Question.

Hi, want to pick someones brains. I had my PM fitted in February, in April I had a heart attack which neccesitated being defibrillated 3 times to get me back to life, successfully apparantly!.. The question that bothered me is.... how come the electric shock from the defib. didn't do some damage to the PM? Does the PM turn itself off if overloaded that way? What would happen if the same thing occurs again? The PM is a Sorin Reply DR,dual lead, and I also wondered why I didn't get upgraded to an ICD seeing as I had a quadruple by-pass and stent afterwards. Some of the guys out there know a lot about the technical side of this stuff,but I'm afraid its not my strong point, so any help in laymans terms would be appreciated. Thanks in advance, and Happy Christmas to one and all, everyone on here is doing a great job in helping.
clockman1

9 Comments

pm vs icd

by Tracey_E - 2012-12-12 04:12:09

You'd have to ask your dr why they went with a pacer rather than icd. Icd's are considerably larger and the batteries last about half as long so unless the icd is necessary they usually go with just the pm. They also have larger leads. Without a crystal ball we can't know for sure if we'll ever use the icd or not, they just go by risk factors when they make the call which to give us.

Pm's are made to withstand the jolt of a defibrillator. When I took my last cpr renewal it was part of the class. They put the paddles off to the side, not on top of the pm, then use it just like on anyone else.

When you were defibrillated, the pm probably just kept on doing what it always does- send out signals to beat if your heart isn't beating fast enough. All the pm can do is send out a signal to beat, it can't make the heart muscle respond to it. If you were in a super fast rhythm or fibrillating the pm would have only been watching anyway, the defib was needed to shock you out of it. If your heart started back up and wasn't beating regularly, which is common after using a defib, the pm would have jumped right in pacing. This is why all icd's come with a pm.

If I were you, I would want the piece of mind now of an icd because one heart attack puts you at higher risk of another. Ask to be upgraded, or at least have a discussion with your doc.

Glad to know you are still with us :o)

Hi Clockman

by Pookie - 2012-12-13 04:12:52

here's what I would do if I were you:

get copies of ALL your medical records, read them, understand them, then sit down with the doctor who decided to give you your latest pm and ask him all the questions that are floating around in your head.

you deserve any question to be answered. and if your doctor won't comply - go over his head, find out who is boss is and put in a formal complaint.

Pookie

Mr Clockman.................

by Tattoo Man - 2012-12-13 05:12:17


........Our Don is certainly on form today,.. what ?

I'm lying here in the marital bed with Mrs TM, with 'Voyager' on the telly...its half-nine in the morning here in the UK and I have a cup of coffee to hand.

Can life get any better.?..Oh Yes !!.....a free lecture on Cardiac Micro Electronics by Nobel prize winning Professor Don.

"Nobody does it better"..was it you ,Don that Carly Simon sang about all those years ago..and not Warren Beatty ??

Clockman...so you are about to become a milionaire now that you can drill a hole in your garden and become a Fracking Oligarch....this will be TOTALLY lost on anyone not aquainted with UK news concerning shale gas extraction in the North East...Google up Fracking Fylde Coast

Its a quarter to ten now..I really must get up...busy day...haircut at one-thirty !

TM

Good Morning Mr. & Mrs TM

by donr - 2012-12-13 09:12:29

Speaking of haircuts - Mrs Don keeps telling me I need one. Guess I'll have to hustle out & get one before the local sheep dogs all descend on me & round me up back into the herd!

I just read your comment at what you would call half-seven east coast time zone - about 4 hrs behind you on the Prime Meridian. Sun is just peeking over the trees & telling us to get out of bed.

Advanced age is giving me a brain cramp right now - I cannot recall the name of the breed of sheep dog common in Scotland. So why the Heck would I care? Because our county here in North Georgia is the center for an annual sheep dog competition demonstrating their capabilities at herding the fluffy beasts. And there is not a single one of the yarn-growing creatures in the state! But we do have - you have to trust me on this, it's weird - a kangaroo rescue sanctuary here. I kid you not. It is surrounded by a humongously tall fence, to say the least.

Actually, I wish to turn down all credit for Carly Simon's rendition - the honor belongs to Frank, definitely. He does it best of all, unless, of course, you are speaking of James Bond. Personally, I liked Harrison Ford & Daniel Craig in "Cowboys & Aliens" for doing it best of all. Can you even begin to imagine what they would be thinking when all those aliens suddenly showed up w/ the ability to fly & used some sort of electrical or light phenomena to project explosions?

That movie took place about in 1880 - 1890, based on the age of Harrison Ford's son & Ford's participation in our Civil War. Makes me wonder what the level of scientific knowledge would have been among the participants & how they would really have reacted to the situation.

What would it take to awe current generations to the same extent as those of that era?

Don

Try this for a n explanation...

by donr - 2012-12-13 12:12:34

The Defib used a pair of paddles placed on either side of the heart. They operate at some voltage known but to the mfgr of the device, somewhere between 200 V & 2500 V. THAT does not count! What does count is the electric current that flows through your body & heart. Since the voltage is fairly high, the very small current - measured in several thousandths of an amp, and lasting but a few thousandths of a second - flows in a pretty narrow path from one paddle to the other. Since the heart is right in its path, it flows through the heart, doing what it is supposed to do.

Now your PM is located above the path of the current flow, so it gets very little of it flowing past it. But - the real secret is that the PM is in a sealed case made of Titanium - a metal & hence a conductor of electricity. The leads are attached to the PM w/ an outer sheath that is electrically connected to the case, hence everything PM connected is sealed inside the conducting outer shell of the device. The current from the external defib device comes up to the case & flows very nicely around it on the outside of its skin. That's just the nature of electric currents & conductors - electric charges reside on essentially the surface of the conductors. Hence none of it gets inside where all the electronic gadgets & gizmos are.

Let me give you an example on a grander scale. Airplanes get hit by lightning all the time. The current flows all around the airplane on the surface of its skin & the passengers inside do not get shocked, electrically. They sure as Heck get the shock of their lives from all the buffeting & noise of the thunder that accompanies the lightning. Unless the lightning disrupts the skin of the plane at the point where it strikes, there is little damage to the structure. I don't recommend intentionally flying into a thunderstorm to see what it is like, however.

Hope this made some sense to you.

Don

Shocking

by RobertS - 2012-12-14 04:12:45

Hi Clockman

Can't top Don's de-fib explanation here but
I can top Don's airplane example.

As a very young police officer in Hong Kong in the early 1960s I was called to the scene of a tram [trolley in the US] derailment. The front bogies had come off the track but the arm connecting the tram to the overhead power cable was still attached to the cable. I couldn't figure out why all the passengers were still inside. I learned then that current flows down the outside of the shell to ground because as I brushed against the outside of the tram I was thrown across the road by the shock. Everyone but me fell about laughing and the conductor jumped out, pulled a bamboo pole from under the car and unhooked the arm. Luckily only my pride was hurt but I learned a lesson.

Loved Cowboys and Aliens, Don - its going to be fun here. Talking of electrical phenomena in movies what about the St Elmo's Fire scene in Moby Dick?

Robert

Robert: Avast - Hast thou...

by donr - 2012-12-14 11:12:42

...seen the Great White Whale?

Never forget reading Moby Dick in a college English course. There are parts of it that are still indelibly stained in my memory, while other parts are mercifully forgotten - just like Silas Marner!

I liked you story about the tram in Hong Kong. At least you were an eye-witness to it. I only know from reports what happens to planes encountering lightning.

I wonder, though, was the inside trim & structure of the tram all wood, hence an insulator?

Lightning does some strange things. I once witnessed a lightning bolt strike adjacent to the outer wall of a house & induce such a large current into a vertical (Parallel) interior wire that it melted some wires & started a fire. Fortunately someone was home & called the fire dept, who arrived w/i 5 minutes before the fire involved very much of the frame structure. Fire station was only a half mile away.

Though there were some holes in the plot of Cowboys & aliens, it was basically a good film. We have watched it twice & each time I've seen things I missed the previous time through it.

Harrison Ford's character, Col Dolarhyde, referred to the Civil War Battle of Antietam, Maryland. There was a terrible battle in a cornfield (Maize to Europeans), where the slaughter was horrific; & his references to the Indian Wars on our New Mexican Frontier were pretty realistic. The film was actually filmed in that state, not far from the capital, Santa Fe.

The most interesting part of the film was the reaction of three diverse groups to a threat that was totally alien, beyond their understanding of HOW it worked, & nearly immune to their efforts to counter it, but equally threatening to all three. That in itself is a subject that could be explored extensively.

Don

What do we call that place?

by donr - 2012-12-15 11:12:36

Depends on where you are from. My wife's grand Uncle called it Sharpsburg - before he died from a Minie ball that tore him apart. He was a volunteer in a Georgia Infantry Regt.

My Great Grand Father called it Antietam - he was a bandmaster in the New Jersey Volunteers and fought there.

So, our children have ancestors who fought on opposite sides & were at the same battle. No, they did not face each other - bandmasters don't get too involved in repulsing infantry charges.

Unknowingly, after being married for nearly 40 yrs, we moved into the North Georgia county where Wife's family came from over 100 yrs prior. MOF, turned out that our voting precinct was named after her father's family.

There exists the "Private Message" system. After you log in All you need do is click on the name of anyone you want to send a Pvt Msg to & a screen will come up allowing you to select their name for a Pvt Msg.Just follow the directions.

Don

You call it Antietam -I call it

by RobertS - 2012-12-15 12:12:05

Sharpsburg!

Hi Don,

Yep -spot on about the tram - wooden insides which is why all the passengers were sitting inside waiting for the guy to unhook it. A lesson in basic physics for me and also not to rush into situations without thinking first. Lucky I learned that the easy way.

When they were making the movie of Moby Dick off southern Ireland the first model of the whale broke free and was lost at sea. May be still out there.

I have spent time in the States [crossed it from sea to shining sea by rail twice when younger] and used to be a keen Civil War buff. Worked closely with guys from State and Langley while in HK and spent time both there and in Quantico. They gave me copies on tape of that wonderful series on the Civil War by Ken Burns. Not been to Santa Fe but went through Taos NM on the train.

Sadly had to get rid of most my Civil War books when we moved to a smaller house and my Vietnam ones too.

Not a thing about pacemakers in this - is that OK? Everyone else on this thread will think we are nuts. Is there a system on this site to send off site messages I wonder.

Shocked and saddenned by the terrible events in Connecticut - I used to live in Dunblane, Scotland before moving here so feel for those poor people.

Robert

You know you're wired when...

You have a high-tech ticker.

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