Implantable Cardioverter Defibrillator A Guide for Patients and Families

Transcription

1 1 Implantable Cardiverter Defibrillatr A Guide fr Patients and Families What is an implantable cardiverter defibrillatr? An implantable cardiverter defibrillatr (r ICD, sunds like eye-see-dee ) is a small electrnic device that cnstantly checks yur heart rate and rhythm. It lks fr any sudden changes that can cause sudden death. When needed, it can either send an electrical impulse t yur heart t trigger a heartbeat r send an electrical shck t trigger the heart rhythm back t nrmal. An ICD has tw parts: a generatr and pacing leads. 1. The generatr is a small cmputer that mnitrs yur heart rate and rhythm. When needed, it sends either an electrical impulse r an electrical shck t yur heart. It is pwered by a specially designed battery. 2. The pacing leads (yu culd have 1 r mre) are insulated wires. One end cnnects t the generatr. The ther end attaches t the inside f yur heart. The electrical impulse r shck travels frm the generatr dwn the lead. ICD Generatr What s inside? Why d I need an ICD?... 2 Are there any risks?... 2 What can I expect befre and after?... 3 When shuld I get help?... 5 Living with an ICD... 6 Frequently asked questins... 9 Helpful resurces..11 Pacing Lead CSBC ICD Patient Resurce July

2 Why d I need an ICD? Yur heart has an electrical system made up f special cells. It signals yur heart muscle t squeeze r cntract t pump bld and xygen t yur bdy. Smetimes this system is damaged by aging r heart disease. This can result in: A slwer than nrmal heart rate (bradycardia) A faster than nrmal heart rate (tachycardia) When the heart beats dangerusly fast, the lwer chambers f the heart cannt pump enugh bld and xygen t the bdy. If this is nt treated quickly, the heart can stp (called cardiac arrest) and death fllws. If yu heart beats t slw, the ICD acts like a pacemaker. It sends an electrical impulse t trigger yur heart t beat at a nrmal rate and rhythm. If yu heart beats dangerusly fast, the ICD acts like a defibrillatr. It sends a strnger electrical impulse t shck the heart back int a nrmal rhythm. An ICD is an ptin fr peple wh: Have had at least 1 episde f life-threatening heart rhythm (ventricular tachycardia r ventricular fibrillatin) Have survived a sudden cardiac arrest Have a prblem with the heart s electrical system that makes it mre likely fr them t have a life-threatening heart rhythm r have a cardiac arrest Are there any risks? The prcedure t insert an ICD is called implantatin. An ICD implant is cnsidered a rutine, minr surgical prcedure with little chance r risk f prblems. Bruising arund the implant site is cmmn. Hwever, as with any medical prcedure, prblems are pssible. Althugh rare, these prblems are imprtant t knw (listed here frm mst likely t least likely): CSBC ICD Patient Resurce July

3 Prblem Chance f it happening Hw it is treated Pacing lead becmes disldged Bleeding arund the ICD site (hematma) Cllapsed lung (pneumthrax) Infectin Cllectin f bld arund the heart (cardiac tampnade) 2 t 3% chance (20 t 30 peple in 1000) 1 t 2 % chance (10 t 20 peple in 1000) 1 t 2 % chance 1 t 2 % chance 0.1 % (1 persn in 1000) Anther prcedure wuld be needed t put the lead back int psitin. Smetimes the bleeding arund the ICD is large enugh that the bld needs t be drained ff. Chest x-ray is dne after the prcedure t check fr this. Often, it des nt need t be treated, but it might need a drain int the chest t help the lung return t nrmal. T prevent an infectin, everyne is given antibitics befre the prcedure. They may be required after the prcedure if an infectin ccurs. Often, it des nt need t be treated, but it might need t be drained. It is imprtant t ask yur dctr abut the risks f an ICD implant in yur specific situatin. What can I expect befre and after? Hw t prepare fr the prcedure Always bring yur BC Services Card (r Care Card) plus a list f the medicatins yu are currently taking t every appintment and the day f yur prcedure. Since yu cannt drive hme after yur prcedure, arrange fr smene t drive yu t the hspital and hme again. Yu als need t arrange fr smene t stay with yu at hme fr the first 24 hurs after the prcedure. Yu will get mre specific instructins frm the hspital r ffice f the dctr ding the prcedure. Yu will be instructed as t hw t take yur medicatins befre the prcedure. Certain medicatins (like bld thinners and diabetic pills) might need be adjusted. It is imprtant t review these instructins carefully and take medicatins as directed. Talk with yur dctr abut future driving restrictins. The B.C. Mtr Vehicle Act has strict rules n when peple are allwed t drive after having an ICD implanted. CSBC ICD Patient Resurce July

4 A week r s befre the prcedure, yu might be asked t g fr sme bld wrk and an electrcardigram (E.C.G.), and an echcardigram. D nt eat r drink anything the mrning f yur prcedure, unless yu have been specifically tld smething different by the hspital r yur dctr. Befre the prcedure Yu are admitted and directed t the prcedure waiting area. If yu are already a patient in hspital, yur healthcare team will help yu get ready fr the prcedure. An intravenus (I.V.) is started in ne f yur arms t give yu medicines during the prcedure. Yu have bldwrk drawn and an electrcardigram (ECG). The dctr reviews the prcedure and then yu will be asked t sign a cnsent frm. During the prcedure Mst peple are awake fr the prcedure. Yu are given a medicine t help yu relax and feel cmfrtable. The dctr injects a numbing medicine under the skin t freeze the area where the ICD is being implanted. A small cut r incisin is made n the right r left side f the upper chest just belw yur cllarbne. Yur dctr talks with yu befrehand abut which side is best fr yu. The dctr uses a special x-ray t guide the pacing lead(s) thrugh a large vein and int yur heart. Once the leads are attached (implanted) in the inside f the heart, they are tested t make sure they are wrking crrectly. The ICD generatr is then placed in a space under the skin. The incisin is clsed with stitches that will disslve n their wn ver time. The prcedure takes abut 1 t 2 hurs. Image: Blausen.cm staff (2014). "Medical gallery f Blausen Medical 2014". WikiJurnal f Medicine 1 (2). DOI: /wjm/ ISSN ( Blausen 0543 ImplantableCardiverterDefibrillatr InsideLeads, CSBC ICD Patient Resurce July

5 After the prcedure Yu are mved t a recvery area. The nurses there mnitr yur heart rhythm and bld pressure. Yu might feel sme discmfrt arund the incisin and yu might have a sre shulder. Let the nurses knw if yu are having any pain s they give yu medicine t relieve it. The nurses will let yu knw when it is safe fr yu t eat and drink. Yu might g hme frm this area r yu might be mved t anther unit if yu need t stay in the hspital lnger. Ging Hme Hw sn yu g hme depends n yur medical cnditin and recvery frm the prcedure. Sme peple g hme the same day. Others need t stay in the hspital fr a few days. Befre yu leave hspital, yu are given instructins fr hw t care fr yurself at hme. The nurse reviews this infrmatin with yu, such as: Caring fr yurself at hme Driving restrictins Caring fr yur incisin Restrictins t arm mvements Managing pain ICD clinic fllw-up appintments When t take medicatins When t get help Nte: The persn staying with yu fr the first 24 hurs shuld be there t hear these instructins. When t get help Cntact yur family dctr right away if yu ntice any f the fllwing: Any redness, swelling, r clured liquid cming frm yur incisin A fever ver 38.5 C (101.3 F) New bruising r redness arund the incisin Pain that gets wrse r des nt imprve with pain medicine Call if yu ntice any f the fllwing: A shck frm yur ICD and yu d nt feel well afterwards Truble breathing r cannt catch yur breath Really bad chest discmfrt r pain CSBC ICD Patient Resurce July

6 Feeling really dizzy r cnfused Heart feels like it is racing r beating really fast 2 r mre shcks within 24 hurs Living with an ICD Mst peple wh receive an ICD can return t their nrmal activities f daily living. Belw are tips t help yu stay healthy. Attend fllw-up appintments Every persn with an ICD needs t be checked regularly by an ICD clinic. These checks are bth in the clinic and remtely frm yur hme. Remte mnitring is a way fr yur ICD t send infrmatin abut yur heart activity wirelessly frm hme. Yur infrmatin is sent thrugh a secure cnnectin t a secure website. If this is an ptin fr yu, the ICD clinic team will yu help yu t get started. Befre yu leave the hspital, speak t yur nurse r dctr abut the ICD clinic clsest t yur hme. Yur first appintment will be within 2 t 4 weeks. After this, yur ICD must be checked in the clinic at least nce every year. Let yur clinic knw f any changes in yur address r phne number. During visits t the clinic, the ICD team: Check yur ICD battery and leads. Review yur ICD settings t make sure it is prgrammed t best meet yur needs. Adjust the ICD settings as needed. Prtect yur pacing leads The mvement f yur arm n the same side as yur ICD may be limited fr a perid f time after the prcedure. The instructins frm the hspital will include what yu can and cannt d. Fr at least 6 weeks after the prcedure, yu are nt allwed t d any strenuus shulder activities like glfing, swimming, tennis, shvelling, raking, r vacuuming. These restrictins prevent the pacing leads frm being disldged. CSBC ICD Patient Resurce July

7 Prtect yur ICD generatr D nt place magnets near yur ICD. Keep magnets at least 6 inches frm the generatr. Never put a cell phne in a pcket ver yur ICD. Walk thrugh anti-theft detectrs at a nrmal pace withut any delay. D nt remain in r near the system fr any length f time. They have electrmagnetic fields and can temprarily affect yur ICD. Keep the generatr away frm these items: At least 6 inches (15 cm) away - hand held electric kitchen appliances (e.g. mixers and knives), electric tthbrush charging bases, electric shavers, exercise bikes and treadmills, hand held hair dryers, stere speakers, vacuums, sewing machines, and radi-cntrlled items (including the antenna). At least 12 inches r 1 ft (30 cm) away - electric fences, vehicle ignitin systems, green electrical transfrmer bxes fund utside, car battery chargers, generatrs 20 kw r less, uninterrupted pwer surces (UPS), and gasline pwered tls (e.g. chainsaws, lawn mwers, weed trimmers, and snw blwers). At least 24 inches r 2 feet (60 cm) away - inductin ck tps, jumper cables, bench munted r free-standing pwer tls with 400hp mtrs r less (e.g. air cmpressrs, drill presses, grinders, pressure washers, table saws, and welding equipment with currents under 160 amps). D nt use: TENS machines, magnetic mattresses r pillws, muscle stimulatrs. Stay away frm large magnets such as the nes fund n cranes r in junkyards t lift cars. If yu wrk in any high vltage areas, talk t yur dctr r ICD clinic. High vltage is fund arund things like arc welders, smelting furnaces, radi and televisin twers, and hydr and radi statins. Knw yur shck plan Review yur shck plan regularly when at the ICD clinic. Shcks can be startling and painful, but they are nt necessarily a sign f truble. It is cmmn t feel anxius that yu might get a shck at any time. CSBC ICD Patient Resurce July

8 Talk with the ICD clinic staff abut yur wrries and cncerns. If yu get 1 single shck and yu feel fine fllwing, write dwn the time yu gt the shck and call yur ICD clinic as sn as pssible. Call if: Yu get 1 shck and d nt feel well fllwing. Yu get 2 r mre shck within 24 hurs. D nt drive until yu are tld it is safe t return t driving. Tell thers yu have an ICD At the hspital, yu are given a temprary ICD identificatin card describing what type f ICD yu have. Always carry yur ICD Identificatin card with yu. The cmpany that made yur ICD will mail yu a permanent ICD Identificatin card 4 t 8 weeks after yur prcedure. Always tell yur dentist, physitherapist, massage therapist, and chirpractr yu have an ICD. They might need t take special precautins befre starting certain medical prcedures r therapies. Take yur medicatins Make a list yur medicatins, the dsage, and the times yu take them. Always bring this list t all yur ICD fllw-up appintments. Remember t update yur list when they change. Take them exactly as instructed. Stay active Mst peple return t their usual daily activities, nce they have recvered. Include physical and mental activity int yur daily schedule. Each persn is unique. Talk t yur dctr abut the kind f activities and exercises that are best fr yu. Start slwly and gradually increase. Fr mst peple, it is safe t resume sexual activity after an ICD implant, hwever try nt t supprt yur weight with yur arms during sexual activity while yur incisin is healing. N harm will cme t yur partner shuld yur ICD give yu a shck, even if yu get the shck during intercurse. CSBC ICD Patient Resurce July

9 Ask questins Call yur heart dctr r family dctr. Call yur ICD Clinic. Call HealthLink BC at any time f the day r night t speak t a registered nurse. During the night, yu can ask t speak t a pharmacist. ICD cmpanies ffer nline supprt fr nn-urgent questins r cncerns. Their cntact infrmatin is available nline r in yur pacemaker infrmatin bklet. Frequently Asked Questins When can I drive? The B.C. Mtr Vehicle Act says that after a ICD implant: Yu must have yur dctr s apprval befre yu can drive again. Yu are nt allwed t drive a private vehicle (class 5 license) until yur dctr says it is safe t drive. This culd be anywhere between 4 weeks t 6 mnths. Yu are n lnger allwed t drive a cmmercial vehicle (class 1 t 4 license) at any time. What is electrmagnetic interference (EMI)? Any items that generate, transmit, r use electricity have invisible electrmagnetic fields arund them. This electrmagnetic field might affect the nrmal peratin f yur ICD. This is called electrmagnetic interference (EMI). Mst husehld items are safe t be near and use, including items such as: battery chargers, curling irns, hair straighteners, electric blankets, guitars r tthbrushes, massage chairs, heating pads, ht tubs, saunas, tanning beds, electrnic weight scales, and kitchen appliances including micrwave vens. It is als safe t be near and use electrnics such as TV s, radis, cmputers, tablets, MP3 players, fax machines, phtcpiers, DVD and CD players with remte cntrl, printers, and GPS devices. CSBC ICD Patient Resurce July

10 What d I d if I think an item is causing EMI? If yu feel dizzy using an electrical item, put it dwn and mve away frm it. Yur ICD shuld return t nrmal. If yu cntinue t feel dizzy r feel wrse, cntact yur ICD clinic r dctr right away. Can I travel with an ICD? It is safe t travel with an ICD. Let the ICD clinic knw if yu are planning t travel. Ask hw t get help medical help if needed and hw t set up yur remte transmitter while yu are away. Tell airprt security persnnel yu have an ICD and shw yur ID card. It is safe t pass thrugh the airprt metal detectr, have a bdy scan and use a hand-held metal detectr. Hw lng will my ICD last? The ICD battery will need replacing ver time. This minr prcedure is called a generatr (battery) change. Yur ICD clinic will rganize a replacement when needed. The battery generally lasts 5 t 8 years but will depend n hw much yur bdy needs the ICD t pace yur heart. If yur pacing leads are wrking well, they are left in place. ICDs d nt stp withut warning. Even as the battery weakens, yur ICD cntinues t wrk as it shuld. What happens t my ICD at end f life? There culd cme a time when yu wuld prefer NOT t have yur death prevented by a shck frm yur ICD. Shcks frm yur ICD can cause pain and anxiety and may nt prlng a life that is acceptable t yu. Yu might wish t have the shck functin turned ff r deactivated. Yur ICD will still wrk as a pacemaker fr slwer heart beats. If yur heart beats dangerusly fast, the ICD wuld nt shck yu, allwing yu t die naturally. Talk t yur family and yur dctr abut turning ff the shck functin. Make sure everyne understands yur wishes. If yu are thinking f getting the shck functin turned ff (deactivating), yur dctr will help yu with the steps. CSBC ICD Patient Resurce July

11 Fr Mre Infrmatin This bklet explains basic infrmatin abut living with an ICD. Fr mre detailed infrmatin abut getting an ICD, read the infrmatin given t yu by yur dctr s ffice r hspital befre the prcedure. Fr mre detailed infrmatin abut yur specific ICD, read the bklet frm the cmpany that made the ICD, r visit their website. If yu have questins that are nt addressed in this bklet, ask yur dctr r clinic. Helpful Resurces Cardiac Services BC BC Heart Failure Heart and Strke Fundatin f Canada Canadian Heart Rhythm Sciety Heart Rhythm Sciety HealthLinkBC Phne: Phne: fr deaf r hard f hearing Medtrnic Device Cmpany Website Abbtt / St. Jude Medical Bstn Scientific Bitrnik Srin CSBC ICD Patient Resurce July

12 July 2018