breath

[김경희 인천세종병원 심장이식센터장] My grandmother, who is now 59 years old, had no underlying disease, but since a year ago, breathing difficulty got worse just walking, so she went to another hospital to see the possibility of angina. listened to and took medication. After taking the medication for more than 6 months, her breathing difficulties did not improve at all, so she visited the hospital for a second opinion.

At the time of admission, the electrocardiogram was normal, but the pulse was beating very slowly (normally, about 60 to 100 beats were normal, but in this patient, it was beating slowly about 40 beats), and the X-ray showed a rather large heart. Among the medications the patient was taking, some of the medications for angina pectoris may slow the pulse, so stop the medication and adjust medications including diuretics because there is a possibility of heart failure. I placed an order for a blood test. Two days after adjusting the medication, the patient called and said that he often collapsed and had dizziness.

Although a very small amount was used, some of the heart failure medications also slowed the patient’s pulse and could cause dizziness, so stop it first and see the echocardiogram. Bradycardia was present internally and externally. Fortunately, the function of the left ventricle was normal, and it was judged that the slow pulse caused breathing difficulties in the patient. Atrial fibrillation was observed, which was not in the outpatient setting. consulted

In the 48-hour electrocardiogram, the patient had a mixture of atrial fibrillation and normal sinus rhythm, and in atrial fibrillation, rapid and slow pulses were repeated and the heart stopped beating for more than 8 seconds as it changed to a sinus rhythm (normal rhythm). As a result, the patient caused dizziness, and when there was a fast pulse, palpitations occurred, when there was a slow pulse, dizziness and shortness of breath occurred. So, after discussing the date with the patient, we decided to put a pacemaker in and proceeded to hospitalization. There was some pain on the first day after the pacemaker was inserted, but the difficulty in breathing and dizziness largely disappeared from the next day, and after 3-4 days, the patient was discharged.

The patient had sinus node dysfunction, sinus node syndrome, and tachycardia-bradycardia syndrome. Words can be too difficult, but the heart sends out an electrical signal on its own to make it beat itself, and there is a way to transmit that signal. In a normal case, a place called the sinus node located at the top of the right atrium makes a periodic electrical signal, and this signal transmits an electrical signal like a wire through the electrical conduction in the heart, causing both ventricles to contract.

It is very interesting and there are many times when I admire how the Creator made a heart like this. When a malfunction of the sinus node that produces the electrical signal of the heart occurs, the electrical signal does not come out properly, resulting in arrhythmias, and symptoms such as dizziness and difficulty breathing while the heart stops beating. In severe cases, the heart may not be beating for a long time and then collapse.

The most common cause is aging, but side effects of drugs, electrolyte imbalance, genetic diseases, complications after acute myocardial infarction, heart valve disease, and cardiomyopathy can also occur. Although the prevalence increases with age, it can occur at any age, so some of my patients have a pacemaker implanted in their 30s or 40s. Sometimes there are no symptoms at rest, but it is confirmed by showing functional impairment during exercise. Usually, it is suspected with clinical symptoms and electrocardiogram, and there are cases where it does not appear on electrocardiogram, which is taken only for 10 seconds in the outpatient department, like the above patients. tests are also performed.

Electrophysiology test is a test that induces arrhythmias by placing several electrical conductors in various parts of the heart through the femoral vein and arteries, recording local electrical changes in the heart at the time of arrhythmia, and stimulating them. These days, you can measure yourself with a watch, and the ECG has a smaller size for 24 or 48 hours compared to the past, so its convenience has improved compared to the Holter that was previously tested.

Symptoms may not be evident unless the severity of sinus dysfunction is severe. However, if there are symptoms such as shortness of breath, dizziness, lethargy, and electrocardiogram abnormalities that can be considered as sinus dysfunction syndrome, a permanent artificial pacemaker is inserted as in the above patient. However, before inserting a pacemaker, it is necessary to carefully examine whether there is a reversible cause. An artificial pacemaker is inserted after checking for drugs, thyroid dysfunction, or valve disease that needs to be corrected. Because the patient has atrial fibrillation, anticoagulant therapy should be administered concurrently.

In the case of an artificial pacemaker, although it varies from patient to patient, the battery needs to be changed every 5 to 10 years, and a pacemaker test must be performed regularly every 6 months to 1 year. All daily activities are possible and exercise is possible, however, it is recommended to raise the arm after the electrode wire is in place where the battery is located, so it is recommended to raise the arm after about 3 months. . Previously, it was sensitive to magnetic fields such as MRI, but recently machines can also perform MRI. However, it is necessary to inform the medical staff before taking an MRI. Present your pacemaker identification card at the airport checkpoint so that it does not pass through the metal detector. In addition, X-ray, CT, ultrasound, dental treatment, and household appliances are mostly safe, so there is no need to worry too much. I’ll give you an explanation.

Recently, a wireless pacemaker has emerged that can be inserted into the heart through the femoral vein without skin incision, leaving no scars, fast recovery after the procedure, and solving the wire problem, but it is not yet applicable to all patients. However, it is certain that medical care is gradually developing and methods are being developed to find and treat patients’ diseases more quickly and more conveniently. I think the secret to living a long and healthy life is to know about one’s body well and to find the right treatment method by consulting with a specialist.