Dr. Surswaric

The treatment of heart disease has come a long way and one of the more important and fairly common devices used to correct rhythmic problems of the heart is a pacemaker. A pacemaker is a device which is put inside the chest or sometimes even the abdomen to send electrical pulses to the heart to keep it beating at a normal rate.

Pacemaker for heart failure

However, the implications in case of heart failure make the usage of the pacemaker much more complicated. In such cases, the device used is a special type of pacemaker which is also called a bi-ventricular pacemaker. This device sends electrical signals to pump the ventricles of the heart so that they can pump at the same time.

There are many factors to be aware of before undergoing this treatment. Some of the factors to consider are mentioned below.

• Requirement for a pacemaker in case of heart failure - When a patient has heart failure, their ventricles or lower chambers of the heart aren't able to pump enough blood into it. This could be due to physical problems with the heart or problems with the electrical system within it which cannot function normally. The doctor will perform multiple tests to determine whether a patient is the right candidate for a pacemaker for heart failure.
• The procedure - In most cases the device is fitted into the chest and it is done without an open heart surgery. Precautions and post operative care for a minor surgery should be followed. The doctor makes a minor incision on the chest and then inserts the device along with three leads which are connected to the ventricles to ensure they keep pumping properly. Sometimes another device known as the ICD or the implantable cardioverter-defibrillator may be put in to shock the heart back to a normal rhythm in extreme cases where the change of sudden death from high heart rate is a possibility.
• Immediate post operative care - As mentioned above, the surgery involved in putting a pacemaker is a minor one and the patient is usually discharged in next 2-3 days or may be more depending on the comorbidities & complexity of the scenario. However, in most cases, people can go home the next day fairly easily although some monitoring is done for the next few days with daily reporting.

Our heart is basically a muscle. So when this muscle weakens the heart is unable to do its function i.e., to pump blood throughout our body and keep us alive.

The heart muscle gets progressively weak due to a disease called cardiomyopathy.

There are different types of cardiomyopathy caused by different causes. Untreated cardiomyopathy can lead to heart failure or early death. Treatment can’t cure the condition but can give you extra healthy years of life and prevent serious complications.

Cardiomyopathy has 4 main types, they are:

1. Dilated Cardiomyopathy: This is the most common form and its principal cause is that your heart muscle becomes too weak to pump blood. The heart muscles stretch and become thinner in this case leading to the four chambers of the heart to expand causing a pathology called an enlarged heart.

2. Hypertrophic Cardiomyopathy: This happens due to genetics. It occurs when the walls of your heart thicken and prevent the flow of blood through this natural pump.

3. Arrhythmogenic Right Ventricular Dysplasia: This is a rare form of cardiomyopathy. It causes sudden deaths of athletes and is caused when fat and fibrous tissues replace muscle in the right ventricle of the heart.

4. Restrictive Cardiomyopathy: This is the least common form of the disease. The cause is the stiffening of the ventricles, the part of the blood which receives blood. When these stiffen, the heart doesn’t get enough blood to oxygenate. Scarring of the heart due to heart disease and a heart transplant operation can be a cause of this stiffening.

5. Ischemic Cardiomyopathy: Ischemic cardiomyopathy is caused due to coronary artery disease which causes blood vessels supplying blood to the heart to become narrow. The heart doesn’t get enough oxygen and a person can die due to a heart attack.

6. Other types of cardiomyopathy are grouped into this category and can include:

   • Left ventricular noncompaction happens when the left ventricle has trabeculations, projections of muscle inside the ventricle.

   • Peripartum cardiomyopathy, another form of the disease can occur during or after pregnancy. This is a form of dilated cardiomyopathy and can be fatal. There’s no documented cause.

   • Alcoholic cardiomyopathy is caused due to alcoholism causing an enlargement of the heart.

   • Takotsubo cardiomyopathy, or broken heart syndrome, happens when extreme stress leads to heart muscle failure. Though rare, this condition is more common in post-menopausal women.

Treatment

Doctors will decide the treatment after finding out the extent of damage due to cardiomyopathy.

Few people will not require treatment till symptoms like chest pain, dizziness, shortness of breath and edema appear.

Others whose life is affected due to symptoms are treated with lifestyle changes and medicines. The bad news is that cardiomyopathy can’t be cured but can only be managed and controlled by doing the following:

1. Heart-healthy lifestyle changes are key. You will be advised to maintain a healthy weight, eat a modified diet, get enough sleep, manage stress, and quit smoking.

2. Exercise is also crucial to keep the heart healthy and maintain a healthy weight through regular bouts of low-intensity exercise.

3. Medications for high blood pressure will be prescribed to prevent water retention, keep the heart beating normally, prevent blood clots and reduce inflammation.

4. Pacemakers and defibrillators can be implanted.

5. Surgery like heart transplant can be done as a last resort. If you wish to discuss about any specific problem, you can consult a homeopath.