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Implantable Cardioverter Defibrillator
What you need to know about an implantable cardioverter defibrillator insertion:
An implantable cardioverter defibrillator (ICD) is a small device that monitors your heart rate and rhythm. It is placed inside your chest or abdomen. It may be used if you have an arrhythmia. An arrhythmia is an irregular heart rate or a heart rate that is too fast or too slow. Some arrhythmias may cause your heart to suddenly stop beating. An ICD can give a shock to your heart to make it start beating again. It can also make your heart beat faster or slower.
How to prepare for ICD insertion:
Your healthcare provider will talk to you about how to prepare for surgery. He may tell you not to eat or drink anything after midnight on the day of your surgery. He will tell you what medicines to take or not take on the day of your surgery. You may be given an antibiotic through your IV to help prevent a bacterial infection. You will need someone to drive you home and stay with you after the procedure. You will not be able to lift anything heavy. Ask your healthcare provider when you can return to work after your procedure.
What will happen during ICD insertion:
- You may be given general anesthesia to keep you asleep and free from pain during surgery. You may also be given a sedative and local anesthesia to numb the surgery area. With local anesthesia, you may still feel pressure or pushing during surgery, but you should not feel any pain. Your healthcare provider will make an incision in your chest or abdomen. A lead will be placed into a vein near your collarbone or neck and guided into your heart. You may have multiple leads placed into your heart.
- The other end of the leads are attached to the generator and placed in a pocket under your skin. This pocket is usually in the shoulder area, but may also be in the abdominal area. The generator has a metal shell with a battery and a small computer. The computer will monitor your heart rate and rhythm. If the computer senses an irregular heart beat it will send electricity from the generator through the leads to your heart. These electrical shocks will make your heart beat normally. Your healthcare provider will close the incision with stitches or staples. He may also place a bandage or tape over your incision.
How shocks from an ICD may feel:
You may not notice the low energy shocks from your ICD or they may feel like a flutter in your chest. The high energy shocks are very short. They may feel like thumping or a painful kick in the chest. Your healthcare provider may give you medicine to decrease the number of high energy shocks.
What will happen after ICD insertion:
You will be taken to a recovery room where you will rest until you are awake. You will be on a heart monitor. A heart monitor is an EKG that stays on continuously to record your heart's electrical activity. You may need a chest x-ray to make sure the ICD is in the right place. You may be able to leave when you are awake and your pain is controlled or, you may go to a hospital room and spend the night.
Risks of ICD insertion:
You may bleed more than usual or get a blood clot after surgery. You may get an infection. The leads could poke a hole in your heart, lung, or vein. The leads may also cause arrhythmias when they are placed. Blood may collect in the pocket where the generator is placed and cause pain or an infection. The leads may disconnect or break, and you may need another surgery. You may also need another surgery to replace the entire ICD. Your ICD may not shock your heart when it needs it. It may also shock more than it should.
Call 911 for any of the following:
- You have any of the following signs of a heart attack:
- Squeezing, pressure, or pain in your chest
- and any of the following:
- Discomfort or pain in your back, neck, jaw, stomach, or arm
- Shortness of breath
- Nausea or vomiting
- Lightheadedness or a sudden cold sweat
- You become weak, dizzy, or faint.
- You feel your heart skip beats or beat very fast or slow, but you do not feel a shock from your ICD.
- You feel lightheaded, short of breath, and have chest pain.
- You cough up blood.
- You have trouble breathing.
Seek care immediately if:
- Your arm or leg feels warm, tender, and painful. It may look swollen and red.
- Your stitches or staples come apart.
- Blood soaks through your bandage.
- You feel more than 3 shocks in a row from your ICD.
Contact your healthcare provider if:
- You have a fever.
- You feel 1 or more shocks from your ICD and feel fine afterwards.
- Your feet or ankles swell.
- The skin around your stitches or staples is red, swollen, or draining pus or fluid.
- You have chills, a cough, and feel weak or achy.
- You are sad or anxious and find it hard to do your usual activities.
- You have questions or concerns about your condition or care.
You may need any of the following:
- Heart medicine may be given to strengthen or control your heartbeat.
- Blood thinners help prevent blood clots. Examples of blood thinners include heparin and warfarin. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
- Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
- Tell your dentist and other healthcare providers that you take anticoagulants. Wear a bracelet or necklace that says you take this medicine.
- Do not start or stop any medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
- Tell your healthcare provider right away if you forget to take the medicine, or if you take too much.
- Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin:
- Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
- You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
- Prescription pain medicine may be given. Ask your how to take this medicine safely.
- Antibiotics help treat an infection.
- Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
Care for yourself at home:
- Apply ice on your wound for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
- Do not lift anything heavier than 3 pounds. Lifting may put too much stress on your incision. Ask your healthcare provider when you can lift heavy objects.
- Limit the use of your arm nearest to your ICD. Place your arm closest to the ICD in a sling. Wear as directed. This will help decrease swelling and pain. Prop your arm on pillows or blankets when you take off your sling to keep it elevated comfortably. Do not lift your arm closest to your ICD, over your heard for 5 days. Perform gentle range of motion exercises (ROM) exercises as directed to prevent arm and shoulder stiffness.
Safety instructions when you have an ICD:
Talk to your healthcare provider about driving and playing sports after you have an ICD placed. The following are instructions to keep you safe with an ICD:
- Carry an ID card for your ICD at all times. This card has important information about your ICD. Healthcare providers need to know if you have an ICD so they can keep you safe during medical procedures and tests.
- Wear medical alert jewelry that says you have an ICD. Ask your healthcare provider where to get these items.
- Stay away from magnets or machines with electric fields. Some MRI machines may be safe to use with your ICD. Ask your healthcare provider before you have an MRI. Avoid leaning into a car engine or doing welding. These things can interfere with how your ICD works.
- Keep your cell phone and MP3 player away from your ICD. Do not place your cell phone or MP3 player in a breast pocket over your ICD site. Use your cell phone with the ear on the opposite side from your ICD. Wear arm bands with cell phones or MP3 players on the opposite arm from where your ICD is.
- Tell airport security you have an ICD. You may need to be searched by hand when you go through a security gate. The security gate or handheld wand could harm your ICD.
- Keep an ICD diary. Record when you get a shock and what you were doing before you got the shock. Keep track of how you felt before and after the shock, as well as how many shocks you received. Write down the day and time of each shock. Bring the diary with you when you see your healthcare provider or cardiologist.
Learn how to take your pulse:
Check your pulse any time you feel light headed, dizzy, or short of breath. Use the second hand of a clock or a timer. Flip your hand with palms face up. Place your pointer finger and second finger onto the side of your wrist that is under your thumb. Apply gentle pressure. When you feel your pulse, count the number of beats in 15 seconds. Multiply this number by 4 to find the beats per minute. A normal pulse is 60 to 100 beats per minutes.
Care for your wound as directed:
Wear loose-fitting clothing over the ICD site. Do not get your wound wet until your healthcare provider says it is okay. Carefully wash the wound with soap and water. Dry the area and put on new, clean bandages as directed. Change your bandages when they get wet or dirty. Do not put powders or lotions over your incision. Check your wound everyday for signs of infections such as swelling, redness, or pus.
Follow up with your healthcare provider as directed:
Your healthcare provider will check your ICD frequently. He will place a special magnet over your ICD to check it. Information will be sent to a computer about your heart rhythm, and how well your ICD is working. Your ICD battery may need to be replaced every 5 to 7 years. Write down your questions so you remember to ask them during your visits.
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