: Medicines like diuretics help attain frequent urination, so that fluid is not retained in the body are suggested. Medications to improve the heart pumping function and reduction of load on the heart are prescribed by the cardiologists.
2. Surgery: Depending on your medical history and current status, surgeries are performed to improve the heart pumping function. Coronary bypass surgery and heart valve replacement or repair are the types of surgery performed. With various trial and encouraging results, heart transplants are also a preferred method of treatment

Implantable devices: Implantable cardioverter-defibrillators (ICDs) help in providing a direct shock treatment through pacemaker, whenever an abnormal rhythm is detected. Cardiac resynchronisation therapy(CRT-P/D) is used in which by programming a pacing device, the heart is stimulated mechanically to establish the synchronisation of heart-pumping functions.