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Pacemaker not Peacemaker

Changing Lifestyle
September 28, 2018
Falling in Love
November 26, 2018

What A Difference Does it Make



Peacemaker


Aristotle, “It is not enough to win a war; it is more important to organize the peace

Peacemaker is an online mediation support tool for peacemaking professionals. It is part of the UN’s overall effort to provide advice and support to the Secretary-General and his Representatives in their efforts to resolve international disputes and internal conflicts.

It is also intended to be useful to UN partners actively engaged in peacemaking efforts, including Member States, regional organisations, civil society, non-governmental organisations and national mediators.

Peacemaker offers key tools and resources to support mediators and their teams in managing peace processes and negotiating peace agreements, including: A comprehensive database of more than 750 peace agreements.

Guidance documents on mediation. Information on UN mediation support activities and services. A library of selected literature on key mediation issues (e.g. power-sharing, wealth-sharing, constitutional issues, mediation processes and strategies etc.)....AND



Make Peace with Yourself


Regret can have a powerful hold on us. Our experiences of loss, heartache, and disappointment tend to stick with us and the negative consequences of our actions - or inactions - at times are often hard to shake.

A critical piece of being able to let go of our deepest regrets is being able to make peace with ourselves. While I wish there was an easy prescription for doing this, there is no magic formula. But I believe in my heart that each of us has the ability to do it. We are each capable of putting an end to the torment of regret and moving on with our lives.

Make a list of all the good qualities you intend to cultivate. Are you going to be kinder, fairer, more tolerant, more magnanimous, more patient, more dignified? What are your responses to difficulties going to be? What principles do you wish to uphold?

I could have made my life a lot easier if I had validated the attempts I was making to do the right thing even when things were a struggle. Instead, I beat myself up and made myself feel worse because I was angry with myself for not living right. It’s all a journey. Allow yourself to be imperfect, and yet still make progress.

You won’t have a peaceful mind if you allow negativity to dominate your thinking. Try to understand others rather than judging them. Forgive others and you free yourself. Radiate compassion and be a good Samaritan. Not only will others benefit; you’ll also add to your own sense of self-esteem.

You will not get to feel that lovely sense of peace if you don’t take the time to fully acknowledge it. In difficult situations, look at what you did well. If you’ve been struggling, notice when you make progress. At the end of each day, summarize to yourself how you’ve acted well and kept your integrity.



Pacemaker


Welcome to my world , one e less and the word has completely changed to "save me " which is no far different from the word peacemaker, they both prevent life from extinction if you think about it , although pacemaker is a device with wires connected to your heart and tha detects the movement of your heart any mistakes the wires swent small electric shock to your heart and that saved your life.

After talking to some people I met with heart condition and already have pacemaker inside them I decided I will go ahead and put the device inside me as well after all I want to live longer and this is the only way to do it. It's not just the heart failure I am facing but heart attack to follow as they told me and who knows what is next. Drugs are around and they are doing a good job but so does the heart

It is so complex medication I am taking as well, I don't understand it as I take a tablet to get rid of water from my body and I am not allowed to have more than 1.5 litre of liquid a day which means at some point my kidneys are going to suffer if they are.

Then my heart beats faster in order to supply my body with blood and oxygene by reducing the beat wuith the medication I am given is my heart going to supply the amount of blood needed?



The heart tablet is so tiny but has massive side effects, sleepless nights followed by stupid nightmares and some mood swings followed by depression and by nature I am not a downer at all so having those negative feelings taking over me I feel trapped and no matter how much I am fighting the drugs are winning most of the time and the result is mornings of negative thoughts taking over the plans for the day and some days are worse than others.

Not in a million years I thought of having heart problems and now having to live with a failed heart and the symptoms to follow I find it hard to adjust the new lifestyle and I don't know which one to look after first the heart failure or the HIV+ issue which is equal importand. With no immune system how can you fight and make your heart strong? and with no heart how can you feed the body ?

With thoughts full of questions about this I wake up in the morning and going to sleep at night, friends become doctors and nurses they advice me all the time as they are experts and some of them are worth listen to and others I name them Google Doctors as they are talking thin air most of the time, but they are good company and as angry as i feel sometimes they are a good source to release my anger



How does a pacemaker work?


The pacemaker is a small metal box weighing 20–50g. It is attached to one or more wires, known as pacing leads, that run to your heart.a battery, which usually lasts from 8 to 10 years depending on how advanced the device is (pacemakers that are more advanced tend to use more energy so have a shorter battery life)


an impulse generator,


a tiny computer circuit that converts energy from the battery into electrical impulses, which flow down the wires and stimulate your heart to contract The rate at which these electrical pulses are sent out is called the discharge rate.

Almost all modern pacemakers work on demand. This means that they can be programmed to adjust the discharge rate in response to your body's needs. If the pacemaker senses that your heart has missed a beat or is beating too slowly, it sends signals at a steady rate. If it senses that your heart is beating normally by itself, it does not send out any signals.

Most pacemakers have a special sensor that recognises body movement or your breathing rate. This allows them to speed up the discharge rate when you are active. Doctors describe this as rate responsive.



Implantable Cardioverter Defibrillator (ICD)


An implantable cardioverter defibrillator (ICD) is a device similar to a pacemaker. An ICD delivers an electrical shock to the heart during a life threatening heart rhythm.

The aim is to ‘reboot’ the heart to get it back into a normal rhythm again. Some modern devices contain both a pacemaker and an ICD. ICDs are often used a preventative treatment for people who are thought to be at risk of cardiac arrest at some point in the future.

If the ICD senses that the heart is beating at a potentially dangerous abnormal rate, it will deliver an electrical shock to the heart. This can often help return the heart to a normal rhythm.

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After a pacemaker implant


You should be able to get back to normal physical activities very soon afterwards. As a precaution, it is normally recommended that you avoid strenuous activities for around 3 to 4 weeks after having your pacemaker fitted. After this, you should be able to do most activities and sports

.

You will be able to feel the pacemaker, but you will soon get used to it. At first, it may seem a bit heavy and may feel uncomfortable when you lie in certain positions.



You will need to attend regular check-ups to make sure your pacemaker is working properly. Most pacemakers store information about your natural heart rhythms. When you have follow-up appointments, doctors can retrieve this information and use it to check how well the pacemaker and your heart are working.

Most ordinary household electrical equipment is safe to use and will not interfere with your pacemaker. This includes microwaves, as long as they're in good working order.

Having a pacemaker implanted is usually a very safe procedure with a low risk of complications. The biggest concern is that the pacemaker loses the ability to control the heartbeat, either because it malfunctions or the wire moves out of the correct position.

Sometimes it is possible to 're-programme' the pacemaker to fix a malfunction by using wireless signals. However, further procedures may be required if the pacemaker moves out of position.


How a pacemaker is fitted


Before having a pacemaker fitted, you are likely to have a pre-operative assessment. The team looking after you will check that you are fit for the procedure. You can also discuss the operation and ask any questions you have.

Tests, such as blood tests and X-rays, can be arranged at this stage so that there are no delays when you are called into hospital. You will be asked about your general health, your heart problems and how these affect you.



You'll also be asked about any additional medical problems and previous operations you've had, as well as any problems or reactions you or your family may have had with anaesthetics.

Taking steps to improve your fitness and health - such as quitting smoking if you smoke, and eating a healthy diet - should help speed up your recovery time and reduce the risk of complications

A heart specialist, known as a cardiologist, who will probably have a special interest in pacemakers, will carry out the procedure. If you are being treated in a large heart hospital, an electrophysiologist will most likely carry out the operation.

An electrophysiologist is a cardiologist who specialises in heart rhythm disorders.


Epicardial implantation


Epicardial implantation is an alternative and less widely used method of fitting a pacemaker. In this method, the pacing lead or leads are attached to the outer surface of your heart, which is called the epicardium.



Epicardial implantation is often used in children and people who have heart surgery at the same time as the pacemaker implantation. The procedure is done under general anaesthetic, so you will be asleep during it.

The surgeon attaches the tip of the lead to your heart and the other end of the lead to the pacemaker box. This is placed in a pocket created under the skin in your abdomen (below your chest). This usually takes 1 to 2 hours, but could take longer if you are having other heart surgery at the same time. Recovery usually takes longer than when using the transvenous approach.


Will I be in pain after the procedure?


You may feel some pain or discomfort during the first 48 hours and will be given pain-relieving medication. There may also be some bruising where the pacemaker was inserted. This usually passes within a few days. Tell the staff if your symptoms are persistent or severe.


Arrhythmias, which are abnormal heart rates or rhythms, are caused by issues with the electrical system of the heart. While there are many types of arrhythmias and a variety of treatment options, some arrhythmias may require a pacemaker or implantable cardiac defibrillator (ICD) to keep the heart beating as it should.

Pacemakers and ICDs are small devices that typically are implanted under the skin on the chest. They use electrical signals through wires, called leads, to address the electrical problems in the heart causing the arrhythmia.


The Difference Between a Pacemaker and ICD


The main purpose of a pacemaker is to make sure the heart rate does not get too slow. It also can monitor and record the rate and rhythm of the heart. Depending on the pacemaker, it may have one, two or three wires used to send electrical pulses to the heart.

An ICD has the ability to act as a pacemaker. However, it also has the ability to detect dangerously fast heart rates, called ventricular tachycardia or ventricular fibrillation, and stop them.



"Ventricular tachycardia or ventricular fibrillation can be fatal," said Adam Shapira, MD, medical director of electrophysiology services at Baylor Scott & White The Heart Hospital – Plano. "ICDs can detect these arrhythmias and terminate them either by pacing someone at a deliberately fast rate to try to terminate the arrhythmia or by shocking someone back into a normal rhythm."


Getting a Pacemaker or ICD


Several factors are used to determine whether you may need a pacemaker or an ICD, including your medical history and what other medical problems you may have, such as heart failure. Typically, only those considered high risk for a life-threatening ventricular arrhythmia and sudden cardiac death need an ICD

.

"Of the people who need a medical device, a small subset need defibrillators," Dr. Shapira said. "Far more people need pacemakers."

The placement of a pacemaker or an ICD requires a minor surgery. Physicians thread the pacemaker or ICD wires through a vein into the heart. The pacemaker or ICD device is then placed under the skin on the chest using a small incision. Most people go home within a day or two.

Physicians on the medical staff at Baylor Scott & White Heart – Plano perform a high volume of pacemaker and ICD procedures with outcomes that compare favorably (if not better) to those seen at much larger institutions. The hospital also offers advanced technology in the area of pacemakers and ICDs, such as leadless pacemaker technology.

For appropriate candidates, leadless pacemakers offer the same function as a normal pacemaker but using a device that is the size of a multivitamin with no attached wires.



Living with a Pacemaker or ICD


While there are some precautions required with a pacemaker or ICD, pacemakers and ICDs typically do not restrict everyday tasks. You may have to be careful around some equipment that could interfere with your device, like MRI scans, magnets and metal detectors.

It may be recommended that you carry a device ID card with you. You also should let health professionals, such as radiology technicians or dentists, know about your pacemaker or ICD.

"Having a medical device initially is a lifestyle, but after a while, the devices tend to become more of an afterthought." Dr. Shapira said.

In addition to these lifestyle factors, it is important to have regular checks with your physician to maintain your device. Once implanted, the average device has a battery life of anywhere from approximately five to 12 years.


Overview of Pacemakers and Implantable Cardioverter Defibrillators (ICDs)


What is a permanent pacemaker?


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A permanent pacemaker is a small device implanted in the chest to send electrical signals to start or regulate a slow heartbeat. It's most often placed in the chest area just under the collarbone. A pacemaker may be used if the heart's natural pacemaker (the SA node) is not working properly causing a slow heart rate or rhythm, or if the electrical pathways are blocked.

A variation of the standard pacemaker, called a biventricular pacemaker, is used for ventricles that don't contract at the same time. This lack of synchrony between the ventricles can worsen heart failure. A biventricular pacemaker paces both ventricles at the same time, increasing the amount of blood pumped by the heart. This type of treatment is called cardiac resynchronization therapy (CRT).

The newest option for permanent pacemaking is the leadless pacemaker. This miniaturized version of the modern pacemaker is implanted using a minimally invasive approach from a vein in the groin thereby avoiding any surgical incisions on the chest. It may reduce some of the complications associated with traditional pacemakers, but it does not offer all of the capability of a traditional pacemaker that can monitor both the atria and ventricles.



What is an implantable cardioverter defibrillator (ICD)?


A transvenous implantable cardioverter defibrillator (ICD) looks similar to a pacemaker, though slightly larger. It works very much like a pacemaker. However, the ICD can send a low-energy shock that resets an abnormal heartbeat back to a normal. It can also send a high-energy shock if an arrhythmia becomes so severe that the heart can't pump at all.

Many devices combine a pacemaker and ICD in one unit for people who need both functions. After the shock is delivered, a "back-up" pacing mode is available if needed for a short while.

The ICD has another type of treatment for certain fast rhythms called anti-tachycardia pacing (ATP). This is a fast-pacing impulse sent to correct the rhythm. This can be used instead of shocking the heart in some cases.

For those patients who do not require either “back-up” pacing or ATP, a Subcutaneous Implantable Defibrillator (S-ICD) is available. It allows for the delivery of high-energy shocks while avoiding the potential risks and complications associated with leads that traverse the veins leading to the heart.


What is the reason for getting a pacemaker or an ICD?


Pacemakers are most often used when your heart beats too slowly. ICDs are advised if you are at risk for potentially fatal ventricular arrhythmias. There may be other reasons for your healthcare provider to advise placement of a pacemaker or ICD.

When your heart's natural pacemaker or electrical circuit malfunctions, the signals sent out may become erratic: either too slow, too fast, or too irregular (arrhythmia). Arrhythmias can cause problems with contractions of the heart chambers by:

Not allowing your heart chambers to fill with enough blood because the heart pumps too fast. Not allowing enough blood to be pumped out to your body because your heart pumps too slowly or too irregularly.



How does the heart beat?


The heart is, in the simplest terms, a pump made up of muscle tissue. The heart's pumping action is regulated by an electrical conduction system that coordinates the contraction of the filling and pumping chambers of the heart.

In an adult, the sinus node generates a steady electrical stimulus. The right and left atria (the two upper chambers of the heart) are stimulated first and contract a short period of time before the right and left ventricles (the two lower chambers of the heart). The electrical impulse travels from the sinus node through the atria to the atrioventricular node (also called AV node),

where impulses are slowed down for a very short period, then continue down the conduction pathway via the bundle of His into the ventricles. The bundle of His divides into right and left pathways, called bundle branches, to provide electrical stimulation to the right and left ventricles.

At rest, the heart normally contracts about 60 to 100 times a minute, depending on your age and physical condition. Each contraction of the ventricles is one heartbeat. The atria contract a fraction of a second before the ventricles so their blood empties into the ventricles before the ventricles contract

.

Under some abnormal conditions, certain heart tissue is capable of starting a heartbeat, or becoming the pacemaker. An arrhythmia (abnormal heartbeat) occurs when: The heart's natural pacemaker develops an abnormal rate or rhythm The normal conduction pathway is interrupted Another part of the heart takes over as pacemaker



In any of these situations, the body may not get enough blood because the heart cannot pump well. The effects on your body are often the same, however, whether the heartbeat is too fast, too slow, or too irregular. Some symptoms of arrhythmias include:

Weakness

Fatigue

Palpitations

Dizziness

Fainting

Shortness of breath

The symptoms of arrhythmias may look like other medical conditions. See your healthcare provider for a diagnosis.



What are the components of a permanent pacemaker/ICD?


A permanent pacemaker or ICD has 3 main components:

A pulse generator with a sealed lithium battery. The pulse generator produces the electrical signals that make the heart beat. Most pulse generators can also receive and respond to signals that are sent by the heart itself.

One or more wires (also called leads). Leads are insulated flexible wires that conduct electrical signals between the heart and the pulse generator. One end of the lead is attached to the pulse generator and the electrode end of the lead is positioned in the heart. In the case of a biventricular pacemaker, leads are placed on both ventricles.

Electrodes, which are found on each lead.Pacemakers can "sense" when the heart's natural rate falls below the rate that has been programmed into the pacemaker.

Pacemakers that pace either the right atrium or the right ventricle are called "single-chamber" pacemakers. Pacemakers that pace both the right atrium and right ventricle of the heart and require two pacing leads are called "dual-chamber" pacemakers. Pacemakers that pace the right atrium and right and left ventricles are called "biventricular" pacemakers.



How is a pacemaker/ICD implanted?


Your doctor will insert the pacemaker or ICD in the cardiac catheterization, or the electrophysiology lab. You are awake during the procedure, although your doctor will provide local anesthesia over the incision site.

He or she will also sedate you to help you relax during the procedure. You may need to spend the night in the hospital so that your doctor can make sure the device is working properly.

Shown here is a chest X-ray. The large, white space in the middle is the heart. The dark spaces on either side are the lungs. The small object in the upper right corner is an implanted pacemaker.

Your doctor will make a small incision just under the collarbone (clavicle). He or she will insert the pacemaker/ICD lead(s) into the heart through a blood vessel that runs under the collarbone. Once the lead is in place, your doctor can test it to make sure it is in the right place and is working.

He or she then attaches the lead to the generator (battery), which is placed just under the skin through the incision made earlier. Your doctor will close the incision with stitches, staples, or a medical adhesive (glue) and apply a dressing.

Subcutaneous ICDs are inserted in a similar fashion although the single lead is tunneled under the skin next to the sternum while the generator is inserted underneath the skin on the left side of the chest. A leadless pacemaker requires that a catheter be inserted from the femoral vein in the groin.



The catheter is removed once the pacemaker has been inserted into the heart. Once the procedure has been completed, you will go through a recovery period or several hours.

There are certain instructions related to having an implanted permanent pacemaker or ICD. For example, after you get your pacemaker or ICD, you will get an ID card from the manufacturer that includes information about your specific model of pacemaker and the serial number as well as how the device works

.

You should carry this card with you at all times so that the information is always available to any healthcare professional who may have reason to examine or treat you. After you have a pacemaker or an ICD implanted make sure you ask and understand the instructions from your healthcare provider regarding:

Activity restrictions

Driving

Medicines you should be taking

Any precautions that should be observed with your device

How often you should have follow up appointments

How your device will be monitored

Signs and symptoms you should report to your healthcare provider after the procedure


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Photos by pixabay.com

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