Monday, January 6, 2020


The idea of having a pacemaker to control your heart may at first appear daunting. The good news is that living with a pacemaker is not a difficult thing so long as one can get back to one’s usual life.

What is a heart block and when is a pacemaker necessary?
Electrical stimulus is necessary for the heart to beat. Electrical circuit located in the heart muscles ensures regular and synchronous contraction of the chambers of the heart. Heart block results when there is a failure of initiation or conduction of electrical impulse through the heart resulting in slowing of the heart beat. The slowing of the heart rate may cause breathlessness, dizziness and even blackout.
Pacemaker is necessary when heart block is causing symptoms or has the potential to cause death.

What are the causes of heart block?
Premature ageing of the electrical circuit is one of the many causes of heart block. Heart block may also be associated with heart attack or diseases of heart muscles and heart valves.

What are the different types of pacemakers and how do they function?
Pacemaker consists of a generator (‘box’) and either one or two wires called ‘leads’. Pacemakers with one lead are called ‘single chamber pacemakers’ and those with two leads are ‘dual chamber pacemakers’. The modern pacemaker generators are smaller than the size of a matchbox. The energy from the batteries is transformed into a series of electrical impulses by the electronic circuit in the pacemaker. These impulses are conducted down the leads to the heart causing the heart to contract and produce a heartbeat.
All the modern pacemakers are of the ‘on demand’ type. The pacemaker can sense that the heart is beating on its own and refrain from discharging any electrical impulse. Only when it senses a missing beat or too much slowing down of the heartbeat, it starts discharging electrical impulses at a fixed rate. Some pacemakers (rate responsive pacemakers) have the ability to speed up their discharge rate when necessary to meet the demand on the heart, for example during periods of vigorous physical activity. Dual chamber pacemakers offer some advantage over the single ones although all pacemakers should prevent blackouts.

How is a pacemaker implanted?
Permanent pacemakers implantation is done under local anaesthetic. The lead is inserted into a vein at the shoulder and passed into the desired cardiac chamber under X-ray screening and the position is secured. The lead is then connected to the pacemaker box, which is positioned in a small ‘pocket’ between the skin and the chest muscle.

What precautions are necessary?
Once the pacemaker is implanted the patient should be able to return to his normal lifestyle. He is allowed to do most ordinary activities, however certain ‘contact sports’, such as football should be avoided as they could damage the pacemaker. Domestic appliances such as electric shavers, hairdryers and microwave ovens do not cause any problem provided they are properly connected and earthed. It is advisable to hold a mobile phone to the opposite ear. The phone should not be carried in the breast pocket next to the generator.  A pacemaker can cause a false alarm when going through an airport security system. Strong electromagnetic fields as associated with arc welders, TV and RADAR transmitters and certain surgical procedures such as diathermy can interfere with pacemaker function. MRI scans should better be avoided unless the pacemaker is MRI compatible.

Any safety tips for those wishing to start exercises?

·      If you have been fairly inactive until now, don’t rush straight into being very active. Aim building up your activities gradually over time.
·  Sporadic vigorous activity in someone who is used to less physical activity is harmful
·      Try to avoid heavy exercises after meals
·      Keep to well lit areas and try to avoid walking alone at night
·      If you have high blood pressure or any heart condition, or if you are in the wrong side of forty, consult your doctor before taking on any vigorous form of exercise

How active should one be and what type of exercise should one do?

Being more active will mean different things to different people. It depends on your age, lifestyle and associated medical conditions. The first step should be to ascertain whether you currently do at least 30 minutes of ordinary physical activity (such as walking) in the course of one day. More intense exercise such as jogging for 20 minutes may substitute for 30 minutes of brisk walking. If you find you enjoy being more active, then you can gradually step up your activities.

By exercise is meant physical activity. This not necessarily means taking up a sport or lengthy exercises. Everyday ordinary activities such as walking or climbing stairs do also contribute to physical activity. Aerobic exercises such as brisk walking, swimming, cycling are good for the heart.

You yourself will be able to make out the right intensity of the physical activity. Put in a fair amount of effort so that your breathing becomes faster than normal, but not so much that you are gasping for breath. You should always be able to talk easily during the activity. Your pulse rate will be faster and you should also be a bit sweaty. The activity should make you feel good but not leave you exhausted.

Try to maintain your activity most of the days in a week. At least 30 minutes of moderate-intensity daily activity should be a must, but the more you can take the better. Fitness gains are similar when physical activity occurs in several short sessions (such as three 10 minutes sessions) as when the same total amount of activity occurs in one longer session. If you usually do only little physical activity, then perhaps brisk walking is a good start for you. Trying to be too ambitious too soon, might be stressful and counterproductive.

Why do we need exercise?

Exercise strengthens our muscles and preserves the mobility of our joints. It helps the function of the lungs and improves circulation. It reduces the chance of heart attack. In diabetics, it controls blood sugar. Regular exercises help to reduce weight, prevent constipation and make you sleep better. It also relieves stress and depression. Most importantly, it not only keeps one fit, but also makes one feel fit.


The idea of having a pacemaker to control your heart may at first appear daunting. The good news is that living with a pacemaker is not...