Doctors recommend pacemakers for many reasons. The most common reasons are bradycardia and heart block.
Bradycardia is a heartbeat that is slower than normal. Heart block is a disorder that occurs if an electrical signal is slowed or disrupted as it moves through the heart.
Heart block can happen as a result of aging, damage to the heart from a heart attack, or other conditions that disrupt the heart's electrical activity. Some nerve and muscle disorders also can cause heart block, including muscular dystrophy.
Your doctor also may recommend a pacemaker if:
Before recommending a pacemaker, your doctor will consider any arrhythmia symptoms you have, such as dizziness, unexplained fainting, or shortness of breath. He or she also will consider whether you have a history of heart disease, what medicines you're currently taking, and the results of heart tests.
Many tests are used to detect arrhythmias. You may have one or more of the following tests.
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular).
An EKG also records the strength and timing of electrical signals as they pass through your heart. The test can help diagnose bradycardia and heart block (the most common reasons for needing a pacemaker).
A standard EKG only records the heartbeat for a few seconds. It won't detect arrhythmias that don't happen during the test.
To diagnose heart rhythm problems that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors.
A Holter monitor records the heart's electrical activity for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG.
An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.
For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.
You can wear an event monitor for weeks or until symptoms occur.
Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves are working.
Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and injury to the heart muscle caused by poor blood flow.
For this test, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records the heart's electrical signals.
Your doctor uses the wire to electrically stimulate your heart. This allows him or her to see how your heart's electrical system responds. This test helps pinpoint where the heart's electrical system is damaged.
Some heart problems are easier to diagnose when your heart is working hard and beating fast.
During stress testing, you exercise to make your heart work hard and beat fast while heart tests, such as an EKG or echo, are done. If you can't exercise, you may be given medicine to raise your heart rate.
Clinical trials are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans.
September 2, 2014
Gary H. Gibbons
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The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.