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The Heart & Vascular Center A Patient’s Guide to Cardiac Implant Devices

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for choosing Gwinnett Medical Center for your healthcare needs.

we are grateful to have had the opportunity to serve you.

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elcome to Gwinnett Medical Center Welcome to the Heart & Vascular Center of Gwinnett Medical Center. We are committed to providing the safest and best medical care in an environment that promotes healing and wellness. Our center offers a full array of cardiac and vascular services making your health care safe and convenient.

This booklet contains information to help you prepare for your procedure and make a quick and successful recovery.

We want you and your family to feel comfortable and safe.

Your comments are always welcome. Please do not hesitate to talk with your nurse or physician.

Thank you for choosing Gwinnett Medical Center.

Sincerely,

Phil Wolfe President & CEO Gwinnett Medical Center

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ardiac Implant Devices Your doctor has recommended that you have a procedure that places a cardiac implantation device into your body. Cardiac implant devices are medical devices, such as pacemakers, cardioverter defibrillators, and cardiac resynchronization devices. They help regulate your heart beat and improve your hearts ability to pump blood throughout your body.

Our team of cardiologists, nurses, and technicians will work together to ensure that you feel prepared for your upcoming procedure.

Why Do I Need a Cardiac Implant Device?

You may need a cardiac implant device because you have a: • Slow heart beat (bradycardia) • Fast heart beat (tachycardia) • Irregular heart beat (arrhythmia) • Heart beat that needs continuous monitoring • Risk of your heart suddenly stopping (sudden cardiac arrest) • Heart condition that causes symptoms, such as fainting, dizziness, shortness of breath, feeling tired or run down

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What is a Cardiac Implant Device?

Your body produces electrical impulses that cause your heart to beat. When these electrical impulses do not travel through your heart correctly, it causes your heart to beat too fast, too slowly, or skip a beat. This is a serious condition called arrhythmia and may be fatal if not treated.

To help your heart beat at a more regular rate and speed, your doctor may recommend a cardiac implant device, such as a pacemaker, implantable cardioverter defibrillator (ICD), or cardiac resynchronization therapy (CRT).

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What is a Pacemaker?

A pacemaker is small, electronic device placed under the skin near the heart. It is used to detect a too slow heartbeat. When it senses your heart is beating too slowly, it delivers an electrical impulse to the heart to help it return to a normal rate.

A pacemaker contains two parts: • A pulse generator which includes a small battery and a computer unit. The computer senses your heartbeat and sends out electrical impulses to help your heart return to a normal rate.

• Flexible insulated wires that deliver electrical impulses from the generator to the heart.

What is an ICD? An ICD (implantable cardioverter defibrillator) is small, electronic device placed under the skin near the heart. It is used to detect a too fast or chaotic heartbeat. When it senses your heart is beating too fast or in a disorganized way, it delivers a strong electrical impulse or “shock”. This helps the heart rhythm return to normal.

An ICD records your heart’s activity before, during, and after each shock. This helps the doctor understand why your heart is not beating regularly. It also helps the doctor fine-tune your ICD to prevent unnecessary shocks.

An ICD contains two parts: • A pulse generator which includes a small battery and a computer unit. If the generator senses an irregular heartbeat, it sends an electrical impulse or “shock” to help your heart return to a normal rate and rhythm.

• Flexible insulated wires that deliver electrical impulses from the generator to the heart.

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What is CRT? CRT (Cardiac Resynchronization Therapy) is a medical treatment that coordinates or “resynchronizes” the heart so both chambers beat at the same time. CRT uses a small, electronic device placed under the skin near the heart. When it detects the two lower chambers of the heart not working together, it delivers an electrical impulse or “shock”. This helps the chambers of the heart to resynchronize and begin beating at the same time.

The device used for CRT combines the features of a pacemaker and an ICD. It can stimulate one or both sides of the heart to help create a more coordinated and effective heartbeat. It contains two parts: • A pulse generator which includes a small battery and a computer unit. If the generator senses an irregular heartbeat, it sends an electrical impulse or “shock” to the heart to restore it to a rate and normal rhythm.

• Flexible insulated wires that deliver electrical impulses from the generator to the heart.

Risks and Complications Any procedure involves some risk. Cardiac cath and PCI both involve the same types of risks; however, the level of risk is higher with PCI. Although rare, possible complications may include: \ •

Bleeding or clotting

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Infection or nerve damage

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Bruising or swelling at the incision site

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Clotting or air bubbles in the vein

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Puncture of the lung or heart muscle

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Tearing of the vein or artery wall

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Heart attack, stroke, or death (very rare)

Your doctor will discuss the risks and possible complications with you.

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Preparing for Your Procedure Being well prepared can make you feel more at ease on the day of your procedure. There are several things you can do.

• Ask if all of the necessary tests and exams are done, such as blood work, EKG, or chest x-rays. Be sure to make the results available to your doctor.

• Ask if you should stop taking any of your medicines before the procedure.

• Make arrangements with a friend or family member to drive you to and from the hospital.

• Ask questions. Especially about anything you do not understand.

Before your procedure, tell your doctor if you:

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Take any medicines. This includes prescription, over-the-counter, herbs, supplements, and vitamins.

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Have any allergies (especially to iodine, shellfish and latex or rubber products).

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Are pregnant or think you are pregnant. We can postpone the procedure.

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Are right handed or left handed. This may influence which side of the chest your doctor places your implant device.

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Engage in activities that involve your chest or shoulders.

This may influence which side of the chest your doctor places your implant device.

The Night Before Your Procedure • Drink plenty of fluids early in the evening.

• Do not eat or drink anything after midnight.

• Follow your doctor’s instructions about when or if you should take any medicines.

On the Day of Your Procedure • Take only the medicines prescribed by your doctor with small sips of water.

• Bring comfortable clothing and toiletries in case you are admitted to the hospital.

• Arrive at the hospital at least two hours prior to your scheduled procedure.

• Be prepared to wait. While we make every effort to start your procedure on time, sometimes there are emergencies and other circumstances that may delay your appointment.

Remember to follow your doctor’s instructions completely.

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What to Expect During Your Procedure Just before your procedure, your nurse will place a small needle called an IV into your hand or arm so that we can give you medicines and fluids. We may give you medicine to help you relax and remain still during the procedure. The medicine may make you feel sleepy.

During the procedure, the doctor makes a small cut into the skin near your collar bone. This creates a small “pocket” to hold the cardiac implant device.

A lead wire is threaded through the incision into a vein in the upper chest. With the help of x-ray monitors, your doctor guides the lead wire into your heart. Depending on the type of cardiac implant device you need, the process may be repeated to guide lead wires to other areas of your heart. The doctor attaches all the lead wires to the heart muscle to keep them in place.

Next your doctor attaches the pulse generator to the lead wires and inserts it into the “pocket” under the skin.

Once in place, the doctor tests the device to make sure it works correctly and uses stitches, surgical glue, or staples to close the incision.

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Your Recovery You will probably stay overnight in the hospital and go home the next day.

Be sure to ask your nurse for pain medicine to help relieve any discomfort.

We will monitor you closely after the procedure. Your nurse checks your blood pressure and the incision site often and will let you know when you can begin to move around.

After Your Procedure You May Have a: • Special monitor, called a telemetry monitor that displays your heart rhythm in the nursing unit. This allows us to observe your heart rate and rhythm.

• Holter monitor, a small recorder attached to your chest.

The holter monitor records your heart rhythm to make sure the cardiac implant device is working properly.

• Slight bulge visible under the skin where the device is located.

• Chest x-ray to check your lungs and the position of the cardiac implantation device.

• Before going home, we will remove the holter monitor and send the results to your doctor.

Most patients receiving cardiac implants will have some adjustments made to the settings to optimize their heart function. Sometimes this is done after you leave the hospital during an echocardiogram or ultrasound of the heart.

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Before Leaving the Hospital • Make an appointment to see your doctor.

• Ask questions and make sure you understand how and when to take your medicines.

• Reread your patient education.

• Ask questions and make sure you understand how to care for yourself at home.

Back at Home To help speed your recovery, be sure to follow all of your doctor’s instructions.

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Driving Home For your safety, please arrange for a family member or friend to drive you home. You cannot drive yourself home after your procedure. Talk with your doctor about when you may resume driving.

If your ride home takes longer than two hours, plan to stop at least once every hour to stand and walk for five to ten minutes.

At Home Most people return to their normal activities soon after going home. Ask your doctor when you can return to work. • Follow the instructions given to you by your nurse. • Take your medicines as prescribed. Talk with your doctor before changing how you take your medicine or adding new medicines, including vitamins, herbs, and sleeping pills. • Follow-up with your doctor to make sure your cardiac implant device is working properly.

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How to Care for Your Incision It’s normal to have some pain and stiffness around your incision for a few days. Talk with your doctor about things you can do to help relieve any discomfort. Use these tips to care for your incision • Change or remove the dressing as instructed by your doctor.

• Keep the incision site clean and dry. You can take a sponge bath at first. Ask your doctor when you can begin showering.

• Do not scrub the area and do not let water spray directly on the incision.

• Pat the incision dry. Do not use creams, lotions, or ointments on the incision site.

• Do not take a bath, swim, or soak in a hot tub until your doctor tells you it is safe.

Activities Limit your activities during the first week at home. You can move about, but do not strain or lift heavy objects. Your doctor will tell you when you can return to your normal activities.

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Check your incision each day for changes. Call your doctor if you notice your incision becomes increasingly red, swollen, painful, and warm to the touch.

Follow these general activity guidelines for the first week •

Do not raise your arm closest to the incision site above shoulder level for more than a few minutes at a time.

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Avoid lifting anything heavy (over 10 pounds).

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Avoid activities that require pushing or pulling, such as mowing a lawn or vacuuming.

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Try to walk as much as possible for exercise.

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Stop any activity before you become over tired.

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Resume your normal activities slowly after the first week.

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Talk with your doctor about when it is safe to resume sexual activity.

Avoid golfing, swimming, tennis, and bowling for at least 6 weeks after the procedure. Ask your doctor when you can resume more strenuous activities.

When to Call your Doctor During the first two weeks after your procedure, call your doctor if you notice any of the following: •

The incision becomes increasingly red, swollen, painful, and warm to the touch

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Bleeding or discharge from the insertion site

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Fever over 101°F

Call 911 or Go to the Emergency Room if you have: •

Chest pain

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Difficulty breathing

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Dizziness, too fast or slow heart beat, irregular heart rhythm

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Trouble speaking or swallowing

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Will Electrical Device Affect my Cardiac Implant Device?

You can use electric blankets, heating pads, and microwave ovens without interfering with your cardiac implant device.

Be sure to…

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Use a cell phone on the opposite side of the cardiac implant device.

Avoid placing a cell phone directly against your chest or on the same side as your device.

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Walk quickly through any anti-theft devices.

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Avoid strong magnetic or electric fields found near electrical generators, power plants, or radiofrequency transmission towers.

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Do not undergo any tests that require magnetic resonance imaging (MRI).

Your doctor or nurse can provide more information about what types of equipment may interfere with your device.

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aking Care of Your Heart It takes more than a cardiac implant device to achieve a healthy heart. It involves a change of heart about your lifestyle. To take good care of your heart: • Take your medicines as prescribed by your doctor. Medicines can help the heart work better.

• If you smoke, quit. Smoking and other forms of tobacco use harm the blood vessels and heart. Ask your doctor or nurse for help with quitting.

• Exercise. Frequent, moderate exercise can improve your overall physical, mental, and social functioning.

• Learn to manage related conditions. Diabetes, high blood pressure, high cholesterol, and obesity can harm your health. Your doctor, a dietitian, and other specialist can help you learn how to better control these risk factors.

The goal is to strengthen your heart, improve your health, and reduce the risk of future problems. Ask your doctor or nurse for more information about a heart healthy lifestyle.

Questions for My Doctor

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dditional Information For more information, you may contact: Gwinnett Medical Center Patient Education Lawrenceville, GA 30046 Patient Information: http://gwinnettmedicalcenter.kramesonline.com CardioSmart American College of Cardiology Resource Center Washington, DC 20037 Patient Information: http://www.cardiosmart.org/ American Heart Association Georgia Branch: Marietta, GA 30067 Phone: (678) 224-2000 / (800) 257-6941 Patient Information: http://www.heart.org/HEARTORG/ Conditions/Conditions_UCM_001087_SubHomePage.jsp The Society of Thoracic Surgeons Chicago, IL 60611 Phone: (312) 202-5800 Patient Information: http://www.sts.org/sections/patientinformation/

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