Preparing for pacemaker

Overview

A pacemaker is a small device placed under the skin near your collarbone to help your heart beat at a steady, normal rhythm. It sends tiny electrical signals to your heart when it beats too slowly.

Yes, pacemakers are a common treatment. Hundreds of thousands of people worldwide have them, and they improve quality of life for many.

A pacemaker is used for people whose heart beats too slowly (bradycardia) or has an irregular rhythm. This can happen at any age, but is more common in older adults.

Symptoms

Common symptoms

• Feeling dizzy or lightheaded
• Fainting or near fainting
• Fatigue or feeling very tired
• Shortness of breath, especially with activity
• Chest pain or discomfort
• Heart palpitations (feeling like your heart is skipping, fluttering, or pounding)

Symptoms in children

• Poor feeding or slow growth
• Unusual tiredness or lack of energy for play
• Fainting or near fainting during activity
• Breathing that seems fast or hard

Symptoms in older adults

• Fainting or falls without warning
• Confusion or forgetfulness that comes and goes
• Feeling extremely weak or tired
• Shortness of breath with mild activity

Causes

Main causes

• The heart's natural pacemaker (the sinus node) does not send signals fast enough, causing a slow heart rate (bradycardia).
• The electrical signals in the heart are blocked (heart block), preventing the heart from beating regularly.
• Certain heart conditions, such as cardiomyopathy (weakened heart muscle), can affect the heart's electrical system.
• Some medications for other conditions can slow the heart too much.

Risk factors

• Growing older (over 65)
• Past heart attack or heart surgery
• Heart disease, including coronary artery disease or heart failure
• Taking medications that slow the heart rate
• Infections affecting the heart, such as Lyme disease or rheumatic fever
• Family history of heart rhythm problems

When to see a doctor

See a doctor urgently if:

• You faint (pass out) and it is not a one-time thing
• You have chest pain that does not go away with rest
• You feel your heart racing or skipping beats many times in a row

Book a routine appointment if:

• You feel tired or short of breath during daily activities
• You often feel dizzy or lightheaded
• You notice your pulse is very slow (under 50 beats per minute) and you have symptoms
• You are worried about your heart rhythm after being told you might need a pacemaker

Diagnosis

To see if you need a pacemaker, your doctor will check your heart's electrical activity with a simple, painless test called an electrocardiogram (ECG). You might also wear a small monitor for 24 hours or longer to record your heart's rhythm during daily life.

Tests that may be done

• Electrocardiogram (ECG) – stickers on your chest record your heart's electrical signals
• Holter monitor – a portable ECG you wear for 24 to 48 hours
• Event recorder – a device you press when you feel symptoms to record your heart rhythm
• Echocardiogram – an ultrasound of your heart to check its structure and function
• Blood tests – to check for other causes of slow heart rhythm

What to expect at your appointment

Your doctor will review your test results and talk with you about whether a pacemaker is right for you. If it is, you will have a preoperative appointment where you learn how to prepare, including what to eat, what medicines to take, and what to bring to the hospital.

Treatment

For a slow or irregular heart rhythm that causes symptoms, a pacemaker is the most common treatment. The device is implanted in a minor surgery. You will be awake but given medicine to relax. The doctor makes a small cut near your collarbone, guides one or more thin wires into a heart vein, and connects them to the pacemaker. The cut is closed with stitches or glue. Recovery is usually quick.

Self-care at home

• Follow your doctor's instructions about showering and keeping the incision clean and dry for the first few days.
• Avoid lifting heavy objects or raising your arm above shoulder level on the side of the pacemaker for about 6 weeks.
• Wear a loose shirt those first weeks to avoid rubbing the incision.
• Take pain relief as advised – usually paracetamol (acetaminophen) is enough. Check with your doctor before taking any other medicines.
• Call your doctor if you notice swelling, redness, fever, or the incision opens up.

Medical treatments

Before and during the pacemaker procedure, you may receive medicine to prevent infection (given through a vein). After the device is implanted, your doctor may adjust your other heart medicines to work well with the pacemaker. The pacemaker itself is programmed to keep your heart rate within a healthy range. You will have regular check-ups where the device is tested and its battery checked.

When is surgery considered?

Pacemaker implantation is considered minor surgery. Most people go home the next day. The procedure itself takes about 1–2 hours. You will be awake but given a sedative to help you relax, and the area will be numbed.

Living with this condition

After you heal, you can usually return to most normal activities, including work, hobbies, and travel. You will need to avoid strong magnetic fields (like MRI machines, large industrial equipment) and keep your pacemaker away from certain electronics (like strong magnets close to your chest). Your doctor will give you a card to carry that says you have a pacemaker.

Lifestyle tips

• Avoid contact sports or activities that could hit your chest directly for the first month.
• Do not lift heavy objects (over 10 pounds) with the arm on the pacemaker side for 6 weeks.
• Keep your mobile phone at least 15 cm (6 inches) away from your pacemaker – use the ear on the opposite side.
• Avoid putting headphones or earbuds directly over your pacemaker.
• Tell any doctor, dentist, or healthcare worker you have a pacemaker before procedures.

Diet and exercise

You can eat a normal, healthy diet. There are no special dietary restrictions. Light walking is encouraged soon after surgery to prevent blood clots. Wait until your doctor says it is safe to return to running, swimming, or other exercise. Most people can do all activities within 4 to 6 weeks.

Mental health and emotional wellbeing

It is normal to feel anxious or worried about having a device inside you. Many people feel better once they see how much their symptoms improve. If you feel sad, anxious, or have trouble sleeping, talk to your doctor. They can help connect you with a mental health professional.

Prevention

Many conditions that lead to needing a pacemaker, such as aging or heart disease, cannot be fully prevented. However, you can reduce your risk of heart problems by staying active, eating a balanced diet, not smoking, and managing blood pressure and diabetes. Talk to your doctor about your heart health.

Vaccines

Not directly related. But staying up to date on vaccines (like flu and pneumonia) can help prevent infections that might affect your heart.

Screening programmes

If you have symptoms like fainting or a very slow pulse, see your doctor. Regular check-ups can catch heart rhythm problems early. There is no routine screening for the general public.

Complications

If left untreated

• If a slow heart rhythm is not treated, it can lead to fainting and falls, which may cause injury.
• It can cause chronic fatigue, making everyday tasks very hard.
• In severe cases, it can lead to heart failure or sudden cardiac arrest (the heart stops beating effectively).

Long-term outlook

With a pacemaker, most people feel much better. Symptoms like dizziness, fainting, and extreme tiredness often go away. The device is reliable and safe. You can expect to live a normal, active life. Your doctor will check your pacemaker regularly to make sure it is working well. For the vast majority, the benefits far outweigh the risks.

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