Q: My 70-year-old husband has been told by his doctor that he may need a pacemaker in a couple of years. He has an abnormally slow heartbeat due to a heart blockage. How long do pacemakers last and does it require a general anesthetic to insert it? Also is it true that he will not be able to go near the microwave oven?
A: First, I will clarify your use of the words heart blockage. This implies there is a blockage of one of the blood vessels supplying the heart muscle, either the coronary artery or one of its branches. If this is the case, your husband may need more than a pacemaker. He may require bypass surgery, which is a major operation carried out under a general anesthetic.
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However, I think what you are referring to is a heart block. This is where there is some type of interruption of the nerves to the heart that control the heartbeat. These are branches of the vagus nerve and the severity of the condition depends on whether the main bundle of nerve fibres is affected, or just the right or left branches.
There can be partial or complete blocks. I expect your husband has only a partial block, leading to a slower heartbeat. If the block gets worse, his heartbeat could go as low as 30 beats per minute and this would cause fainting and blackouts, which could be dangerous.
A pacemaker keeps the heart beating at the normal rate and only kicks in when the natural rhythm drops below this point. Occasionally they can be used to control an abnormally high heart rate.
The pacemaker machine consists of a power pack or battery and leads, which are wires that enter the heart through one of the large veins and are fixed in place. The battery and generator weigh less than an ounce. They have been much improved in recent years. The battery should last up to eight years and will then need to be replaced. The patient is monitored regularly to test the battery life, and if necessary the battery will be replaced before it loses all its power.
It is not major surgery to implant a pacemaker. The generator is placed in a small pocket made in the left side of the chest wall, under the skin. The procedure takes about an hour and the patient is awake. Pain medications and local anesthetics are given. He will be observed as an outpatient for about a day, but there is no need for a hospital stay.
There is no need to worry about microwaves or other household appliances. Most cell phones are fine too, although it may be best not to keep one in his shirt pocket, close to the pacemaker. Machines with powerful magnets, such as arc welders, may interfere with the pacemaker and should be avoided.
The Medical Post recently undertook a survey of physicians in Canada and asked them if front line medical doctors should remain on duty during a flu pandemic.
Reassuringly, 50 percent said that they considered it their duty as physicians to stay on the job, while the remaining 50 percent said they also would continue to work providing they were adequately compensated and insured. Although this sounds as though doctors are willing to do anything for money, at least we know that we can still get a doctor to see us. That is, unless she catches the flu as well. Hopefully, front line workers will be the first to receive vaccinations.
Clare Rowson is a retired medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
