Special pacemakers used in heart failure (Cardiac Resynchronization Therapy - CRT) increase pumping power by enabling simultaneous contraction of the heart's right and left ventricles.
✓What is Heart Failure?
Heart Failure is a condition in which the heart, damaged for various reasons, cannot pump a sufficient amount of blood that the body needs, and it generally results from heart attacks, long-term hypertension, heart valve diseases, or congenital heart muscle problems. Heart Failure, being a chronic and progressive disease, can be managed with regular treatment and follow-up; medication therapy can help control symptoms, and in some cases, the heart muscle can strengthen over time.
✓How Does Heart Failure Occur?
Heart Failure occurs as a result of the heart's inability to pump a sufficient amount of blood to the body and generally develops after high blood pressure or a heart attack. This condition causes structural changes in the heart muscle, weakening the heart's pumping power. The body activates mechanisms that increase water and salt retention to balance the decreased blood flow, but this further increases the workload on the heart.
✓Symptoms of Heart Failure
Among the most common symptoms of Heart Failure are shortness of breath, extreme fatigue, swelling in the feet and legs (edema), rapid or irregular heartbeat, and frequent urination at night. Additionally, chest pain, weight gain or loss, decreased appetite, difficulty concentrating, and dry, persistent cough are among the commonly seen symptoms. These symptoms generally occur as a result of the heart's inability to pump sufficient blood to the body and may worsen over time.
Early-stage Heart Failure usually presents with mild symptoms, and these symptoms occur only during physical activity. Mild shortness of breath, quick fatigue, reduced exercise capacity, and mild edema are among the first-stage symptoms. However, in advanced stages, these symptoms become more severe and continue even during rest. For example, in advanced stages, shortness of breath may increase at night when lying down, fatigue can reach a level that prevents daily activities, and swelling in the feet and legs becomes pronounced.
Another distinguishing feature in advanced stages is the more frequent occurrence of sudden weight gain, chest pain, and serious heart rhythm disturbances. The more pronounced nature of advanced-stage symptoms and their characteristic of seriously reducing quality of life increase the severity of the disease and require emergency medical intervention.
Symptoms of Heart Failure can sometimes result from other health problems. For example, shortness of breath can also be associated with conditions such as asthma, lung diseases, or anemia. Swelling in the feet and legs can result from kidney or liver disease, while fatigue can be a sign of thyroid disorders or depression. Additionally, rapid or irregular heartbeat can be associated with anxiety disorders or heart rhythm problems. Therefore, medical examination is recommended for proper evaluation of symptoms.
✓What Causes Heart Failure?
Heart Failure occurs as a result of heart muscle damage or weakening and can develop depending on various causes. Coronary artery disease, high blood pressure, heart attack, diabetes, and heart valve disease are among the most common causes of this condition. Underlying factors negatively affect the heart's pumping power, leading to failure.
✓The causes of Heart Failure are as follows
✓Coronary artery disease,
✓High blood pressure (hypertension),
✓Heart attack,
✓Heart muscle diseases (cardiomyopathy),
✓Heart valve diseases,
✓Diabetes,
✓Arrhythmias (rhythm disturbances),
✓Congenital heart diseases,
✓Thyroid diseases (hypothyroidism or hyperthyroidism),
✓Infections (for example, myocarditis),
✓Anemia,
✓Lung diseases (for example, chronic obstructive pulmonary disease - COPD),
✓Alcohol or drug use,
✓Heart damage after chemotherapy or radiation therapy.
✓Stages of Heart Failure
Heart Failure Stage 1 (Stage A)::
✓Stage 1 of Heart Failure is a period of high risk but without yet having structural heart disease. At this stage, the heart's pumping function is normal, but conditions such as high blood pressure, diabetes, and coronary artery disease increase the likelihood of developing Heart Failure in the future.
✓Symptoms of Stage 1 Heart Failure are generally not seen. People are mostly asymptomatic, and diagnosis is determined based on the presence of risk factors.
✓Heart Failure Stage 2 (Stage B)
✓Stage 2 of Heart Failure is a period when deterioration in heart structure has begun but symptoms have not yet appeared. At this stage, there may be weakening in left ventricular function.
✓Symptoms of Stage 2 Heart Failure are again not pronounced. People generally do not experience complaints in their daily lives, but imaging tests reveal a reduction in heart muscle function.
✓Heart Failure Stage 3 (Stage C)
✓Stage 3 of Heart Failure is a period when deterioration in heart structure becomes more pronounced and symptoms appear. At this stage, the heart struggles to meet the amount of blood the body needs.
✓Among the symptoms of Stage 3 Heart Failure are complaints such as shortness of breath, fatigue, quick tiredness, edema, and reduced exercise capacity. Although symptoms sometimes lighten, they have a permanent character, and the disease becomes more severe as it progresses.
✓Heart Failure Stage 4 (Stage D)
✓Stage 4 of Heart Failure is defined as advanced Heart Failure. During this period, the disease seriously affects quality of life and symptoms continue even at rest.
✓Among the symptoms of Stage 4 Heart Failure are severe shortness of breath, advanced fatigue, increasing chest pressure even at rest, fluid accumulation that makes breathing difficult, and inability to continue daily activities. At this stage, most patients may need advanced therapies (ventricular support device, heart transplant, etc.).
✓What Does Heart Failure Lead To?
If left untreated, Heart Failure can lead to serious problems and affect many organ systems. Insufficient blood pumping to the body can cause problems such as kidney failure, liver function disorders, and fluid accumulation in the lungs (pulmonary edema). Additionally, the heart's weak pumping capacity can lead to blood pooling, creating edema in the legs and abdomen.
✓Treatment for fluid accumulation in the lungs due to Heart Failure is planned on providing the elimination of excess fluid with diuretic medications, using medications that reduce blood pressure and heart load, and, if necessary, applying oxygen therapy.
✓Rhythm disturbances (arrhythmia) increase the risk of sudden cardiac death, while insufficient blood flow affects brain function, causing cognitive disorders or stroke. Besides these, risk factors contributing to Heart Failure include high blood pressure, diabetes, obesity, smoking, coronary artery disease, and a family history of heart disease. These conditions both accelerate the development of Heart Failure and increase the risk of other potential problems.
✓Heart Failure Diagnosis and Tests Applied
Physical examination and medical history evaluation,
✓Electrocardiogram (EKG),
✓Echocardiography,
✓Chest X-ray,
✓Blood tests (measurement of BNP or NT-proBNP levels),
✓Stress test,
✓Heart MRI (magnetic resonance imaging),
✓Coronary Angiography,
✓Heart catheterization.
✓Heart Failure Treatment
Heart Failure Treatment includes a multidisciplinary approach aimed at controlling the disease's symptoms, slowing its progression, and improving quality of life. Treatment generally includes lifestyle changes, medication therapy, and when necessary, surgical interventions. Among medications are options such as ACE inhibitors, beta blockers, diuretics, and angiotensin receptor blockers that reduce the heart's load and improve its function.
✓Lifestyle changes include elements such as healthy nutrition, regular exercise, and control of salt and fluid intake, while in advanced-stage disease conditions, mechanical support devices, heart pacemakers (CRT), or heart transplant as advanced treatment methods can come into play. Thanks to modern technologies and new treatment approaches, Heart Failure Treatment management is continuously evolving and providing patients with a longer and higher-quality life.
Is There a Heart Failure Treatment?
Although there is no definitive cure for heart failure, it is possible to manage symptoms, slow disease progression, and improve quality of life. Treatment is typically carried out through medications, lifestyle changes, and surgical interventions when necessary, usually depending on underlying causes. In advanced cases, methods such as heart support devices or heart transplantation can also be applied. However, the treatment process may differ from patient to patient, and it is important to follow a personalized approach with regular doctor monitoring.
Where Does Heart Failure Affect?
Heart failure causes the body to not receive sufficient blood and oxygen. This condition most affects the lungs, liver, and kidneys.
How Long Do People Live With Heart Failure?
Early diagnosis and regular follow-up can significantly extend patients' lifespan. For this, Heart Failure Treatment and adherence to lifestyle changes are required.
Is There No Cure for Heart Failure?
Although there is no definitive cure for heart failure, medications, surgical methods, and lifestyle changes can positively affect the course of the disease. In some patients, heart transplantation can be a permanent solution.
Does Heart Failure Kill?
Advanced heart failure can pose a life-threatening risk. However, with regular treatment and monitoring, the fatal course of the disease can be slowed.
Can Heart Failure Be Cured?
Although heart failure does not completely disappear, with proper treatment, symptoms can be controlled and disease progression can be slowed. Medication therapy, lifestyle changes, and in some cases device or surgical methods can significantly improve heart function.
How Many Years Do People With Heart Failure Live?
Lifespan varies depending on the stage of the disease, response to treatment, and the person's overall health status. Many patients receiving appropriate treatment can continue living for years and maintain their quality of life.
What is a Pacemaker?
It is a metal device weighing approximately 20 grams that sends small electrical impulses to the heart muscle to maintain the heart's correct rate and proper beating when, due to diseases seen in the heart's conduction system, the necessary nerve stimuli are not being produced from nerve cell centers and the heart rate slows down. The Pacemaker device, which detects and monitors the heart's natural beating mechanism and sends various impulses according to the situation to cause heart muscle contractions, can be applied temporarily or permanently in two different ways.
What Are the Types of Pacemakers?
TEMPORARY PACEMAKER::
Temporary pacemakers are devices placed to be removed when the patient's heartbeats return to normal. These pacemakers consist of a cable that is inserted through the neck, below the collarbone, through the arm or groin area to reach the heart, and a small box located on the outside of the body. These pacemakers can be easily removed when the patient's general condition improves.
PERMANENT PACEMAKER::
Permanent pacemakers, usually placed below the collarbone and just below the skin, are preferred for treating more chronic diseases such as atrioventricular block, tachycardia, bradycardia, hypertrophic cardiomyopathy, and congestive heart failure. Permanent pacemakers that create the necessary stimulus for the heart's contraction and relaxation are classified in 3 different ways according to the stimulated area of the heart:
Single-chamber pacemaker: A type of pacemaker consisting of a single cable and used for stimulating only the right atrium or right ventricle of the heart.
Dual-chamber pacemaker: Pacemakers used to stimulate both the right ventricle and right atrium of the heart are called dual-chamber pacemakers. While one of two separate cables is placed in the right ventricle, the other is placed in the right atrium, and when necessary, contractions are achieved in both the ventricle and atrium.
Triple-chamber pacemaker: This type of pacemaker, also called a biventricular pacemaker, is known as a Cardiac Resynchronization Therapy Pacemaker (CRT-P) and has an important stimulation pattern necessary for heart failure treatment. Thanks to three different cables placed in the right atrium, right ventricle, and left ventricle areas of the heart, even weakened heart muscle contracts properly and each chamber of the heart works synchronously.
ICD (Implantable Cardioverter Defibrillator): This special pacemaker not only regulates rhythm but also delivers shock when necessary to stop life-threatening arrhythmias. It is suitable for patients at risk of sudden cardiac arrest.
How is a Pacemaker Implanted?
Pacemaker implantation is a procedure performed in several steps, usually lasting 1-2 hours and typically performed under local anesthesia. Before the procedure, the patient's general health status and the degree of heart rhythm disorder are evaluated. On the day of surgery, the patient is given detailed information about the procedure and preparations are completed.
First, the doctor makes a small incision in the chest area, usually just below the left collarbone. This incision is made to create a pocket where the pacemaker will be placed. The pacemaker is small in size and designed so that the pocket fits comfortably under the skin.
The pacemaker's electrodes are passed through blood vessels to reach the heart. The electrodes are placed in appropriate areas of the heart and positioned to regulate the electrical activity of the heart muscles. During electrode placement, the surgeon uses a special X-ray device called fluoroscopy to determine the correct position. After the electrodes are placed in the heart muscles, they are connected to the pacemaker device.
The pacemaker is a programmable device and is adjusted by the doctor according to the patient's needs. The device continuously monitors the heart rhythm and sends electrical impulses when necessary. During surgery, tests are performed to ensure the device is functioning properly. Once the correct placement of the pacemaker is confirmed and it is functioning properly, the incision is closed and the surgery is completed.
What is the Lifespan of a Pacemaker?
Traditional pacemakers (single/dual-chamber): Generally last between 5–12 years.
ICD (Implantable Cardioverter Defibrillator) or shock-delivering devices: Last about 5–7 years as they consume more energy.
CRT (Cardiac Resynchronization Therapy) devices: Have an average lifespan of 5–8 years.
When the battery life is approaching its end, the device alerts during regular check-ups. In this way, the replacement surgery is planned (generally only the battery part is replaced, the wires remain).
How Long Does Pacemaker Surgery Take?
Surgery generally lasts 1-2 hours and is performed under local anesthesia.
How Long Do Patients Stay in the Hospital After Pacemaker Surgery?
Patients are generally kept under observation in the hospital for 1-2 days after surgery.
Is Wireless Pacemaker Surgery a Painful Procedure?
No, it is generally performed with local anesthesia and is painless. There may be mild discomfort after the procedure.
What is the Recovery Time After Pacemaker Surgery?
The recovery process generally takes 4-6 weeks, during which heavy physical activities should be avoided.
How Long Does a Pacemaker Work?
Pacemakers generally work for 5-15 years and the batteries need to be replaced regularly.
Can a Pacemaker Be Charged Externally?
Most pacemakers used today cannot be charged externally. A pacemaker contains a battery with a limited lifespan inside it, and when the battery runs out, only the battery part is replaced with a surgical procedure (generally the wires remain in place).
Can People With a Pacemaker Use Cell Phones?
Yes. It is recommended to keep it on the opposite side of the device and 15 cm away.
Can People With a Pacemaker Do Sports?
Yes, light exercises approved by your doctor can be performed. Avoid excessively strenuous movements.
What Are the Risks of Pacemaker Surgery?
During surgery, there are risks such as infection, bleeding, and incorrect placement of electrodes.