Risks of Medical Devices on the Patients with Congestive Heart Failure - Research Paper Example

What are the Possible Complications / Risks of Medical Devices in the Treatment of Patients with Congestive Heart Failure? Introduction Globally, congestive heart failure (CHF) affects more than 22 million people. Before, this life-threatening disease could only be treated with medication, changes in lifestyle, and heart surgery. On the other hand, not all patients, especially those with more serious indications, find relief from these possible treatment practices. In addition, almost half of CHF patients have arrhythmia, an irregular heartbeat (“Cardiac Resynchronization Therapy”). Treatment of heart failure may include medication, such as angiotensin converting enzyme (ACE) inhibitors that lessen the pressure in the blood vessels; beta blockers that reduce the heart’s tendency to beat faster; and antiarrhythmia medications that keep the rhythm regular and prevent sudden cardiac death. In some cases, patients with heart failure may need implantation of mechanical devices, such as pacemakers and cardioverter defibrillators or ICDs (Saxon et al). This paper will discuss the different kinds of mechanical devices that can be used for the treatment of congestive heart failure. Risks and complications associated with the use of these devices will likewise be tackled. What is Congestive Heart Failure? Congestive heart failure or heart failure is a condition in which the heart cannot pump sufficient oxygenated blood to meet the needs of the other organs of the body. CHF causes pumping malfunctions of the heart in either the left or right side. In some cases, both sides are impaired. Oxygenated blood from the lungs goes to the left ventricle of the heart which is then pumped to the other body organs (Berger). Malfunction of the heart’s pumping ability may cause blood to collect in areas of the body, such as the lungs, liver, kidney, gastrointestinal tract and arms and legs, causing oxygen and nutrition losses. These losses decrease the organs’ capacity to work efficiently (Berger). Congestive heart failure may result from underlying heart problems, such as coronary artery disease; cardiomyopathy; congenital heart disease; heart valve disease, infections of the heart valve and heart muscles; and arrhythmias. Hypertension, anemia, hemorrhage, and diabetes are also contributory to heart failure (Berger). Cardiologists may suggest mechanical device implantation of single or dual chamber pacemaker to help regulate the heart’s normal rate; a biventricular pacemaker or cardiac resynchronization therapy (CRT) to help both sides of the heart in simultaneously synchronizing contractions and improving pumping capacity; and an implantable cardioverter-defibrillator (ICD) that detects when the heart is beating rapidly and converts the fast rhythm to a normal rhythm (Berger). Pacemakers Generally, a pacemaker’s purpose is to monitor and ensure efficient rate of heartbeats in CHF patients. It uses indiscernible electrical impulses to stimulate the beating of the heart. Nearly all pacemakers are equipped with two electrode wires leading to the left and right ventricles. Pacemakers can be externally programmed by a cardiologist to adjust the most favorable pacing modes for individual patients, improving synchronization of both upper and lower heart chambers (“Cardiac Resynchronization Therapy”). Types of Pacemakers A single-chamber pacemaker has only one lead that is positioned into either the atrium or the ventricle. It delivers electrical impulses to and from the atrium when placed in the atrium and transmits impulses to and from the ventricle when positioned in the ventricle. The cardiologist chooses the position of the single lead, depending on the basis and characteristics of the slow heart rate (“Pacemaker – Electronic Device for the Heart Condition”). A dual chamber pacemaker has two leads, one to the right atrium and one to the right ventricle. It mimics the heart’s natural pacing activities. A dual chamber pacemaker is more advanced than a single chamber pacemaker. Electrical signals are transmitted to and from both the right ventricle and the right atrium, allowing simultaneous harmonized pacing and contractions of the atrium and ventricle, thus restoring and maintaining a regular heartbeat (“Pacemaker – Electronic Device for the Heart Condition”). Dual Chamber versus Single Chamber Ventricular Pacemakers Pacemakers send electrical impulses to one or more chambers of the heart. These impulses help the heart to contract in a normal rhythm. A single chamber pacemaker has one lead that paces only one of the heart’s pumping chambers. A dual chamber pacemaker paces both pumping chambers of the heart. Although more costly, a dual chamber pacemaker is more effective than a single chamber pacemaker because it gives a more natural synchronization to the heart by sustaining atrioventricular and sinus node synchronization. Patients with dual chamber devices have lower risk of fatalities, stroke and hospitalization. These patients have better survival and enhanced quality of life. On the other hand, a big percentage of CHF patients today receive only the single chamber pacing (Dretzke et al). Possible Complications of Pacemaker Implantation The safety and reliability of pacemaker implantation are ensured only when performed by a certified cardiologist or electrophysiologist. The mortality rate attributable to direct complications of pacemaker implantation is below 1 in 10,000 patients. Complications may comprise hemorrhage, bruising, and site infection. Accidental entry of air in between the lung and chest wall, puncture of the heart, stroke, cardiac arrest, and injury to blood vessels are also possible complications. Because of its modern sophistication, dual-chamber pacemakers are highly at risk to problems of abnormal racing of the heart. The leads are more susceptible to failure. Several patients may need only a single chamber pacemaker implantation (“Pacemaker – Electronic Device for the Heart Condition”). Cardiac Resynchronization Therapy Cardiac resynchronization therapy (CRT) is a modern and beneficial therapy that can alleviate CHF indications by developing better synchronization of the heart’s contractions. CRT device corrects the timing of the heart’s contraction, thereby keeping CHF patients from irregular heart patterns (“Cardiac Resynchronization Therapy”). Heart failure patients suffering from arrhythmia are best candidates for cardiac resynchronization therapy. Through the leads and into the heart muscle, small amounts of electrical energy are delivered. This energy causes the heart’s lower chambers to beat in harmony. When synchronization is achieved, sufficient amount of oxygenated blood is distributed throughout the body (“Cardiac Resynchronization Therapy”). CRT device has 2 or 3 leads or wires, one lead is implanted through a vein in the right atrium; one in the right ventricle and one into the coronary sinus vein to pace the left ventricle. The device generates electrical impulses that navigates from the wires to the heart muscle. These impulses cause the right and left ventricles to pump in synchrony. The two-way pacing of the CRT device is also called “bi-ventricular pacing”. Overall, CRT improves cardiac function (“Cardiac Resynchronization Therapy”). Complications with Cardiac Resynchronization Therapy Implantation A considerable number of CRT implantation fail to work due to incorrect positioning of the leads in the left ventricle of the heart. Other complications comprise trauma of coronary vein, collapsed lung, injury to diaphragmatic nerve, and site infection (Mc Alister et al). In a study performed by Finlay Mc Alister and his associates, “Cardiac Resynchronization Therapy for Patients with Left Ventricular Systolic Dysfunction: A Systematic Review,” out of 6123 patients who underwent CRT implantation, 7% was unsuccessful; 0.3% died during surgery; 5% had device malfunction; 2% were hospitalized due to site infection; and 7% had lead problems (Mc Alister et al). In a research done by Kostas Perisinakis and his associates, “Fluoroscopically Guided Implantation of Modern Cardiac Resynchronization Devices: Radiation Burden to the Patient and Associated Risks,” it was found out that there are no marked indications of skin injuries caused by radiation from fluoroscopy after implantation of fluoroscopically-guided cardiac resynchronization device unless improperly implanted. With young patients, risk of cancer from radiation should be studied (Perisinakis et al). Implantable Cardioverter Defibrillator An implantable cardioverter defibrillator is used in patients susceptible to persistent, ventricular tachycardia or fibrillation. The ICD is attached to wires placed on the heart’s surface or inside the heart, to detect cardiac pacing and to correct it by sending electric impulses. The wires are connected to a “pulse generator” and inserted in a pouch under the chest skin. ICDs are usually slightly bigger than a wallet, constantly monitoring heart rate and heart rhythms, sending electric impulses whenever the ICD detects an abnormal activity of the heart. Many modern ICDs are smaller and can conveniently be inserted through blood vessels, thereby reducing the necessity for an open heart surgery (“Implantable Cardioverter Defibrillator”). Implantable cardioverter defibrillators reduces occurrences of cardiac arrest in (CHF) congestive heart failure patients; and constant ventricular tachycardia or fibrillation. Researches are now being conducted as to the effectiveness of ICDs in guarding sudden death to high-risk patients suffering from severe ventricular arrhythmia (“Implantable Cardioverter Defibrillator”). Risks of Having Implantable Cardioverter Defibrillator Inappropriate firing of electrical shocks are the most observed problem of patients with ICD implantation. Arrhythmias due to excessive physical activity or a perforated wire; and the patient’s neglect of regular medicine intake can also cause unnecessary pulses (“Risks of Implantable Cardioverter Defibrillator”). Young patients who have ICDs have a higher risk of receiving needless pulses or shocks because children exert more physical energy than adults. Unnecessary shocks can cause heart injury and abnormal heartbeat. If this happens, the cardiologist can reset the ICD program and give proper medication to stop these unnecessary shocks from recurring (“Risks of Implantable Cardioverter Defibrillator”). The procedure of ICD implantation pose some risks to patients. These risks include site infection where the ICD was implanted; injury to the vein where ICD leads are attached; bleeding around the heart; allergic reaction to the anesthesia used during the procedure; swelling, bruising and bleeding at implantation site; and blood-leak through the heart valve where ICD was implanted. Patients with ICDs have higher risk for congestive heart failure, heart attack, and post-operative stroke (“Risks of Implantable Cardioverter Defibrillator”). There are also possible serious dangers associated with the improper functioning of the ICD device once it is in place. Malfunction of the ICD may hinder the device’s primary function of correcting abnormal heart rhythms. In that case, only a certified and qualified cardiologist can reprogram or replace the ICD (“Risks of Implantable Cardioverter Defibrillator”). Conclusion The rate of mortality for congestive heart failure is alarmingly high. To ensure that the heart pumps enough oxygenated blood throughout the rest of the body, some CHF patients may need the use of mechanical devices. Cardiac transplantation is an alternative for those patients suffering from severe heart failure. However, because of organ donor unavailability, there is a possibility that patients will die before getting a donor. The lengthy wait and the heart donor shortage necessitates the search for alternative solutions to sustain patients with heart failure. Moreover, other major organs such as the kidney and liver may be permanently injured before the patient has cardiac transplantation (“Congestive Heart Failure”). Therefore, there is a strong reason and necessity for use of mechanical devices as a substitute to cardiac transplantation. Although pacemakers and cardioverter defibrillators are lifesaving, they are not long-term solutions. Moreover, there are reported complications associated with the use of these mechanical devices either during or after the implantation. These complications may be caused by unsuccessful implantation, device malfunction, site infection and lead problems. Complications of electronic device implantation increase as the level of device sophistication increases. Proper education of patients and their families, health providers, and the public will facilitate protection of patients with implanted electronic devices from complications and risks. Works Cited Berger, Alan. “Heart Failure.” Medline Plus Medical Encyclopedia. 2009. 29 Jan. 2010. “Cardiac Resynchronization Therapy.” Heart Rhythm Society. n.d. 29 Jan. 2010. “Congestive Heart Failure.” University of Virginia Health Systems. 2008. 29 Jan. 2010. Dretzke, Janine et al. “Dual chamber versus single chamber ventricular pacemakers for Sick sinus syndrome and atrioventicular block.” Cochrane Database of Systematic Reviews. 2004. 29 Jan. 2010. “Implantable Cardioverter Defibrillator.” American Heart Association. 2010. 29 Jan. 2010. Mc Alister, Finlay A. et al. “Cardiac Resynchronization Therapy for Patients with Left Ventricular Systolic Dysfunction: A Systematic Review.” Journal of American Medical Association. 2007. 297:22. “Pacemaker – Electronic Device for the Heart Condition.” Medicine net. 2010. 29 Jan. 2010. Perisinakis, Kostas et al. “Fluoroscopically Guided Implantation of Modern Cardiac Resynchronization Devices: Radiation Burden to the Patient and Associated Risks.” Journal of the American College of Cardiology. 2005. 46:2335. “Risks of Implantable Cardioverter Defibrillators.” National Institute of Health. n.d. 29 Jan. 2010. Saxon, Leslie A. et al. “Cardiac Resynchronization Therapy in Heart Failure.” Up to Date. 2009. 29 Jan. 2010. Read More