Consequences and treatment after pacemaker insertion

According to medical statistics, in 3-5% of cases negative consequences occur after the installation of an ECS.

Despite the fact that pacemaker implantation is performed under X-ray control, there is a risk of developing early surgical complications:

• Internal bleeding.
• Infectious processes in the area of the surgical wound.
• Damage to the tightness of the pleural cavity.
• Thromboembolism.
• Electrode displacement.
• Device insulation failure.

In some cases, late complications develop. Patients experience the so-called ECS syndrome. Frequent headaches and dizziness appear, loss of consciousness, shortness of breath and a sharp drop in blood pressure are possible. The implant can cause tachycardia. There is also a risk of malfunction of the device and its premature failure.

The appearance of any of the above symptoms is a reason for immediate medical attention. A cardiologist examines the patient and prescribes treatment methods for the pathological condition. The patient is then placed on a dispensary register with mandatory scheduled check-ups every 3-4 months.

Arrhythmia

A pathological disturbance of the rhythm, frequency and sequence of contraction/excitation of the heart muscle is arrhythmia. After the installation of an artificial pacemaker, it most often occurs due to the high sensitivity of the device.

To eliminate the unpleasant symptom, you should consult a cardiologist. The doctor will reprogram the device and adjust its functions. Changing the stimulation parameters will help restore the physiological heart rhythm.

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Heart pain after pacemaker installation

Many patients mistakenly perceive the appearance of discomfort and painful sensations in the chest after pacemaker implantation as heart problems. In this case, to exclude serious pathologies, it is necessary to contact a number of specialists: a cardiologist, a neurologist, a psychotherapist.

Emergency medical care is necessary if heart pain after the installation of a pacemaker occurs with the following symptoms:

• Frequent hiccups.
• Fainting and dizziness.
• Feeling electrical discharges from the implant.
• A sharp drop in pulse rate below the level set by the pacemaker.
• Swelling and inflammation of the tissues around the scar.
• Sound signals of the device.
• Increased heart rate and muscle twitching in the area of the device.

Squeezing sensations in the chest (exertional angina) are most often associated with the following factors:

• Overfatigue and increased physical activity.
• Changes in muscle tone.
• Problems with pacemaker settings or electrodes.
• Neurological disorders.
• Osteochondrosis.

If pain occurs several months or years after surgery, then first of all it is necessary to exclude intercostal neuralgia of the thoracic spine. This pathology is characterized by severe pain and attacks of difficulty breathing with stabbing sensations when inhaling.

To exclude the above reasons and establish the true factors of the disorder, you should consult a cardiologist. The doctor will conduct diagnostics of the cardiovascular system and spine, since some diseases of the back can radiate to the chest area. The pacemaker and its settings are also subject to verification.

High pressure

The pressure returns to normal after the pacemaker is installed, i.e. its increase is not related to the implanted device and is physiological in nature. In this case, complex drug therapy with diuretics, calcium antagonists and other drugs is carried out to restore the pressure.

The artificial pacemaker does not affect blood pressure in any way. The main task of the device is to generate impulses for normal heart contraction. At the same time, many patients who suffered from hypertensive crises before the operation note the normalization of the painful condition.

The normal pressure in the presence of an ECS is considered to be 110-120 to 70-90. Indicators higher or lower than the norm require diagnosis and, if necessary, treatment. To correct high blood pressure, patients are prescribed antihypertensive drugs. If necessary, antidepressants and sedatives are prescribed.

Extrasystole with a pacemaker

One of the types of heart rhythm disorders with premature ventricular contractions is extrasystole. With an implantable artificial pacemaker, it does not occur often. The painful condition is manifested by the following symptoms:

• A feeling of a malfunction in the heart.
• Increased weakness.
• Respiratory failure.
• Dizziness.
• Angina pain.

To eliminate signs of ventricular extrasystoles, it is recommended to change the pacemaker mode towards increasing the stimulation frequency. In other cases, patients are prescribed antiarrhythmic drugs, sedatives and ß-blockers. Diagnostics using ECG and Holter monitoring are mandatory.

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Pain in the arm

Some patients who have undergone surgery to install a medical device to maintain heart rhythm report pain in the arm. The discomfort is manifested by a feeling of aching, loss of sensitivity and slight swelling. In this case, unpleasant symptoms occur in the limb near which the pacemaker is installed.

• The most common cause of pain is side effects and allergic reactions to medications prescribed in the postoperative period.
• Discomfort may be associated with circulatory disorders in the vessels of the limb, osteochondrosis, arthritis, and scapulohumeral periarthritis.
• The arm may hurt due to prolonged immobilization. In medicine, such pains are called contractures. Unpleasant sensations occur in the first period after surgery, and also if any movements of the arm where the pacemaker is implanted are avoided for 1-2 months. As the limb develops, the pain goes away.
• Pain occurs when the implant is located close to the nerve endings, as well as when the pacemaker bed is inflamed.
• Another possible cause of pain is a medical error. This may be damage to the vein when inserting the electrodes or infectious complications. In the first case, thrombophlebitis develops, the limb is hyperemic and painful, and increases in size relative to the healthy one.

In order to determine what caused the pain and eliminate it, you should consult a cardiologist or surgeon and undergo a series of diagnostic tests.

Swelling of the legs

Heart failure is one of the common causes of lower limb edema. Heart problems cause a disruption in the removal of fluid from the body, which leads to its accumulation in different parts of the body. The pathological condition is called anasarca and requires serious treatment.

The appearance of edema after implantation of an artificial pacemaker is possible in the first months after surgery. As healthy stimulation is restored, excess fluid ceases to be retained in the body and is excreted physiologically.

If the swelling is systematic, spreads to other parts of the body and goes away over a long period of time, this may indicate kidney pathologies. In this case, the patient is prescribed drug therapy, which will help get rid of the swelling and prevent its further development.

Cough with pacemaker

Coughing fits after pacemaker installation can occur due to various reasons, let's look at the main ones:

• Side effects of the drugs used. In addition to coughing, shortness of breath, increased sweating, paresthesia of the extremities, dryness and peeling of the skin appear.
• Cardiac or respiratory pathologies. In this case, coughing urges occur against the background of chest pain, shortness of breath, rapid heartbeat and elevated temperature.
• If the pacemaker was implanted after coronary heart disease or a heart attack, then coughing may be a symptom of pulmonary embolism.

In order to determine what really caused the cough, you should undergo a medical examination with a comprehensive diagnosis of the heart muscle and lungs.

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Medications after pacemaker installation

To speed up the recovery process after pacemaker implantation and reduce the risk of complications during the device's survival, drug therapy is indicated. Let's consider the main groups of drugs that are prescribed after the pacemaker is installed.

To thin the blood - drugs reduce the risk of blood clots (thrombi) that clog veins and blood vessels.

• Aspirin-cardio

Belongs to the pharmacological group of NSAIDs, inhibits the production of inflammatory hormones, relieves pain, slows down the processes of platelet aggregation and adhesion.

• Indications for use: risk of excessive thrombus formation, prevention of ischemic heart disease, unstable angina, myocardial infarction, stroke, recent heart or vascular surgery. Transient cerebrovascular accidents, ischemic heart disease, pulmonary infarction, thrombophlebitis, pulmonary embolism.
• Method of administration: orally, with liquid. The dosage and duration of treatment is determined by the attending physician, individually for each patient.
• Side effects: pain in the epigastric region, bloating, spasms, peptic ulcer, pancreatitis, loss of appetite. Skin allergic reactions, dizziness and headaches, decreased renal excretion, bronchospasms.
• Contraindications: hypersensitivity to the components of the drug, aspirin asthma and triad, ulcerative lesions of the gastrointestinal tract, liver cirrhosis, pregnancy and lactation.
• Overdose: dyspeptic disorders and headaches, impaired consciousness, vomiting. Treatment is symptomatic with gastric lavage and intake of sorbents.

Aspirin-cardio is available in the form of oral tablets with an enteric coating in dosages of 100 and 300 mg.

• Cardiomagnyl

A medicinal product with a combined composition. Contains acetylsalicylic acid and magnesium hydroxide. Has analgesic, anti-inflammatory and antipyretic properties. Reduces the risk of blood clots.

• Indications for use: acute or chronic ischemic heart disease, prevention of thrombus formation and cardiovascular diseases. Arterial hypertension, hypercholesterolemia.
• Method of administration: orally 150 mg per day. Maintenance dose – 1 tablet per day. The course of treatment is determined by the attending physician, individually for each patient.
• Side effects: increased risk of bleeding, decreased platelet aggregation, neutropenia, hypoglycemia, headaches, insomnia, tinnitus, heartburn, nausea and vomiting.
• Contraindications: individual intolerance to the components of the drug, risk of bronchospasm, tendency to bleeding, in the first days after surgery. The drug is prohibited in the third trimester of pregnancy.
• Overdose: headaches and dizziness, decreased hearing and vision, increased sweating, nausea and vomiting, respiratory collapse.

Cardiomagnyl is available as enteric-coated tablets for oral administration.

• Thrombo ASS

An antiplatelet drug with the active component acetylsalicylic acid. Belongs to the pharmacological group of NSAIDs. Has anti-inflammatory and analgesic properties.

• Indications for use: treatment and prevention of cardiovascular diseases, complex treatment for unstable angina, prevention of myocardial infarction, secondary prevention of infarction and stroke. Prevention of pulmonary embolism, cerebral circulatory disorders.
• Directions for use: Take the tablets orally with water. Do not crush, swallow or break the capsules. The daily dosage is 50-100 mg, the course of treatment is determined by the attending physician.
• Side effects: nausea, vomiting, heartburn, painful sensations in the epigastric region, ulcerative lesions of the gastric mucosa and duodenum. Headaches, dizziness, tinnitus, allergic reactions are also possible.
• Contraindications: hypersensitivity to the components of the drug, erosive and ulcerative lesions of the gastrointestinal tract, bronchial asthma, pediatric patients, hemorrhagic diathesis. Use during pregnancy is not recommended.
• Overdose: tinnitus, headaches and dizziness, upset stomach. Treatment is symptomatic with mandatory dosage adjustment.

The drug is available in the form of enteric-coated tablets.

• Lospirin

A medicinal product that has an antiaggregatory effect on platelets. Normalizes blood rheological factors. Reduces the risk of myocardial infarction.

The drug contains an active component - acetylsalicylic acid. It does not belong to selective cyclooxygenase inhibitors, it reduces the production of gastroprotective prostaglandins.

• Indications for use: prevention of myocardial infarction in angina pectoris, secondary prevention of infarction. Prevention of embolism and thrombosis, cerebral blood flow disorders of the ischemic type.
• Method of administration: orally after meals, with a sufficient amount of liquid. Tablets must not be chewed or broken. The dosage depends on the indications for use, on average it is 75-300 mg per day.
• Side effects: bowel disorder, nausea and vomiting, iron deficiency anemia, thrombocytopenia, allergic reactions.
• Contraindications: intolerance to salicylates and components of the drug. Blood coagulation pathologies, hemophilia, thrombocytopenia, bronchial asthma, liver disease, pediatric practice. Use during pregnancy is possible only for vital indications.
• Overdose: hearing and vision impairment, confusion, increased body temperature, vomiting, dizziness. Treatment is symptomatic.

Lospirin is available in tablet form, 10 capsules per blister, 3 blisters per package.

For the prevention of atrial fibrillation and stroke.

• Propanorm

Antiarrhythmic drug for the treatment of supraventricular and ventricular heart rhythm disorders. Blocks slow calcium channels of cardiomyocytes.

• Indications for use: prevention of attacks of ventricular and atrial arrhythmia. Ventricular extrasystoles, Clerk syndrome and WPW syndrome, ventricular tachycardia.
• The method of application and dosage are determined by the attending physician, individually for each patient. On average, the drug is taken 450-600 mg per day.
• Side effects: dyspeptic disorders, headaches and dizziness, sleep disturbances, decreased visual acuity. Allergic reactions, blood rheology towards increased bleeding are also possible. Overdose has similar signs. Treatment consists of detoxification measures followed by symptomatic therapy.
• Contraindications: hypersensitivity to the components of the drug, uncontrolled heart failure, intoxication with cardiac glycosides, cardiogenic shock. It is used with special caution in arterial hypotension and bradycardia. Use during pregnancy and lactation is prohibited.

Propanorm is available in tablet form for oral administration.

• Cordarone

Antiarrhythmic drug of class III with antianginal and antiarrhythmic properties.

• Indications for use: paroxysmal tachycardia, ventricular/supraventricular paroxysmal tachycardia, atrial fibrillation and atrial flutter. Prevention of the above conditions.
• The method of administration depends on the form of the drug. Tablets are taken at 600-800 mg per day, gradually increasing the total dosage to 10 g. The duration of treatment is individual for each patient.
• Side effects: lipofuscin deposition in the corneal epithelium, dermatological reactions, respiratory failure, neutropatheia, limb tremor, bradycardia, arterial hypotension. Overdose has similar symptoms.
• Contraindications: intolerance to the components of the drug, sick sinus syndrome, impaired atrioventricular and intraventricular conduction, absence of a pacemaker. Thyroid dysfunction, pregnancy and lactation, patients under 18 years of age.

Cordarone is available in the form of tablets and a solution for intravenous injection.

• Xarelto

Contains the active ingredient – rivaroxaban from the group of factor Xa inhibitors with a high bioavailability when taken orally.

• Indications for use: reducing the risk of stroke, atrial pathology, non-valvular arrhythmia, deep vein thrombosis, pulmonary artery occlusion, long-term immobilization, prosthetics.
• Method of administration: parenterally during meals or 20 minutes before them. Daily dosage is 20 mg, for primary pathologies 15 mg. The course of treatment for thromboembolism and thrombosis is 21 days. In other cases, the duration of therapy is determined by the attending physician.
• Side effects: arterial hypotension, anemia, tachycardia, bleeding, dyspeptic disorders, liver and kidney dysfunction, allergic skin reactions.
• Contraindications: heavy bleeding and predisposition to it, liver and kidney diseases, lactase deficiency, patients under 18 years of age. The drug is prohibited during pregnancy and lactation.
• Overdose: bleeding, allergic reactions, renal dysfunction. Treatment is symptomatic with drug withdrawal.

Release form: enteric-coated tablets of 2.5, 10, 15 or 20 mg of active ingredient.

• Accupro

An antihypertensive drug with the active component quinapril hydrochloride. It inhibits the activity of angiotensin-converting enzyme, activates depressor systems that implement the vasodilatory effect.

• Indications for use: heart failure, persistent increase in blood pressure.
• Method of administration: orally 100 mg 1-2 times a day, if necessary, the dosage can be doubled. The maximum single dose is 200 mg, and the daily dose is 400 mg. The course of treatment is determined by the doctor.
• Side effects: headaches and dizziness, a sharp drop in blood pressure when moving from a horizontal to a vertical position, exacerbation of ischemia, tinnitus, coughing fits, nausea, allergic reactions.
• Contraindications: intolerance to the components of the drug, predisposition to edema, narrowing of the renal arteries and aorta, narrowing of the mitral valve, pregnancy and lactation, patients under 14 years of age.

Accupro is available in tablet form in dosages of 50, 100 and 200 mg.

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Anticoagulants and antiplatelet drugs – reduce the risk of blood clots and are prescribed for atrial fibrillation.

• Quinidine

It is used to prevent and relieve attacks of atrial fibrillation, paroxysmal supraventricular tachycardia, extrasystole, ventricular tachycardia and other heart rhythm disorders. The medicine is taken 1 tablet 2-3 times a day. The optimal dosage is selected by the attending physician.

The drug is contraindicated in case of intolerance to its components, cardiac decompensation, during pregnancy and lactation. Side effects include suppression of cardiac activity, attacks of nausea and vomiting, diarrhea, allergic reactions. In particularly severe cases, atrial fibrillation is possible. Quinidine is available only in tablet form.

• Novocainamide

Reduces the excitability of the heart muscle, suppressing ectopic excitation foci. Used for various heart rhythm disorders. The dosage and course of treatment are determined by the attending physician.

The medication may cause the following side effects: a sharp decrease in blood pressure, nausea, headaches and sleep disturbances, general weakness. The drug is contraindicated in severe heart failure, hypersensitivity to the components of the drug and cardiac conduction disorders.

Novocainamide is available in several forms: tablets for oral administration of 250 and 500 mg, ampoules of 5 ml of 10% solution for intravenous administration.

• Disopyramide

An antiarrhythmic drug from the category of class IA antiarrhythmics. Reduces heart rate, lowers systolic blood pressure. It is used for atrial and ventricular extrasystoles, heart rhythm disorders. The method of administration and dosage are determined by the attending physician. The drug is available in capsules of 100 mg and as a 1% solution in ampoules for injection of 5 ml.

• Aymalin

Antiarrhythmic agent. Used to treat and prevent the following conditions:

• Atrial and ventricular extrasystole.
• Paroxysmal tachycardia.
• Arrhythmias caused by digitalis intoxication.
• Acute myocardial infarction.

The drug is administered intramuscularly and intravenously at 2 ml of a 2.5% solution diluted in 10 ml of isotonic sodium chloride solution or 5% glucose solution.

Side effects include increased weakness, nausea and vomiting. It is also possible to have a decrease in blood pressure, allergic reactions and a feeling of heat at the injection site.

Aymaline is contraindicated in severe disorders of the cardiac conduction system, severe heart failure, hypotension and inflammatory changes in the heart muscle.

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Beta-adrenergic blockers are used for sinus bradycardia and high heart rate associated with pacemaker insertion.

• Propranolol

Non-selective beta-blocker. Reduces the strength and frequency of heart contractions. Reduces myocardial contractility and cardiac output, reducing myocardial oxygen demand. Restores blood pressure and increases bronchial tone. Reduces the risk of bleeding in the postoperative period.

It is used for ischemic heart disease, heart rhythm disorders, some forms of ischemic heart disease and sinus tachycardia.

• Oxprenolol

Non-selective beta-blocker with sympathomimetic activity. Has anti-ischemic, antiarrhythmic and blood pressure-lowering properties. Used for arterial hypertension, angina attacks. Reduces the risk of myocardial infarction. Stops functional cardiovascular disorders caused by overexcitation of the sympathetic nervous system.

• Pindolol

Non-cardioselective beta-blocker with blood pressure-lowering properties. It is used for hypertension and hypertensive crisis. The drug is started with a dosage of 5 mg 2-3 times a day, gradually increasing the dose to 45 mg per day. For intravenous administration, 2 ml of a 0.02% solution is used with constant monitoring of blood pressure.

• Alprenolol

A non-selective beta-blocker of long action, does not have a pronounced effect on heart contractions. It is used for angina pectoris, atrial and ventricular extrasystole, heart rhythm disturbances due to cardiac glycosides, as well as for persistent increase in blood pressure. The drug is taken 50 mg 3-4 times a day, the duration of treatment depends on the effectiveness in the first days of therapy.

In addition to the above-mentioned drugs, patients may be prescribed antibiotics, painkillers, anti-inflammatory drugs and other medications in the postoperative period. As for the possibility of further drug therapy with a pacemaker, there are no restrictions. The device allows you to take any medication, but only as prescribed by a doctor.

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