Pacemakers are used to fix electrical issues in the heart. This picture shows a heart and the electrical nodes within that control the heart rate and rhythm. Pacemakers may be placed on the chest, or implanted under the skin in the chest. They might be temporary or permanent, depending on the patient’s condition. The patient must have an X-ray to ensure that the pacemaker is in the correct place. Next let’s explore the use of pacemakers in more detail.

Okay so first let’s review the electrical signals of the heart.  The electrical signals of the heart make the heart beat by setting the pace for the rate and rhythm, and making sure that the ventricles contract to pump blood through the vessels of the body. Without the signals, the body would not be perfused with blood. This picture shows where each part of the electrical system is in the heart. The atria are located on the top,  and the ventricles below. The SA node is the natural pacemaker of the heart so first it will send the signal through the atria making the atria contract first. Next, the AV node signal is going to go through the bundle of his into the purkinje fibers. This allows the ventricles to contract after the atria.

So, a patient may have damage to the SA node of the heart. If the natural pacemaker of the heart is damaged, the signals are out of whack causing alternating slow and fast heart rates. A pacemaker may be implanted in any situation where there are poor electrical signals in the heart, irregular rhythms, heart rates that are too slow, or ineffective pumping like in heart failure.  

There are different types of pacemakers that the doctor may choose to implant in the patient’s chest depending on what the issue is with their heart.  The single chamber pacemaker has one wire and is placed in the patient that is having bradycardia, but the chambers are pumping as they should be. In this case the SA node is not providing the electrical impulses at the necessary rate to effectively perfuse the body. The dual-chamber has two wires, one is placed in the atrium and one in the ventricle to treat slow heart rates, heart block, or atrial fibrillation.  So in this case, the AV node is faulty as well and needs some help on providing signals to the ventricles. Biventricular pacemakers are used for patients with heart failure where the ventricles aren’t working together. It has three wires that are placed to help the ventricles pump at the same time. Now, some pacemakers respond based on the signals present in the heart and give signals as needed. These are called rate-responsive pacemakers.

So, when you’re taking care of a patient with a pacemaker, it’s important to ensure that it’s functioning properly. If your patient’s experiencing dizziness, syncope, confusion, shortness of breath, intolerance of exercise, or pain and swelling at the site, you should immediately notify the doctor. Interrogation of the pacemaker may be done by a professional using a device to check the settings.