Completely amazing, simple and effective. i m waiting for the part 2. Also, i hope u'll make a part 3 self-assessment for the chest x ray serie. That would be wonderful. Thank you again for your efforts.
Appears to me you have mostly comments from medically interested people. Here's something a little different. I just got my pacemaker installed 6 weeks ago. Mine was installed thru the groin while I was awake. Currently trying to learn a different lifestyle. Thanks for the info.
I know there are usually precautions the Patient must take once a pacemaker is placed: ie. no lifting of you arm above shoulder height on the side the pacemaker has been placed, avoid heavy lifting etc..my questions are: 1.) Are these precautions usually for both permanent and temporary pacemakers? 2.) Will the arm that You’re not supposed to lift above shoulder height always be ones Left arm, where the heart is located OR does it mean if the wires are placed in the R atrium/ventricle, then not to raise your R arm? Thanks for your help!
For a permanent pacemaker, the precautions are for the arm on the side where the generator (i.e. the "box") is implanted (usually the left side), and last 4-6 weeks at which time there is usually a device check to ensure that capture thresholds are still good. The term "temporary pacemaker" most commonly refers to transvenous pacemakers which are much more tenuous since the generator and controls are external to the body. Different hospitals and different countries might approach temp pacemakers differently, but at the hospitals I've worked at, anyone with a transvenous pacemaker needs to be in the ICU or an intermediate ICU, and can only ambulate short distances with direct assistance from a nurse (in addition to the arm precautions on the side where the pacing wire exits the body (which can either be left or right, but in my anecdotal experience is more commonly right).
Sir I am an avid fan of yours. Could you please make a radiology series on abdomen like you did on X rays, It would be so much helpful for junior doctors!
Implantation of pacemakers are usually done on the left, even in left-handed individuals, primarily because it is a technically easier procedure since the leads (i.e. wires) are advanced into the right side of the heart as one continuous curve. When placing devices in the right upper chest, the leads need to make several slight turns within the blood vessels. There are some exceptions to this placement preference - for example, if the patient has an AV fistula for dialysis in the L arm, or if there is an anatomic obstruction such as a left subclavian thrombus, the cardiologist would typically place the device on the right side. ICDs are (almost) always placed on the left because the "can" (i.e. the generator) itself is part of the defibrillation circuit, and the closer proximity to the heart on the left is believed to increase the probability of a successful defibrillation.
That will be the topic of an upcoming video within the ECG series. I'm hoping to post it by early fall, depending on how the pandemic progresses over the next month here in California.
@@StrongMed Thank you sir. That would be of great help to us. I always look forward to your videos. Although I am practicing in India with some differences in demography of pt and law related to Medicine but knowledge you provide gives us new perspective to look at the subject/topic.
Yes, this seems like it should be possible and has been proposed before, but it never gained any traction. After seeing your comment, I asked an electrophysiologist about it and she had no idea why it wasn't a thing. Right now, the futurists of medicine seem more excited about technology like biomechanically charged pacemakers that get their energy from the motion of the heart beating itself (which is pretty cool, if it ever works). www.nature.com/articles/s41569-019-0208-z
@@StrongMed wait what instead of just putting a coil in and charge it every few years we over engineer the problem Why not And if your heart stops your pretty fucked if it can't generate any more power To be fair if that happens you have bigger problems
Why would they use a simple battery setup that needs to be replaced with surgery? It would seem a better option would be wireless charging against the skin on the patient
There are several reasons that a wireless rechargeable battery has not taken off with pacemakers. A few: - Depending on the specific device and its needs, the conventional pacemaker battery can last 5-10+ years. Rechargeable batteries don't necessarily last longer. - When the battery is replaced every 5-10 years, it's not just the battery that gets replaced, but the entire device (minus the leads). With pacemaker technology continually improving, this allows patients the benefit of having devices with new features that their original lacked. This can include improved ability to change programing parameters, and different methods of rate-responsiveness. Having said that, there is work being done on a battery-less pacemaker (or more strictly speaking, a pacemaker with a trivially small battery) which uses the kinetic energy of the heartbeat to generate the electrical energy and current that triggers the next heartbeat. These devices also lack leads/wires, which is a significant advantage since the wires are the most common cause of pacer malfunction and pacemaker infection. However, they can only pace one chamber, when most patients' condition requires pacing of at least 2 chambers in order to maintain synchrony of cardiac contraction.
@@StrongMed i personally would rather have the rechargeable battery and wireless charging pad in my nipple, even if I had to recharge every 3 years its just a quick thing of putting the pad up to the nipple for some juice. To me having to go under the knife is always best to be avoided, I would rather keep a rechargeable can then go under the knife again... I wouldn't care about getting a newer more feature packed version if the one I had worked. But that's just me. Thanks for your response, have a wonderful day.
Excellent breakdown as always. I love how your topics are always relevant to clinical practice, and simple to understand. Thank you!
Simple and straight forward.
Thank you!
Thank you so much for this video! I am a 4th year med student on my cardiology rotation. This is extremely helpful!
So glad I was able to find your UA-cam channel again! UA-cam had conveniently unsubscribed me from your channel among others.
Thank you for your time and effort.
simple clarified as your usual
Thanks Dr. for your great efforts
stay safe
Excellent teaching presentation 👌
It was very helpful. Thank you so much.
Thank you sir as always superb ..
Cristal clear thank you Sir
Vital content and engaging presentation
Thank u so much for this comprehensive video
Thank you for sharing 🙏💫🤞
Completely amazing, simple and effective. i m waiting for the part 2.
Also, i hope u'll make a part 3 self-assessment for the chest x ray serie. That would be wonderful.
Thank you again for your efforts.
Very helpful thanks.
Brilliant breakdown of the topic…. 📖
Thank you!
Thank you sir!
Appears to me you have mostly comments from medically interested people. Here's something a little different. I just got my pacemaker installed 6 weeks ago. Mine was installed thru the groin while I was awake. Currently trying to learn a different lifestyle. Thanks for the info.
This amazing❤
Thank you , invaluable video. How soon can one travel on aeroplane after insertion of pacemaker
Thank Sir.
SUPER!!!!!
I know there are usually precautions the Patient must take once a pacemaker is placed: ie. no lifting of you arm above shoulder height on the side the pacemaker has been placed, avoid heavy lifting etc..my questions are: 1.) Are these precautions usually for both permanent and temporary pacemakers? 2.) Will the arm that You’re not supposed to lift above shoulder height always be ones Left arm, where the heart is located OR does it mean if the wires are placed in the R atrium/ventricle, then not to raise your R arm?
Thanks for your help!
For a permanent pacemaker, the precautions are for the arm on the side where the generator (i.e. the "box") is implanted (usually the left side), and last 4-6 weeks at which time there is usually a device check to ensure that capture thresholds are still good. The term "temporary pacemaker" most commonly refers to transvenous pacemakers which are much more tenuous since the generator and controls are external to the body. Different hospitals and different countries might approach temp pacemakers differently, but at the hospitals I've worked at, anyone with a transvenous pacemaker needs to be in the ICU or an intermediate ICU, and can only ambulate short distances with direct assistance from a nurse (in addition to the arm precautions on the side where the pacing wire exits the body (which can either be left or right, but in my anecdotal experience is more commonly right).
Strong Medicine Thank you so much for that helpful explanation and the great videos/content! It’s appreciated :)
Sir I am an avid fan of yours. Could you please make a radiology series on abdomen like you did on X rays, It would be so much helpful for junior doctors!
Great video. Anyone knows the difference between CRT; ICD and pacemaker?
Can you lpease tell me the differece of implan in the right side,most of the implan is in the left
Implantation of pacemakers are usually done on the left, even in left-handed individuals, primarily because it is a technically easier procedure since the leads (i.e. wires) are advanced into the right side of the heart as one continuous curve. When placing devices in the right upper chest, the leads need to make several slight turns within the blood vessels. There are some exceptions to this placement preference - for example, if the patient has an AV fistula for dialysis in the L arm, or if there is an anatomic obstruction such as a left subclavian thrombus, the cardiologist would typically place the device on the right side.
ICDs are (almost) always placed on the left because the "can" (i.e. the generator) itself is part of the defibrillation circuit, and the closer proximity to the heart on the left is believed to increase the probability of a successful defibrillation.
Sir! could you also explain ECG associated with permanet pacemaker.
That will be the topic of an upcoming video within the ECG series. I'm hoping to post it by early fall, depending on how the pandemic progresses over the next month here in California.
@@StrongMed Thank you sir. That would be of great help to us. I always look forward to your videos. Although I am practicing in India with some differences in demography of pt and law related to Medicine but knowledge you provide gives us new perspective to look at the subject/topic.
hi please help me,how many pounder may i lifting up { pacemaker}
I'm sorry, but I cannot offer specific, individualized medical advice here.
when are the other videos coming.......cant wait!!!!
Plan on posting part 2 on this upcoming Sunday, and part 3 on the Sunday after that.
Magufulii
Couldn't you charge the pacemaker with induction, so you don't need to charge them anymore
Yes, this seems like it should be possible and has been proposed before, but it never gained any traction. After seeing your comment, I asked an electrophysiologist about it and she had no idea why it wasn't a thing. Right now, the futurists of medicine seem more excited about technology like biomechanically charged pacemakers that get their energy from the motion of the heart beating itself (which is pretty cool, if it ever works). www.nature.com/articles/s41569-019-0208-z
@@StrongMed wait what instead of just putting a coil in and charge it every few years we over engineer the problem
Why not
And if your heart stops your pretty fucked if it can't generate any more power
To be fair if that happens you have bigger problems
ANYONE HERE FROM MEDICAL INSTRUMENTATION CLASS?
Why would they use a simple battery setup that needs to be replaced with surgery?
It would seem a better option would be wireless charging against the skin on the patient
There are several reasons that a wireless rechargeable battery has not taken off with pacemakers. A few:
- Depending on the specific device and its needs, the conventional pacemaker battery can last 5-10+ years. Rechargeable batteries don't necessarily last longer.
- When the battery is replaced every 5-10 years, it's not just the battery that gets replaced, but the entire device (minus the leads). With pacemaker technology continually improving, this allows patients the benefit of having devices with new features that their original lacked. This can include improved ability to change programing parameters, and different methods of rate-responsiveness.
Having said that, there is work being done on a battery-less pacemaker (or more strictly speaking, a pacemaker with a trivially small battery) which uses the kinetic energy of the heartbeat to generate the electrical energy and current that triggers the next heartbeat. These devices also lack leads/wires, which is a significant advantage since the wires are the most common cause of pacer malfunction and pacemaker infection. However, they can only pace one chamber, when most patients' condition requires pacing of at least 2 chambers in order to maintain synchrony of cardiac contraction.
@@StrongMed i personally would rather have the rechargeable battery and wireless charging pad in my nipple, even if I had to recharge every 3 years its just a quick thing of putting the pad up to the nipple for some juice.
To me having to go under the knife is always best to be avoided, I would rather keep a rechargeable can then go under the knife again... I wouldn't care about getting a newer more feature packed version if the one I had worked.
But that's just me.
Thanks for your response, have a wonderful day.