Bhul b

@@upendranathverma1740 d

Ha,ha ha, god pointed!😁

did it... make your heart flutter.. after all these years?

Glad it was helpful!

I'm glad it was helpful. Good luck in your new career!

The argument would be lower longevity because of the battery usage requiring more replacements. But nowadays the modes can be adjusted through a programmer. I am not sure but I believe some pacemakers can change their own setting if an event is detected.

Is implantation of the lead system more involved/difficult?

I'm sorry, but I can't offer specific, individualized medical advice here. I recommend your father speak with his cardiologist. Luckily, pacemakers have a variety of data that gets recorded, so his cardiologist might be able to download that information to let him know what his underlying rhythm is, and how often the pacemaker needs to "kick in".

@Sonia Barriga Muñoz.... youre so brave....i hope i have youre braveness...im only 33 years old and i have sinus bradycardia.... im afraid of having a pace maker...im too young....i wanna live a long life...😥😥😥...am dealing with anxiety...im so anxious...😢😢😢im always crying....

my heart stops 6-8secs like 20x a day but the episodes were far apart. 2019 i had a emergency dual chamber PM implant coz the intervals of the episodes were just to close that before my heart can recover it ill stop again. without my PM my heart rate is just 19-29....so basically i'm battery operated now. i'm slowly going back to riding my mtb on light trails and playing ball games.

Hi, how are you now?

I can't give specific, individualized medical advice on here, and I recommend discussing any questions directly with her cardiologist. Having said that, by "turning down the volume", the cardiologist most likely was referring to turning down the "output". If this was the case (and that's a big "if", which is why you should check with the cardiologist), the most likely explanation is that when the pacemaker thresholds were tested to see how much current was necessary to pace her heart, the previous output setting was higher than necessary. This isn't generally dangerous - it just drains the battery faster. So by turning down an unnecessarily high output, it extends the length of time until a person needs their pacemaker generator (which includes the battery) changed.

I can't give specific, individualized medical advice here, and I recommend your husband speak to his cardiologist about this. Having said that, I am unaware of any data that the act of getting a pacemaker, in itself, increase the risk of developing atrial fibrillation. However, there are certain pacing modes (VVI) that are associated with developing a-fib.

@@StrongMed I forgot to mention last visit at his cardiologist’s office it showed some arrows on the pacemaker monitor. The Dr. didn’t explain why. He said that he’s going to adjust the mode but he keeps repeating that his heart condition has nothing to do with the pacemaker. I am not 100% convinced.

Depends on age of the patient. If he's having Atrial fibrillation, mode of pacemaker shud be VVI

It depends on the circumstances. If the myocardial infarction affected the sinus or AV nodes (i.e. part of the conduction system), then a pacemaker could prevent an unusually slow rhythm from occurring. If the myocardial infarction resulted in impaired contractile force (i.e. a low ejection fraction), a biventricular pacemaker can be used to help improve contraction (if there is evidence of impaired electrical conduction through the ventricles), but this is only done after at least 3 months of optimal medical therapy to see if the problem can be addressed without the need for a pacemaker. Also, in a patient with impaired ejection fraction after MI and a period of medical optimization, an ICD is often implanted as well, which will provide an electrical shock (a.k.a. defibrillation) in the event of a potentially fatal heart rhythm.

Yes, this is a potential problem that can happen. The first line intervention would be to suppress the PVCs with a beta blocker. There aren't really great strategies to mitigate this with only changes to pacemaker programming.

VVI means that the pacemaker's firing of a single ventricular lead is inhibited (as in momentarily blocked) if it senses the ventricle has already depolarized. AAI means that the pacemaker's firing of a single atrial lead is inhibited if it senses the atria has already depolarized.

@@StrongMed The pacemaker inhibit, so the pacemaker not fire?

@@judypeng4748 Yes, that's correct. It does not fire for a single heart beat.

@@StrongMed thank you! So if I want to fire the pacemaker, I need to adjust the pacemaker to turn on make it fire

Thanks for the suggestion, but unfortunately, I don't do any actual programming of the devices myself. Our cardiologists would have a heart attack if they heard that a hospitalist was reprogramming their patients' pacemakers! ;) EDIT: I'll add that every device manufacturer (e.g. Medtronic, Boston Scientific, Abbott - formerly St. Jude) has a different system/user interface for programming. So to show what the screen actually looks like on the programmer, you'd need a separate video for each company.

@@StrongMed Thanks 🙏 for your understanding and answering my questions … You are right cardiologists I try my best for learning this

Implantation of pacemakers are usually done on the left, even in left-handed individuals, primarily because it is a technically easier procedure since the leads (i.e. wires) are advanced into the right side of the heart as one continuous curve. When placing devices in the right upper chest, the leads need to make several slight turns within the blood vessels. There are some exceptions to this placement preference - for example, if the patient has an AV fistula for dialysis in the L arm, or if there is an anatomic obstruction such as a left subclavian thrombus, the cardiologist would typically place the device on the right side. ICDs are (almost) always placed on the left because the "can" (i.e. the generator) itself is part of the defibrillation circuit, and the closer proximity to the heart on the left is believed to increase the probability of a successful defibrillation.

@@StrongMed could there potentially be any complications from putting them on the right side? My pacemaker is on the right. It's there because of an infection from the first one that was on the left.

@@kooldesign4u Because the procedure is *slightly* technically more difficult to place them on the right, it would be expected that the immediate complication rate from right-sided placement would be *slightly* higher. But these kinds of complications are still rare, and would usually be immediately apparent within hours (or even minutes) from placement. I do not know of any difference in medium and long-term complication rates (e.g. infections) between the right and left sided placement.

I'd love to cover biostatistics on this channel, but it's a monster of a topic. Unfortunately, I'm not convinced I could do the topic justice.

@@StrongMed sir could you please consider a video on approach to altered mental status.

@@shubhamvr05 It's on my short list! (i.e. hopefully will get to it this fall)

This link should work: drive.google.com/file/d/1B3Jn_7KbJWtukSrCWcbpBSqi86it0PXw/view?usp=sharing

I do too, but I think we are both in the minority. ¯\_(ツ)_/¯

Strong Medicine I also enjoy classical music.