Living with your pacemaker


	Cheryl Missildine, RN, Device Nurse
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Now that you have a pacemaker (or soon may get one), you may be wondering why you need one and how a pacemaker works. Your artificial pacemaker is a modern marvel; it's medical science's solution to the electrical problems of a slow or irregular heartbeat. But before you can understand how your pacemaker works, you first need to know a little about your heart. Basically, your heart is a pump made of special muscle. It pumps blood to all your body's cells. This is vital, because the blood carries oxygen and nourishment to keep your cells alive and healthy.

Your heart beats (pumps blood) because special cells in your heart (the heart's natural pacemaker, called the sinus node) produce electrical impulses. These cause your heart to contract and pump blood. The impulses travel from the pacemaker cells down certain electrical paths in the muscle walls, causing a contraction. As long as the electrical impulses flow down your heart's walls at regular intervals, your heart pumps at a rhythmic pace. Sometimes, though, something happens to interfere with how the electrical impulses of your heart's natural pacemaker are made or flow down your heart. When this occurs, the natural pacemaker can't do its job as well as it needs to.

Problems that change the heart rhythm include:

A complete block of the heart's electrical pathway
A slow beat
An irregular rhythm

If you have a slow and often irregular heartbeat — or if your heartbeat is sometimes normal and sometimes too fast or too slow — blood isn't pumped around your body well. In that case your doctor may recommend an artificial pacemaker. A pacemaker will make your heart beat more regularly. That will help ensure that enough oxygen and nourishment gets to your body's cells. An artificial pacemaker system has two parts: a generator and wires (leads).

The pacemaker generator is a small battery-powered unit. It produces the electrical impulses that start your heartbeat. The generator is implanted under your skin through a small incision. The generator is connected to your heart through tiny wires that are implanted at the same time. The impulses flow through these leads to your heart and are timed to flow at regular intervals just as impulses from your heart's natural pacemaker would.

Modern pacemakers last much longer than earlier models. As with any electronic device, your artificial pacemaker will require some care. The batteries, for example, will wear down over time and the pacemaker will need to be replaced. This is a minor surgical procedure. Your healthcare provider can explain it to you.


	Pat Meadows, Patient Tech

Most pacemakers work only when they're needed. They're called demand pacemakers. Demand pacemakers have a sensing device that shuts them off if the heartbeat is above a certain rate. When the heart is beating slower than the pacemaker rate, the sensing device turns the pacemaker on again. In this way, a demand pacemaker works something like a thermostat. The difference is that instead of working according to temperature, it works according to your heart rate.

As the batteries wear down, your pacemaker will slow down, but it won't stop right away. Using a special analyzer, your doctor can detect the first warning that the batteries are running down. This can be done before you can detect any changes yourself. A sudden, major slowing down of your heart rate, which you may detect, probably indicates a more serious problem. If that occurs, call your doctor.