Manning returns to Cuba for pacemaker

PRIME MINISTER Patrick Manning returns to Cuba this weekend to have a pacemaker inserted. According to a statement from his office yesterday, the decision was based on the advice of medical practitioners following the routine medical analysis done on his heart in Cuba last week. The statement said, “This procedure, pending for some time, will take approximately 45 minutes and will be performed under local anaesthetic.” On April 21, 1998, Manning (who was Opposition Leader at the time) went to Cuba and underwent a three-and-a-half hour operation to repair two valves in his heart.

The Prime Minister went to Cuba last week for a check-up on his heart because the doctors who performed the initial procedure would have been in the best position to make a proper diagnosis. This week, Health Minister John Rahael spoke about the positive effects the Cuban doctors were having on the delivery of health care to the population, particularly in remote areas of TT. The Medical Professionals Association of TT, however, has questioned the qualifications of these doctors and Government’s rationale for bringing them into the country.

Manning will be out of the country for four days and Community Development and Community Development and Gender Affairs Minister Joan Yuille-Williams will act as Prime Minister. Asked about the state of the Prime Minister’s health at yesterday’s post-Cabinet news conference at White Hall, Public Administration Minister Dr Lenny Saith said Manning chaired Cabinet as usual and he appeared to be in good health. Education Minister Hazel Manning smiled knowingly as Dr Saith gave his response to reporters.

Minor surgery to implant pacemaker

A PACEMAKER is a treatment for dangerously slow heartbeats. Without treatment, a slow heartbeat can lead to weakness, confusion, dizziness, fainting, shortness of breath and death. Slow heartbeats can be the result of metabolic abnormalities or occur as a result of blocked arteries to the heart’s conduction system. These conditions can often be treated and a normal heartbeat will resume. Slow heartbeats can also be a side effect of certain medications in which case discontinuation of the medicine or a reduction in dose may correct the problem. Sometimes, however, the conduction system of the heart becomes irreversibly damaged for any one of a number of reasons.

And some people require medications that cause slow heartbeats as a side effect in order to prevent other serious problems. Since there is no medication that one can take on chronic basis to speed up the heart rate, a pacemaker is the only solution. Fortunately, having a pacemaker implanted is only a minor surgical procedure. This is not open heart surgery. After a pacemaker is implanted, most people resume their previous lifestyle with little or no limitations. The procedure is performed with mild sedation and a local anesthetic. Patients are not put to sleep. A two-inch incision is made parallel to and just below a collar bone.

Pacer wires are then inserted into a vein that lies just under the collarbone and advanced through that vein under fluoroscopic guidance into the heart. The other end of the pacer wires are connected to a “generator” that is implanted under the skin beneath the collar bone. This generator is about half an inch deep and one and a half inches wide. The skin is then sutured closed and the patient leaves the hospital later that same day or the following day. Incisional pain is mild and transient and usually responds to Tylenol. It is possible to feel the pacer generator under the skin and a slight deformity of the skin can be visually noticed. Patients may not shower for a week after the procedure to keep the incision dry and should avoid excessively exerting the arm on the side the pacer was placed for that week. After a week, the patient may resume their prior lifestyle without limitation.

Household appliances do not interfere with modern day pacemakers. However, cellular phones may. These should be kept 12 inches away from the pacemaker when on — preferably at the ear on the opposite side of the pacemaker. Never leave the cell phone in a pocket overlying the pacemaker. Patients with pacemakers should avoid powerful electromagnetic fields which may reprogramme the pacemaker. MRI (magnetic resonance imaging) scans cannot be performed on patients with pacemakers for that reason. The pacemaker generator contains a lithium battery and what is, essentially, a little computer. The generator can communicate with an external device placed on the skin overlying the pacemaker. Through this device, a physician can change the programming of the pacemaker to best suit the individual patient’s needs and investigate the status of the pacemaker. Some pacemakers also report on the performance of the patient’s heart.

After surgery, PM must be careful with cell phones

A pacemaker will not require Prime Minister Patrick Manning to change his lifestyle, but he will have to avoid metal detectors and any device that will give off electronic waves, said cardiologist Dr Roy Tilluckdharry. A pacemaker is an electronic device that stimulates or regulates the heartbeat by sending electrical impulses to one or more chambers of the heart. According to HeartCentreOnline, people with pacemakers are advised to exercise caution in certain situations: avoid walking through metal detectors or spending any length of time near store security gates or entrances; avoid magnetic resonance imaging machines and tests.

They should also “hold cell phones at least 12 inches from the pacemaker at all times, even if the phone is turned off. Use and store the cell phone on the side of the body opposite the location of the pacemaker.” Dr Tilluckdharry said insertion of a pacemaker was a common procedure today. He said many years ago, approximately 24 were done annually. Describing the procedure, he said, “An incision is made below the collarbone and the pacemaker inserted, a wire is threaded through a vein and the surgeon moves the wire down to the right ventricle of the heart, then the pacemaker is implanted on the pectoral muscles under the skin.” The pacemaker begins working when it senses a slowing down of the heartbeat. Dr Tilluckdharry said the batteries in the pacemaker should be changed between five and ten years.

The patient’s heart defect will determine whether a single or dual chamber pacemaker is used. The cardiologist said dual chamber pacing involves putting a pacemaker into the atrium and ventricle. This device ensures synchronicity of the heartbeat and “better quality of life.” A single chamber pacemaker can cost approximately US$14,000 and the dual US$35,000. A pacemaker does not prevent a heart attack. “The heart attack results from disease of the artery, the pacemaker is only helping one aspect of the heart.”