Life with a pacemaker: what can and cannot be done?

In the first period after the pacemaker is installed, the patient's life changes significantly. This is due to certain restrictions and a long rehabilitation period. Let's consider what you will have to face after the pacemaker implantation:

• Patients spend the entire first week after surgery in the hospital under medical supervision. This is necessary for monitoring the heart rate and postoperative wound care.
• If healing occurs without complications and the device operates as intended, the patient is discharged home. For further rehabilitation, the doctor opens a sick leave.
• During the first month after the operation, it is necessary to maintain moderate physical activity. Regular visits to a cardiologist are also recommended to assess the condition of the scar and the work of the pacemaker. If everything is normal, the next examination by a doctor should be in 3 months, then in six months and a year.

A pacemaker imposes restrictions on the use of electronic devices. It is not recommended to talk on a mobile phone for a long time, walk through a metal detector, or expose yourself to electromagnetic/magnetic radiation.

At the same time, many patients do not notice significant changes in their lifestyle after pacemaker implantation. Athletes can continue to play sports (after rehabilitation in 2-3 months), and all restrictions in work are reduced to minimizing exposure to radiation, which can disrupt the operation of the device. Regular examinations by a cardiologist, healthy nutrition and a positive psychological attitude are also added to the usual rhythm of life.

How to use a pacemaker?

Many patients who have had an artificial pacemaker installed wonder how to use it. So, first of all, it should be noted that all settings regarding the functioning of the device, that is, its stimulation, are made by the doctor during the operation.

The doctor selects the required operating mode and tests it. The patient cannot make any changes independently. The use of the pacemaker is limited to preserving it from mechanical trauma. The device does everything else automatically.

Restrictions

Medical devices for maintaining heart rhythm are maximally adapted to the conditions of modern life. There are few restrictions for patients with a pacemaker, but they must be followed.

Let's look at the main restrictions for owners of ECS:

• Be exposed to strong electromagnetic or magnetic fields.
• Conduct an ultrasound scan with the device beam directed at the body of the artificial pacemaker.
• Injure the chest area.
• Try to move or turn the body of the device under the skin.
• It is not recommended to be in the same room with a working microwave oven.
• Pass through metal detectors.
• Perform magnetic resonance imaging if the stimulator is not labeled MRI.
• Use physiotherapeutic treatment methods: magnetic therapy, microwave therapy.
• Stay in a bathhouse or sauna for a long time.

In addition to the above restrictions, the time spent using a mobile phone should be minimized. At the same time, patients can engage in physical exercise and sports, use a computer, perform X-ray examinations and computed tomography.

Pacemaker syndrome

A complex of psychological symptoms that arise due to the impact of negative hemodynamics or electrophysical factors of an artificial pacemaker on the body is pacemaker syndrome. This disorder occurs in 7-10% of cases and is associated with a decrease in cardiac output.

Symptoms of the syndrome:

• Congestive heart failure.
• Respiratory distress, shortness of breath.
• Reduction of blood pressure to critical values.
• Significant fluctuations in blood pressure throughout the day.
• Headaches.
• Fainting state.
• Decreased visual and hearing acuity.
• Cerebral circulatory disorder.
• Cardiomyopathy.
• Induced cardiac pacing with left ventricular dilation and decreased ejection fraction.

The appearance of a painful symptom is associated with many factors, but most often it is caused by the following reasons:

• Asynchrony of the atria and ventricles.
• Blood flow into the pulmonary and cava veins due to contraction of the atria with the tricuspid and mitral valves closed.
• Retrograde conduction of impulses to the atria.
• The pacemaker stimulation frequency does not correspond to the optimal heart rate.

To diagnose pacemaker syndrome, the patient undergoes daily monitoring of the heart and blood pressure using an ECG.

To eliminate the syndrome, it is necessary to change the cardiac stimulation mode, choosing a function that best matches the physiological work of the heart. The main frequency and frequency adaptation function are also changed. Drug therapy is mandatory.

Load with a pacemaker

One of the most common questions from patients who have had an implanted pacemaker is the possibility of exercise. The installation of a pacemaker involves significant restrictions on any activity in the first months after surgery. This is explained by the fact that the electrodes, like the body itself, must take root in the body.

During this period, active sports and weight lifting are contraindicated. Also prohibited are tight clothes that squeeze the body and can cause skin irritation at the site of attachment of the device or its electrodes.

In this case, it is strictly forbidden to specifically limit movements in the shoulder joint. Since prolonged immobilization can lead to the development of arthrosis and a number of other pathologies. Therapeutic gymnastics is recommended, which consists of smooth, slow movements. Returning to normal life and work takes about 2-3 months after surgery.

High heart rate with pacemaker

Implantation of an artificial pacemaker helps to normalize both slow and rapid pulses due to frequency adaptation. If the high pulse is within the normal range of the established pacemaker mode, this is not a cause for concern.

But if the heart rate does not change with increasing load, then you should consult a cardiologist. The doctor will reconfigure the device. Most often, this problem is faced by patients whose heart does not maintain its own rhythm.

Shortness of breath with a pacemaker

The occurrence of respiratory failure in patients with an artificial pacemaker is extremely rare. As a rule, patients note the disappearance of shortness of breath after the installation of a pacemaker.

Possible causes of shortness of breath:

• Incorrect stimulation mode.
• Heart disease and other body disorders.
• Neurological pathologies.
• Damage to the device electrodes.
• The pacemaker battery is discharged.
• Excessive physical activity.

If breathing problems occur a couple of months after the pacemaker was installed and persist, you should see a cardiologist. The doctor will conduct a comprehensive examination and determine the true cause of the unpleasant symptom.

[ 1 ], [ 2 ], [ 3 ]

How to behave after installing a pacemaker?

Implantation of an artificial pacemaker is a real test, both from a physiological and psychological point of view. After the operation, almost all patients ask themselves how to behave, what habits should be changed and how to build their future life.

The installation of a pacemaker imposes certain restrictions on previously familiar life, but they are not significant. The main recommendations for patients include:

• Medical examinations using electromagnetic radiation (MRI, diathermy, electrocoagulation, external defibrillation) may negatively affect the functioning of the device and are therefore prohibited.
• It is forbidden to be near sources of electric current or electromagnetic radiation. It is better to carry a mobile phone in a trouser pocket, not in a breast pocket.
• The chest should be protected from trauma to avoid damaging the pacemaker.
• Physical activity is permitted, as is any work that is not associated with electromagnetic radiation or an increased risk of injury.

Patients also need to change their diet towards healthy food. It would not be superfluous to take multivitamin complexes and dietary supplements to enhance the protective properties of the immune system.

What can't you do if you have a pacemaker?

After the installation of an artificial pacemaker, the patient faces a number of restrictions that must be followed in order not to harm the functioning of the pacemaker.

The category of prohibitions includes:

• Wearing a mobile phone or magnets near your chest.
• Being in the area of action of devices that generate electromagnetic waves: motion sensors, anti-theft detectors.
• Metal detector frames and full body scanners at airports and train stations.
• Magnetic resonance imaging and a number of other medical procedures.
• Work involving electric arc welding.
• Radiation treatment of cancer.
• Trauma to the chest or attempts to independently change the position of the implant.

Following the above recommendations does not cause any difficulties, but allows you to return to a full life without serious problems.

Is it possible with a pacemaker:

The presence of a medical device in the body to maintain the heart rhythm has a number of contraindications, both relative and absolute, which all patients must adhere to. Let's consider what is prohibited and what can be done with a pacemaker.

Take an x-ray

X-rays are an approved diagnostic method for patients with pacemakers. In addition, X-rays reveal displacement or breakage of the device electrodes.

It should also be noted that the pacemaker implantation surgery itself is performed under X-ray control. That is, X-rays, like fluorography, have no limitations when implanting into the heart.

[ 4 ], [ 5 ], [ 6 ], [ 7 ]

Do a massage

Very often, after the installation of a pacemaker, patients sign up for massage courses to keep their body in good shape. But it is not recommended to do massage with a pacemaker. The procedure is allowed if it is carried out away from the sternum and does not cause heart rhythm disturbances.

As for the use of shock techniques or electric massage instruments, this is prohibited. Massage techniques should be as gentle as possible. Also, before the procedure, you should consult with your doctor. The doctor will assess your general health and, if necessary, give you a referral for a massage or prescribe other, safer methods of exercise therapy.

Do an MRI

MRI involves the use of a magnetic field that affects electronic devices and can disable the implant. That is why magnetic resonance imaging is included in the list of contraindications for patients with a permanent pacemaker. If this examination is necessary, it is replaced by X-ray or computed tomography.

Many modern pacemaker models are MRI-compatible. That is, the devices do not fail when exposed to a magnetic field. In this case, before conducting diagnostics, the doctor must make sure that the pacemaker is set up correctly. After the examination, the settings are returned to normal.

[ 8 ], [ 9 ], [ 10 ]

Do a CT scan

The presence of a pacemaker is not a contraindication for CT scanning. Irradiation of the device does not affect the operation of the implant.

But before the procedure, you should warn the doctor about the presence of the device in the heart. This is necessary so that the doctor can adjust the dose of contrast enhancement and choose the best option for CT. In addition, ultrasound and CT are an alternative to MRI.

[ 11 ], [ 12 ], [ 13 ], [ 14 ]

Do an ultrasound

One of the most common diagnostic methods is ultrasound. Ultrasound is a non-invasive technique that allows you to obtain an image of the required organ in different projections.

An ultrasound scan can be performed with an artificial pacemaker if the device’s sensor does not pass over the area where the pacemaker is implanted.

[ 15 ], [ 16 ], [ 17 ], [ 18 ]

Wear a fitness bracelet

A long recovery period after pacemaker implantation involves the use of various devices to track physical activity. Wearing a fitness bracelet with a pacemaker is not only permitted, but also recommended by many rehabilitation specialists.

Fitness bracelets are absolutely safe, they do not cause any side effects and do not affect the operation of the implant. The bracelet collects information about motor activity during the day and the quality of sleep.

In addition, the device counts the number of calories burned, and some models monitor heart rate. Many patients note that wearing the device promotes a healthy lifestyle and speeds up the rehabilitation process.

Get a mammogram

Mammographic screening for both diagnostic and preventive purposes is permitted for patients with an artificial pacemaker. The following diagnostic methods can be used for mammography:

• X-rays – X-rays pass through tissue to produce images of the breasts. This is the gold standard for detecting breast cancer.
• Computer tomography is a clarifying method that is part of the mammographic complex. The study is carried out using a movable X-ray emitter. Thanks to this, the doctor receives a layered image of the mammary glands with detailed information about each layer.
• Ultrasound examination is a painless method that allows obtaining an image of the gland in different projections. It reveals any new growths in tissues and other changes in the structure of the organ.

All of the above methods are permitted for patients with ECS. However, before the examination, you should warn the doctor about the presence of an implant.

[ 19 ], [ 20 ]

Go to the bathhouse

Visiting a steam room or bathhouse in the first months after the pacemaker is installed is contraindicated. As you recover, after about 3-4 months, you can go to the bathhouse for a short time and not steam too much to avoid overheating.

At the same time, the presence of an ECS is an absolute contraindication for visiting an infrared sauna. Also, you should not suddenly start going to the bathhouse and linger in the steam room for a long time if you did not do this before installing the ECS. Since sudden temperature changes can negatively affect your well-being.

Drink alcohol

The restrictions after the installation of an artificial pacemaker include drinking alcohol. Drinking alcohol with a pacemaker should be done with extreme caution and only if you feel well. Abuse of alcoholic beverages is dangerous due to the development of the following pathologies:

• Arrhythmia.
• Hypertension.
• Heart failure.
• Cardiomyopathy.
• Exacerbation of chronic diseases.

It should be taken into account that alcohol causes disturbances in heart rhythm, which is corrected by a pacemaker.

The World Health Organization recommends consuming no more than 30 ml for men and 15-20 ml for women in terms of pure alcohol. This is approximately 200 ml of dry wine, 74 ml of 40-degree vodka and about 600 ml of beer. If you stick to these doses, alcohol will have a preventive effect on the heart.

[ 21 ], [ 22 ], [ 23 ]

Play sports, do gymnastics, exercise therapy

The presence of an artificial pacemaker is not a contraindication for sports. Of course, physical activity should be kept to a minimum in the postoperative period, but as recovery progresses, the load should be increased.

Don't forget about a number of rules that will help protect you from the side effects of sports:

• Avoid excessive stress on the muscles of the upper body.
• Minimize the risk of pressure or impacts to the ECS area. That is, various martial arts and weightlifting should be limited.
• Shooting a gun is prohibited.
• Such sports as basketball, hockey, football and volleyball are not recommended. Excessive arm amplitude can lead to the electrodes being torn off from the heart, and trauma to the sternum can lead to the implant failing.

Gymnastics, swimming and dancing are allowed. Walking will be safe and useful. You should also protect the place where the pacemaker is installed from direct sunlight and do not swim in cold water.

Have sex

Intimacy after the installation of an artificial pacemaker is considered physical activity. Sex can be done after discharge from the hospital and if you feel well. But despite this, many patients are afraid of this kind of activity, although the heart does not strain during sex more than after jogging or morning exercises.

To help patients feel more confident, doctors have created a chart that allows them to independently determine when they can resume intimate relations.

• Sex is contraindicated for a month after the last heart attack.
• After the implantation of the pacemaker, you can have sex no earlier than a week later, that is, after being discharged from the hospital.
• After surgery on the heart valves, the patient must wait until the chest wound is completely healed, which takes 1.5-2 months.

But if, despite following all the recommendations, severe chest pain occurs after sex, you should immediately consult a doctor, and in especially severe cases, call an ambulance.

Fly on an airplane

Air travel for people with implanted pacemakers is permitted. The only danger is metal detector frames with a closed loop. Their magnetic field has a negative effect on the pacemaker and can cause problems in its operation. Medicine knows of cases when passing through magnetic frames at the airport disabled the pacemaker and the person died.

In order to protect yourself from going through metal detectors, when buying a plane ticket, it is recommended to register as a disabled person and notify the airline in advance about the presence of a pacemaker. In this case, when going through security, it will be enough to show the passport of the device and undergo a personal inspection. During the flight, you should wrap the seat belt with a soft sweater or towel so that it does not press on the implant.

[ 24 ], [ 25 ], [ 26 ]

Working with a computer

According to the conducted research, a personal computer and peripheral computer equipment (printer, modem, scanner, fax) do not pose any danger to pacemaker owners. That is, it is possible to work with a computer with a pacemaker. At the same time, it is necessary that the system unit with all its electronic insides is at least a meter away from the pacemaker installation site.

The rest of the rules for working with a PC are the same as for people without a built-in device. First of all, you should not sit at the monitor for a long time, as this has a negative effect on the condition of the organs of vision. It is also recommended to do a small warm-up and gymnastics for the eyes every two hours.

Work as a driver

A medical device that maintains the heart rhythm is not a contraindication for driving a car. That is, it is possible to work as a driver after implanting an ECS. In addition, the presence of the device prevents the development of heart rhythm disorders, fainting and loss of consciousness, which are contraindications for obtaining a driver's license.

The device also does not limit the patient's movement in transport. Traveling by bus, tram, train, or metro is not dangerous. Particular attention should be paid to traveling by plane, or more precisely, going through metal detectors at the airport. If you have an ECS, you must provide the device's passport and not expose yourself to closed magnetic radiation, which can disable the implant.

Do an ECG

The diagnostic method that determines the functional state of the heart is an electrocardiogram. The essence of the study is the study of electrical currents that occur during the work of the heart. The advantage of ECG is its availability and ease of implementation.

It is not only possible, but also necessary to do an ECG with a pacemaker. The device is necessary to determine the following indicators:

• Heart rate.
• Presence of arrhythmia.
• Myocardial damage (acute, chronic).
• Metabolic disorders in the heart.
• Violation of the electrical conductivity of an organ.
• Determination of the electrical axis of the cardiac muscle.

An ECG is performed in the first week after pacemaker implantation, as well as during routine visits to a cardiologist.

[ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ]

Put on a Holter monitor

Holter monitoring is a diagnostic method in which an electrocardiogram is attached to the patient's body for 24 hours. The study is conducted in cases of complaints of irregular heartbeat, frequent dizziness and fainting, sharp chest pains and increased weakness.

It is allowed to install a Holter monitor with a pacemaker. The device allows you to track the work of the artificial pacemaker and, if necessary, change its stimulation mode. Holter is used if there is a suspicion of a malfunction of the pacemaker, as well as during routine checks.

Work in the garden

The installation of an artificial pacemaker imposes certain restrictions on physical activity. But contraindications to exercise apply to the first months of rehabilitation. In the future, it is necessary to gradually return to the usual way of life.

That is, you can work in the garden with an ECS, but you should avoid jerky movements and overexertion. You also need to protect yourself from all kinds of blows to the implant area so as not to damage it.

Pacemaker and metal detector at the airport: how to behave and what to do?

The main danger for patients with artificial pacemakers is the metal detector frames installed at the airport. Unlike store magnetic frames, the airport has devices with a strong magnetic field. When passing through the frames or when inspected with a hand-held metal detector, there is a high risk of disruption of the normal operation of the pacemaker. In addition, there have been cases of death due to passing through a metal detector in the world.

To protect yourself, you must adhere to the following rules:

• Always carry your patient card and device passport with you.
• Avoid locations where magnetic frames, detectors and metal detectors are installed.
• Notify airport staff in advance if you have a pacemaker. In this case, a personal search will be conducted.

When buying a plane ticket, during check-in you must select the status Disabled, that is, disabled. As for the flight itself, it is not dangerous for people with pacemakers.

Diet after pacemaker installation

The diet after the installation of a medical device to maintain heart rhythm should be based on the principles of healthy eating. Patients are prescribed diet No. 15 - a common table. Its main goal is to provide the body with physiologically complete nutrition for its normal functioning.

The chemical composition and caloric content fully comply with the norms for a healthy person.

• Proteins 70-80 g – 55% animal and 45% vegetable origin.
• Fats 80-85 g – 30% vegetable and 70% animal origin.
• Carbohydrates 350-400 g.
• Salt 10-12 g.
• Purified water 1.5-2 l.
• Caloric content: 2500-2900 kcal.

The diet excludes hard-to-digest foods, fatty meats and fish, hot spices and sauces, and refractory animal fats. The basis should be cereals, fresh meat and fish, dairy products and eggs, fermented milk drinks, pasta made from durum wheat, fruits and vegetables, and various flour products.

The diet can include sausages, frankfurters, butter or vegetable oil, a small amount of confectionery. You need to eat fractionally, that is, in small portions throughout the day, so that the body does not feel hungry. 3 main meals and 2-3 snacks are enough.

[ 32 ], [ 33 ], [ 34 ]

Pregnancy with a pacemaker

The presence of an artificial pacemaker is not a contraindication for pregnancy. Even at the planning stage, you should undergo a comprehensive examination and receive a conclusion from a cardiologist and arrhythmologist that there are no contraindications to carrying a child.

In this case, the entire pregnancy with a pacemaker should be under the supervision of a cardiologist and obstetrician. Such medical precautions are associated with an increased load on the entire body, and especially on the heart. Because of this, there is a certain risk of developing heart failure and other side effects.

As for the installation or replacement of the pacemaker during pregnancy, if there are appropriate indications, the procedure is performed, but only up to the 30th week of gestation. The presence of a pacemaker does not prohibit termination of pregnancy, i.e. abortion. Complications may arise when using coagulators that affect the magnetic field.

Childbirth with a pacemaker

Pregnancy with an artificial pacemaker has certain peculiarities, but usually proceeds smoothly. The woman's task is to prepare for the birth process in advance. First of all, you should agree with the cardiologist, since his presence at the birth is mandatory. It is also necessary to conclude a contract for the birth with an obstetrician-gynecologist and choose a maternity hospital that can accept women in labor with an ECS.

The delivery itself is carried out by cesarean section. This is due to the fact that natural childbirth is a dangerous load for the cardiovascular system. In order to maximally protect the expectant mother and child, almost all doctors recommend a surgical method of birth.

[ 35 ], [ 36 ], [ 37 ], [ 38 ]

Pacemaker and magnets

The main rule for patients with implanted pacemakers is a ban on the use of or proximity to sources of magnetic or electromagnetic radiation.

Electromagnetic interference may cause malfunctions in the device, triggering its transition to inhibition mode or stimulation with a fixed frequency. There is also a risk of damage to the electronic circuit and failure of the device, which can be fatal.

It is prohibited to apply magnets directly to the area where the pacemaker is implanted. Such actions lead to a failure of the stimulation mode. Moreover, the failure lasts exactly as long as the magnet is near the chest. Particular attention should be paid to clothing and accessories that may contain magnets.

Removal of a pacemaker

There are several indications for removal of the artificial pacemaker:

• Replacing the battery.
• Damage to the device or its electrodes.
• Development of life-threatening complications.
• Restoration of physiological function of the heart.

Removal of a pacemaker can be performed with or without electrodes. During the operation, the doctor excises the pacemaker bed and removes it from the chest.

As for the explantation of long-term implanted wires, they are removed if there are no serious risks for the patient. If there is a risk of heart rupture or damage to the vascular walls, the electrodes are not removed. Their presence in the vein does not pose any danger to the patient.

Certificate of presence of a pacemaker

After being discharged from the hospital following the operation to install an artificial pacemaker, the patient is given a certificate of the presence of an ECS and a passport for the device itself.

Issuing a certificate is mandatory, since the implant has a number of restrictions that must be followed. First of all, this is a refusal to pass metal detectors at airports and railway stations. In this case, an official document allows you to reduce the risk of premature failure of the medical device.

Disability group after pacemaker installation

Disability is a medical and social category, so assigning the status of a disabled person requires serious grounds. It is not given automatically immediately after surgery.

To receive disability after implantation of a pacemaker, you must contact your attending physician. The doctor will assemble a committee that will make a decision on this issue. The committee is guided by the patient's level of dependence on the pacemaker and the general condition of the body.

If the device does not have an absolute dependence on life, then the status of a disabled person is not granted. If the commission makes a positive decision, then the third or second temporary or permanent disability can be established. The third group is working, and the second has a number of restrictions regarding work activity. At the same time, patients do not receive the status of complete incapacity.

[ 39 ], [ 40 ], [ 41 ], [ 42 ], [ 43 ]

How long do people with a pacemaker live?

Very often patients ask about how life expectancy changes when they have a cardiac implant to stimulate their rhythm.

• First of all, it depends on the duration of the pacemaker's operation. On average, the device can operate for 7-10 years, with about a year spent on tissue scarring, complete engraftment of the pacemaker, and the rehabilitation period.
• From a medical point of view, the life expectancy with the device is determined by the general state of health. The main task of the artificial pacemaker is to prevent death due to a heart attack, block or arrhythmia.
• With regular check-ups with a cardiologist, timely replacement of the pacemaker battery and compliance with all medical recommendations, life expectancy is much longer than that of people without the device. But no doctor can accurately answer the question: how long can a person with a pacemaker live?

As for death in people with cardiac implants, it occurs more slowly. This is due to the fact that the pacemaker sends impulses to the stopped heart, forcing it to beat. Death occurs hard and slowly, but the power of the device is not enough to start the organ, which is not able to contract on its own.

Death due to an ill-adjusted pacemaker

Medicine knows of cases when incorrect operation mode, failure in settings or mechanical trauma of an artificial pacemaker led to the death of a patient. This category also includes the discharge of the device's battery when a patient with a severe form of heart disease delays replacing the battery.

In order to minimize the development of severe adverse reactions and death from incorrect operation of the pacemaker, the patient must undergo regular cardiac examinations. The device is checked by a programmer, who, if necessary, adjusts the stimulation mode, eliminating malfunctions.

To protect yourself from death due to a faulty pacemaker, you should not go through metal detectors at airports, or be near sources of magnetic or electromagnetic radiation. You should strictly adhere to all restrictions regarding the cardiac device.

[ 44 ], [ 45 ]