17173 Lifevest

Overview

A wearable defibrillator is a special vest you wear under your clothes that keeps a constant watch on your heart rhythm. It has sensors that touch your skin and a small monitor you wear on a belt or shoulder strap. If your heart goes into a dangerous rhythm (an electrical problem that stops the heart pumping properly), the vest can warn you and then give a controlled shock to reset the heart. Doctors sometimes call this a 'wearable cardioverter defibrillator' or WCD. LifeVest is one well-known brand name for this type of device. It is meant to protect you for a period of time, not forever — for example while you wait for a permanent implanted device, or while doctors see whether your heart function improves.

It is not common. Only a small number of people are offered a wearable defibrillator each year, usually because their heart is weak for a while and their risk of a dangerous rhythm is higher than usual. Many hospitals now use them, so your care team will be familiar with how they work.

It is mostly used for adults whose heart pump is weaker than normal (doctors call this a low ejection fraction — a measure of how much blood the heart squeezes out with each beat), people recovering after a heart attack, people with certain heart muscle conditions, and people waiting for a permanent implanted defibrillator or a heart procedure. It is used far less often in children and only with specialist advice.

Symptoms

Common symptoms

• There are no symptoms from the vest itself. The symptoms that matter are the ones caused by your underlying heart condition.
• Palpitations — a feeling that your heart is racing, fluttering or skipping beats
• Feeling dizzy, light-headed or faint
• Shortness of breath, especially with activity or lying flat
• Unusual tiredness or low energy
• Chest discomfort or pressure
• Swelling in the ankles, feet or legs (a sign your heart is struggling to pump)
• The vest may also sound a warning alarm if it senses a problem — this does not always mean something is wrong, but it should be checked

Symptoms in children

• Wearable defibrillators are used only rarely in children, and always with a specialist heart team.
• Children may find the vest bulky or uncomfortable, and may need extra help from parents or carers to wear it consistently.
• A child with a weak heart may show poor feeding, slow growth, or getting tired quickly when playing
• Children may not be able to describe palpitations, so watch for sudden changes in energy, colour, or activity level

Symptoms in older adults

• Older adults are more likely to have a weak heart and to be offered a wearable defibrillator
• Skin irritation or sores under the sensors are more common in older, thinner skin
• Confusion or memory problems can make it harder to wear the vest properly or to charge batteries
• A fall or dizzy spell is more likely to cause injury, so it is worth talking to your team about home safety
• Family or carers may need to learn how the alarms work and what to do

Causes

Main causes

• A weak heart pump (low ejection fraction) — the heart squeezes less strongly than it should
• Recent heart attack, while the heart is healing
• Heart muscle conditions such as cardiomyopathy (a disease of the heart muscle)
• Waiting for, or recovering from, a permanent implanted defibrillator or heart procedure
• Inherited heart rhythm conditions that can cause dangerous rhythms
• A previous cardiac arrest or dangerous heart rhythm with no clear explanation yet

Risk factors

• Coronary heart disease or a previous heart attack
• Heart failure or a heart that pumps weakly
• A family history of sudden cardiac death or inherited heart rhythm problems
• Diabetes, high blood pressure and high cholesterol, which damage the heart over time
• Smoking and heavy alcohol use
• Some medicines that can affect heart rhythm (your doctor will check this)

When to see a doctor

See a doctor urgently if:

• You have received a shock from the vest
• The vest alarms repeatedly and you cannot work out why
• New fainting, near-fainting, chest pain or breathlessness
• Skin breakdown, blistering or infection under the sensors
• The device seems damaged, or you cannot wear it as instructed

Book a routine appointment if:

• Your skin is itchy or slightly red where the sensors sit
• You find the vest uncomfortable, heavy or hard to sleep in
• You are struggling to remember to charge the battery or to wear the vest as much as advised
• You feel anxious or low about wearing the device
• You are planning travel, exercise or a return to work and want advice
• You have questions about how the alarms work or what your family should do

Diagnosis

The wearable defibrillator is not a diagnosis in itself — it is a treatment your heart team recommends after assessing your heart. They will look at how well your heart pumps, whether your heart rhythm is stable, and your overall risk of a dangerous rhythm. That usually means a heart tracing (ECG), a heart ultrasound scan (echocardiogram — a painless scan that shows the heart beating), and blood tests. Your doctor will then explain why a temporary device is right for you, how long you may need it, and what the alternatives are.

Tests that may be done

• ECG (electrocardiogram) — a quick, painless recording of the heart's electrical signals
• Echocardiogram — an ultrasound scan that shows the heart's size, valves and how strongly it pumps
• Blood tests to check heart strain, kidney function, salts and other causes of rhythm problems
• Holter or ambulatory monitor — a portable recorder worn for a day or more to catch irregular rhythms
• Cardiac MRI or other imaging in some cases, to look closely at the heart muscle
• A fitting session where the vest is sized, set up and tested, and you and your family are taught how to use it

What to expect at your appointment

You will normally be fitted with the vest in hospital or at a clinic. A specialist will measure you, place the sensors, set up the monitor, and show you how to charge the battery and what the alarms mean. You will practise what to do if a shock is about to be given — usually you press a button to stop it if you are awake and well. You will also be shown how to take the vest off for washing and put it back on. Your team will check your skin and the device's recordings at follow-up visits, and the device sends information to your care team automatically in many cases.

Treatment

The wearable defibrillator is a temporary safety net, not a cure. While you wear it, your medical team works on the underlying heart problem — for example, improving heart function with medicines, opening blocked arteries, or planning a permanent implanted device. The aim is to protect you during the period when your risk is highest, and to remove the vest once your heart is stronger or a long-term plan is in place.

Self-care at home

• Wear the vest as advised — usually all day and night, taking it off only to wash, shower or bathe
• Keep the battery charged and carry a spare charged battery when you go out
• Check the sensors each day and change the sensor pads as your team instructs, to protect your skin
• Keep the skin clean and dry, and check for redness or soreness
• Tell the people you live with how the vest works, what the alarms sound like, and what to do if you collapse
• Carry your device information card and your care team's contact details
• Follow your heart-healthy plan: take medicines as prescribed, keep active within your limits, and avoid smoking
• Follow any driving advice your team gives you — rules vary and depend on your heart condition

Medical treatments

Treatment is two things at once: protection from dangerous rhythms and treatment of the underlying heart condition. Protection comes from the wearable device itself, which monitors your rhythm and can give a shock if needed. Treatment of the heart may include medicines to strengthen the heart's pumping, lower blood pressure, or control rhythm; treatment of blocked arteries; and, in some cases, a permanent implanted defibrillator or another device. Your team will review your heart function regularly to decide when the vest is no longer needed. Always ask your doctor or pharmacist about your own medicines rather than changing anything yourself.

When is surgery considered?

Surgery is not needed to use the vest. However, some people wear a wearable defibrillator while waiting for a procedure — most often implantation of a permanent defibrillator (a small device placed under the skin of the chest), or sometimes heart surgery such as bypass surgery. Your team will explain the timing and what to expect.

Living with this condition

At first the vest can feel bulky and strange, and the alarms can be startling. Most people adjust within a few weeks. You take it off for washing, showering or bathing, and put it back on straight afterwards. The monitor needs charging daily, so it helps to build this into a routine — for example, charging it while you eat breakfast. Avoid swimming, and keep the monitor and battery dry. Tell your family, housemates or carers what to do: if you collapse, they should call emergency services and start CPR, and should not touch the vest while it is delivering a shock warning.

Lifestyle tips

• Keep wearing the vest during light activity and sleep — the risk of a dangerous rhythm does not stop at night
• Avoid swimming, hot tubs and other activities where the device could get soaked
• Plan travel in advance: carry spare batteries and sensor pads, and ask your team for a letter about the device for airports
• Keep follow-up appointments and device checks
• Avoid smoking and limit alcohol, as both put extra strain on the heart
• Ask your team about driving, work and exercise — advice depends on your heart condition and your country's rules

Diet and exercise

A heart-healthy eating pattern helps your heart recover: plenty of vegetables, fruit, wholegrains, beans and fish, less salt, and fewer processed and fried foods. Your team may suggest limiting salty foods if you have heart failure. Gentle, regular activity — such as short walks — is usually encouraged and helps you rebuild strength, but build up slowly and stop if you feel chest pain, breathlessness or dizziness. Ask your team what level of exercise is safe for you, and whether a cardiac rehabilitation programme is available.

Mental health and emotional wellbeing

It is very normal to feel anxious, low or worried about wearing a device that can shock you. Some people feel self-conscious about how it looks, or find it hard to sleep at first. These feelings usually ease with time and support, but they can be heavy — please tell your care team if you feel this way, as help is available, including talking therapies. If you ever feel unsafe or have thoughts of harming yourself, contact your local crisis or mental health support service or your local emergency number straight away.

Prevention

You cannot 'catch' a heart rhythm problem, so prevention means looking after your heart over the long term. That includes treating high blood pressure, high cholesterol and diabetes, not smoking, keeping active, eating well, staying at a healthy weight, and limiting alcohol. If you have a family history of sudden cardiac death at a young age, tell your doctor — they may suggest screening for relatives.

Screening programmes

There is no general screening programme for wearable defibrillators — they are prescribed after a heart assessment. However, if you have a strong family history of sudden cardiac death or an inherited heart condition, your doctor may arrange heart checks for you and your relatives. Regular blood pressure, cholesterol and diabetes checks are a good way to protect your heart.

Complications

If left untreated

• Without protection, a dangerous heart rhythm can cause sudden cardiac arrest — the heart stops pumping and the person collapses
• Sudden cardiac arrest needs immediate CPR and an emergency call; the wearable device is designed to act in exactly this situation
• Ongoing untreated heart failure can cause worsening breathlessness, swelling and reduced quality of life
• Not wearing the device as advised removes the protection it is meant to give

Long-term outlook

For most people, a wearable defibrillator is a short chapter in a longer recovery. It gives your heart time to heal or your team time to plan the right long-term treatment. Many people go on to have their heart function improve, or to receive a permanent device, and return to a normal life. Wearing the vest as advised, keeping in touch with your care team, and looking after your heart give you the best chance of a good outcome.

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