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View Diary: The importance of having a medical power of attorney. (12 comments)

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  •  Pacer or ICD (defibrilator-pacer?) (4+ / 0-)

    "Water on the lungs" sounds like a bout of congestive heart failure. And an ICD is sometimes implanted to provide shocking in the event of a cardiac arrest for people with heart failure.

    While a pacemaker is sometimes implanted because anti-arrhythmic and beta-bockers drugs used in CHF to lower the load on a failing heart can slow the HR too much. A pacer allows more effective levels of meds while sustaining an acceptable HR.

    But an ICD/pacer is installed to supply rescue cardiac shocking in the event there is a sudden cardiac arrest or V-fib episode.

    For people in very advanced CHF an ICD may not be the best choice.  But a pacer can make living with A-fib easier by allowing higher levels of medication to be sustained.

    Implantation is not without risks but comparably (compared to many heart procedures) it is a pretty easy process. It takes half an hour or less.

    Living with one is not at all onerous. (You can usually keep driving for instance.)  Particularly useful if medication isn't resolving the erratic beats, and if RF ablation is not possible.  A-fib is not only uncomfortable, but it substantially raises the risk of clots and strokes as well.

    I agree about the medical proxy issue and have had my own go-rounds on that score, but don't overlook a possibly beneficial technology just because it was sneakily presented.  Get a second opinion, if necessasry.

    BTW, pacers and ICD's are externally adjustable so rate adjustments are simple, in-office procedures.

    They are lucrative for hospitals and docs, though for Medicare patients I don't think they reap as much.

    Good luck to your relative - "water on your lungs" is uncomfortable enough w/o A-fib, too.


    •  B/P and heart rate were fine AFTER med change! (1+ / 0-)
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      wilderness voice

        I am a nurse who has worked in intensive cardiac care and have never seen a pacemaker implanted for this reason! I also have not seen a patient with CHRONIC atrial fib be shocked 3 separate occasions! His ejection fraction is 50% which is within normal limits. The normal is 50 to 70 and is an indication of how effectively the blood is being pumped out into the body.
          Millions of people have chronic atrial fib and are doing just fine taking their medications with slight adjustments at times.They are on a blood thinner so they minimize the chance of a clot A pacemaker is used for people that have Sick Sinus syndrome. That is because the SA(sinus,atrial) node that sends out the electrical impulses is damaged and they can have rapid heart rate and then have a slow heart rate.
      I also find it interesting that you know the time it takes to put a pacemaker in. I think that putting a pacemaker in is VERY LUCRATIVE. This is not a benign procedure because they can stop working properly and they have to be interrogated or you can have a wire break...although not that often.

      I am simply encouraging people to find out all the facts they can, ask questions and not simply agree to any procedure./strong>g>
          Most seniors have Medicare Advantage so they have additional coverage for these kind of procedures.

      "A lie makes it halfway around the world before the truth gets it shoes on." Mark Twain

      by pipercity1 on Mon Feb 25, 2013 at 10:27:10 AM PST

      [ Parent ]

      •  Where did you get the idea that most seniors (1+ / 0-)
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        have Medicare Advantage? That's not close to being true.

      •  What do you find interesting about my knowledge of (3+ / 0-)

        the amount of time a implantation procedure takes?

        Do you suspect (or are you implying) that I am a stooge for for the Pacer/ICD industry?

        Nothing could be farther from the truth. So you can relax, since I am not a propagandist on this topic. (My relative's cardiologists and EP docs would find the idea that I was over-promoting pacers hysterically unlikely.)

        My knowledge is hard-won from years of living with someone with very complex heart issues.

        Since you have added that your relative's EF is >50, then that changes my response, a bit.  It sounds like an ICD would not be recommended. But as a nurse you probably realize that  "water on the lungs" often is a colloquial description of CHF, usually easily resolved with diuertics and fluid/ Na management. But it often occurs when the circulatory system is compromised for some reason, commonly HF..

        I am happy your relative appears to "just" have A-fib without complications of HF, or high HR.  But some of the A/R drugs (Tikosyn, etc.) can slow down a HR in some pts so that optimal A/R dosing can't be tolerated. In those cases a pacer can be a useful adjunct to strengthen the native rate and sometimes permit A-fib management by medication alone. Which is preferable to either living with permanent A-fib or enduring an ablation procedure(s). Pacemakers in A-fib are installed for more than just "sick sinus" syndrome.

        It sounds like your relative is in good hands.  My sympathies for having to deal with A-fib.  It can be miserable.


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