Cardiomyopathy and Implantable Cardioverter Defibrillator?

Question

I was just informed by the Cardiologist that I need a defibrillator implanted in my chest. My heart condition (Cardioyopathy) has become very serious and I am at risk for "sudden death". My doctor has me very frightened. I have looked up a lot of information online and what I read also scares me. I'm afraid of the possible adverse effects, I am worried about how the scar and appearance of how the defibrillator will look since it will be inserted just under the skin beneath my collar bone. Will it distort the smooth look of clothing and will it be seen when I wear a low neck outfit? I know I have no other choice but have the surgery. But I am worrying myself sick. This surgery was to be scheduled as soon as possible, but because I also need a hysterectomy at this time (tumor on my ovary) the doctor now wants to wait to do the defibrillator after the hysterectorectory in case it's malignant and I need radiation. I am absolutely LOST. I hope someone has an answer for me.

Answer 1

What is the nature of your cardiac problem, that the Cardiologist wants to put a defib. in your heart. one thing you should be rest assured that the treatment of cardiomyopaties has changed a complete U turn. I agree with the decision of your cardiologist, he is excellent, and you are in safe hands.
I fully agree with him. As far as the scar is concerned I do not think so it will be a problem , it will be checked out by your doctor.
Go ahead with it, your life is important not the scar.
Best of luck.

Answer 2

I feel for you. Tumors and cardiomyopathy are a real double whammy.

I think it's great that you are asking these questions. You seem to be on the right track, but are looking for some answers. I'll try to give you some pointers to information that you will find useful.

First, if your cardiologist is talking about putting in an ICD, it is probably because your EF has fallen below the 30-35% threshold they use for such things. However, if you have not exhibited any signs of arrhythmia yet, it is probably not urgent to get it implanted. Furthermore, if they add an ICD, they should also consider the need for a bi-ventricular pacemaker. That depends on the dyssynchrony of you heart and the QT interval, to some extent.

Good surgeons are getting much better at implanting ICDs and pacemakers so that they are less noticeable. They can make a pouch for it underneath your pectoral muscle, so that there is no noticeable bump. They can also do a much better job of minimizing scars, potentially even using a plastic surgeon to remove scar tissue after the fact. So ask about that, if you can.

If you don't already see a doctor that specializes in cardiomyopathy, I strongly recommend that you get a second opinion. It sounds like your cardiologist is giving you good advice, but the field is changing so quickly that it's definitely worth getting that extra opinion.

Yes, the prognosis for those with cardiomyopathy has improved by leaps and bounds. Pacemakers and ICDs are the latest innovations that have contributed to these improvements, so you shouldn't be too freaked out. There are quite a few being implanted nowadays!

Information sources and groups of interest:
http://www.chfpatients.com/ -- click on "Read the Manual". This is a phenomenal source of information for those dealing with cardiomyopathy, written by a man who has been fighting it for years, but checked by heart failure doctors for accuracy.

http://www.cardiomyopathy.org/html/which_card_dcm.htm -- The Cardiomyopathy Association (UK-based) has very active bulletin boards where you can seek and find support on a variety of topics.

http://health.groups.yahoo.com/group/cardiomyopathy/ -- The cardiomyopathy Yahoo! group has a number of links to a variety of information sources and is also an active and supporting community. If nothing else, join and read some of th archives. Or feel free to ask more questions there.

Answer 3

An implantable cardioverter-defibrillator (ICD), also known as an automated implantable cardioverter-defibrillator (AICD) is similar to a pacemaker, the difference is that pacemakers are more often temporary and generally designed to consistently correct bradycardia, while AICDs are often permanent safeguards against sudden abnormalities. For obvious reasons, your doctor/surgeon prefers to proceed first with the hysterectomy before the implant because of the risk of radiation. You should follow the advice that you have received. Many other people have been in your position, and they too, have been concerned. Make an appointment with your doctor or your surgeon and discuss your concerns with him / her. They are well able to explain all the items that are giving you cause for concern. Their explanation should put your mind at ease and take the worry out of your life. This is not to belittle your medical conditions, as they are not minor concerns, but with knowledge you will find the strength to overcome your worry. You do not do anything wrong by browsing the internet for answers, but if you do not have much medical training, the answers can be quite frightening. It is possible that the surgeon may have some pictures or an actual AICD to show you how small it is and that it should not obtrude with your choice of dress.

Hope this helps
matador 89

Answer 4

The Cardioverter Defibrillator is important in your disease. It is sort of like a pacemaker, in that it goes under your skin with electrodes that are placed in the different areas of the heart. Cardiomyopathy puts you at risk for sudden death, which comes from a deadly arrhythmia of the heart. The specific arrhythmias it detects are ventricular fibrillation (VF)and ventricular tachycardia (VT).

VF is a condition where the ventricles of the heart just quiver, and they are not pumping blood effectively to any part of your body. Your body then dies from lack of oxygen and nutrients from the blood. VT is a very rapid heart rate, in which the ventricles contract too fast to fill with enough blood to pump through your system. Your body again dies because there is not enough oxygen and nutrients getting to the rest of your body.

The Defibrillator doesn't detect chemical signals in the blood, it detects the electrical rhythm of the heart. When the rhythm turns into VF or VT, the device shocks the heart, just as they do on ER where they put the paddles on the person's chest and say "Clear!" This device does it internally so that no other person has to use the paddles.

Unfortunately, though, the hysterectomy does take precedence in this case, because of the possible radiation. If your heart has problems during the surgery, you will be in the best place for management at that point. I would be interested to find out what type of cardiomyopathy you have (dilated, hypertrophic, restrictive). Good luck with everything, and I wish you the best.

Answer 5

Basically, the hysterectomy needs addressing first, If it is malignant, they will need to administer Radiotheraphy or chemotherapy. With this, both will change the settings of the implanted defibrillator. If that was to happen, they would have to remove it and put it back after adjucting it, therefore that would leave worse skin damage. So they will do that surgery first.

The defibrillator is essential for obvious reasons. Basically it is a tiny little device that when the heart begins to show signs of deteriorating (through chemicals in the blood given off by the brain) it gives a small electrical impulse to stimulate the heart muscles and to make them continue. There are some side effects, but these obviously outweigh the effects of not having one. It will leave a scar, but if it is a large amount of tissue damage, they may use a skin graft from your thigh. This means it will look more normal. It shouldn't affect your skin and your look too much. But it will be noticeable most likely. It has to placed close to the surface in case it ever needs removing etc.
Hope this shed a lil light on your problem and i wish you the best of luck
Matt

Answer 6

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Answer 7

Since African-Americans are at risk for high blood,strokes and diabetes, If your Dr. thinks you need a defibrillator I would do so. This procedure takes about 90minutes, no stitches and you maybe able to go home the same day.You will received pain medication. The ICD, will put the heart into normal rhythm if need be. I have heart failure and dilated cardiomyopathy, I have a heart failure pacemaker/defibrillator, without this device I would not be here. If heart transplant is being considered, sometimes the Dr.'s will use a device that will bridge you to transplant, this device surgically place, two tubes in and out of the body,that will allow the heart to rest, does the work for the heart while waiting for surgery.

Answer 8

I have had a, 'ICD' since 1998, it does not show under the skin but there is a scar about 4ins long just above the left breast, although this will fade considerably, I have also been back to have a new battery fitted but it wasn't much of a problem, the ICD's are a lot smaller than they use to be, they use to have to put them in your stomach area. If it goes off you end up back in hospital, but that has only happened to me twice, the first time was because my medication was not complete. They had to start giving me water tablets (Bumtanide and Spironolactone) You should also have other medication. eg: Imdur,Perindopril, etc. which will greatly reduce the chance of another attack, as you have survived this one 90% of your troubles are over.As for the Hysterectorectory I have no idea but they seem very common, although they may have to do this by local aneasetic