“The human heart pumps blood to every part of your body. The heart is our engine to the body.

Your heart is made up of four chambers, two on the right and two on the left. These are like the rooms of your house.

The top two chambers are called the left and right atrium and the bottom two are called the left and right ventricles.

They are divided by a thin wall called the septum.

There are four heart valves, which act like doors between the chambers of the heart. They open and close as your heart pumps.

The valves only open one way. This stops blood flowing in the wrong direction between the chambers of your heart.

Your conduction system sends the electrical signals which trigger the heart to pump blood around the body, and to and from the lungs.

Blood which has used all its oxygen is returned to the right side of the heart, via large veins called the inferior and superior vena cava. From there it is pumped to the lungs, via the pulmonary artery.

Once the blood has received oxygen from the lungs, it travels through the pulmonary veins into the left side of the heart. From here it is pumped back out around the body, via the aorta.”

Heart Foundation (https://www.heartfoundation.org.nz/your-heart/how-the-heart-works)

The heart is like the engine to a car but for us it’s the “pump” for the human body; without the engine the car won’t run and without the pump we won’t live. The normal size of the heart is about the size of your fist, maybe a little bigger. It pumps blood continuously through your entire circulatory system.

The heart consists of four chambers, 2 on the top & 2 on the bottom. The two on the top are called at atriums the two on the bottom are called ventricles larger than the top ones.

The right side only pumps high carbon dioxide levels of blood, after all the oxygen was used by the tissues and returns to the heart in the right upper chamber and leaves to the lung from the right lower chamber. From the lungs it than goes to the left side of the heart now, which is a very short distance as opposed to where the left side pumps the blood.

The L side of the heart pumps blood down to the feet, up to the brain and all tissues in between with high oxygen levels of blood. This is why the L side of the heart does more work than the R side since the blood leaving the L side has a longer distance in distributing oxygen. The heart pumps the blood with high oxygen blood levels to reach all your tissues and cells, going to the feet, brain, and to all other tissues in between returning home again to the right side of the heart (first into the Rt upper chamber) to get sent to the lungs again for more oxygen. This is why the muscle on the L side of the heart is larger than the right, it works harder.

Every time your heart beats (the sound we call lub dub) the organ is sending out a cardiac output of blood either to the lungs for more oxygen that comes from the right side of the heart or to the body tissues through the aorta to give oxygenated blood to your tissues and cells coming from the left side of the heart. This is the mechanics of how the heart works in our body normally.

Let’s see what can occur if the heart doesn’t function properly.

If your heart is not pumping out a sufficient amount in your cardiac output to either the lungs (from rt. Side) or to the tissues (from the lt. side) than it tries to work harder where it does ok at first but over time weakens. As this weak heart struggles to pump blood the muscle fibers of the heart stretch. Over time, this stretching leaves the heart with larger, weaker chambers. The heart enlarges (called cardiomegaly). If this continues to go on this would effect the R or L sided of the heart causing back up fluid going into heart failure.

When this happens, blood that should be pumped out of the heart backs up in the lungs (L sided failure) or in the tissues (R sided failure). The side the failure is on doesn’t allow proper filling of the chambers on that side and back up happens going backwards with fluid build up to the circulatory system, in which hepatomegaly or liver enlargement and systemic edema are the main symptoms. In many instances, both sides of the heart are involved if this goes on since it will effect the other side.

Remember the Left side of the heart is receiving oxygenated blood flow from the lungs but if the chanbers on the left side are enlarged stretched out muscle the blood flow goes backward to the lungs.  So L side sided failure blood flow goes backwards to the lungs.

The R side of the heart gets blood that is coming back to the heart where the oxygen was used up from the oxygenated cells that were sent from the L side first but now returning with more carbon dioxide blood to the right side of the heart and if the right side of the heart is enlarged, stretched out muscle the blood that is returning to the R side will first back up in the veins which can expand to hold extra blood but at some point dump the extra fluids in your tissues (This is edema in feet due to gravity=swelling in the feet and ankles and up the legs as it gets worse).

On the L or R side of the heart the ending line problem that occurs is this is all due to overloading of the blood that goes backwards and not filling up properly in the upper and lower chambers of the heart to make a good cardiac output of blood and in time the fluid backs up (bad pumping=backup of blood=fluid overload in the lungs (pulmonary congestion) to fluid staying in the skin (first the lower extremities due to gravity=feet which we call edema working its way up the legs.).

This condition in time with no treatment will go into congestive heart failure (CHF) to the other side of the heart if not controlled; where both sides end up overloading and now both R and L sided failure occur. Know CHF can range from mild to severe. Nearly 5 million Americans are currently living with congestive heart failure (CHF).  Approximately 550,000 new cases are diagnosed in the U.S. each year. There is 670,000 cases are diagnosed with this every year and is the leading cause of hospitalization in people over 65 y/o.

Causes of CHF are: heart attack, CAD (coronary artery disease), cardiomyopathy, conditions that overwork the heart like high blood pressure, diabetes and obesity (These diseases can be completely preventable or at least well controlled).

There is many of us in this world with knowing how our activity/exercise, eating, and habits could be better for health but do little action if any on our own to change it, which is a large part for certain diseases being so high in America (diabetes, stroke, cardiac diseases=high blood pressure, atherosclerosis, arteriosclerosis to CHF and more).

If people were more healthier and more active regarding these diseases alone it would decrease in population creating a positive impact on how our health system with insurance presently (a disaster) with our economy for many could get better. A healthy heart can pump to all parts of the body in a few seconds which is good cardiac output from the organ but when it gets hard for the heart to keep up with its regular routine it first compensates to eventually it decompensates causing ischemia (lack of oxygen to the heart tissue). It’s like any tissue in the body, lack of oxygen=lack of nutrients to the body tissue=STARVATION and with lack of oxygen will come PAIN eventually to death if not treated. Take the heart, if it isn’t getting enough oxygen it can go into angina. That is reversible since it is heart pain due to not enough oxygen to the heart tissue=no damage but if left untreated what will occur is a heart attack=myocardial infarction (MI) and is permanent damage because scarring to the heart tissue takes place. Let’s understand what the heart can develop over time with an unhealthy heart due to bad health habits. If you are eating too much for too long foods high in sodium your vessels will narrow in size. By allowing this you increase the pressure in the vessels that increases your blood pressure called hypertension.

If you are also inactive you are at risk of obesity which puts stress on the heart and in time causing high B/P. Constantly be in a high B/P and this could cause the vessel to rupture (at the heart=possible heart attack, at the brain=possible stroke, also called CVA with both on high occurrences in our population of the US.). With bad habits (especially poor diet, inactive, and smoking) you can cause over time atherosclerosis=a blockage in the artery with the resolution surgery (from a cardiac catheterization up your groin or having difficulty in the arm to the heart where an angiogram to an angioplasty with possibly a stent is performed or if the blockage to blockages is so bad a CABG=coronary artery bypass=a 6hr plus operation where diversion of a vein from your leg (donor graft site) around the blockage is done. Smoking can lead to this but it also can cause your vessels to become brittle=arteriosclerosis.

Healthy Habits would impact a positive result for all people who have had this diagnosis before but most important be a great PREVENTATIVE measure for people not diagnosed with cardiac disease.

There are 4 things you have no control over heredity, age, sex, and race but healthy habits are sure to benefit you by keeping the odds down of you inheriting, help your age factor, and race a lot can be associated with eating cultural habits.

If you make the decision to live a life that’s healthy for your heart through proper eating, doing healthy habits and doing some exercise or activity with balancing rest in your busy schedule and would like direction or want to expand your diet/exercise/healthy habits then you came to the right blog to start in the right direction. You make all the choices in your life at 21 y/o or older. Wouldn’t you want less heart disease or obesity or diabetes for yourself and for others throughout the nation including the future generations?

If you like what you see spread the good cheer. Let’s build a stronger foundation regarding HEALTH in America. So start eating a good heart healthy diet usually with still treating yourself at times throughout the year including daily or tri-weekly or bi-weekly exercise and balancing it with rest . At least try to do stretching exercises daily. Also try to keep stress to a minimum which work out helps you decrease.

Recommended is to check with your doctor about your diet and exercise changes especially if you have a disease or illness that the MD can direct you best in changes with knowing about your health history.

“It’s February – American Heart Month – a time when the nation spotlights heart disease, the No. 1 killer of Americans.

President Lyndon B. Johnson, among the millions of people in the country who’d had heart attacks, issued the first proclamation in 1964. Since then, U.S. presidents have annually declared February American Heart Month.

Throughout the month, the American Heart Association’s “Heart to Heart: Why Losing One Woman Is Too Many” campaign will raise awareness about how 1 in 3 women are diagnosed with heart disease annually.

The first Friday of American Heart Month, Feb. 5, is also National Wear Red Day as part of the AHA’s Go Red for Women initiative. Coast to coast, landmarks, news anchors and neighborhoods go red to raise awareness and support for the fight against heart disease. For more information on the event and other activities during the month, visit goredforwomen.org.

This year, the federally designated event is even more important due to the impact of the coronavirus on the public’s heart health, including potential harmful effects on the heart and vascular system, according to recent research.”

American Heart Association (https://www.heart.org/en/around-the-aha/february-is-american-heart-month)

“Folate (vitamin B-9) is important in red blood cell formation and for healthy cell growth and function. The nutrient is crucial during early pregnancy to reduce the risk of birth defects of the brain and spine. Folate is found mainly in dark green leafy vegetables, beans, peas and nuts.

Folate is found mainly in dark green leafy vegetables, beans, peas and nuts. Fruits rich in folate include oranges, lemons, bananas, melons and strawberries. The synthetic form of folate is folic acid. It’s in an essential component of prenatal vitamins and is in many fortified foods such as cereals and pastas.

A diet lacking foods rich in folate or folic acid can lead to a folate deficiency. Folate deficiency can also occur in people who have conditions, such as celiac disease, that prevent the small intestine from absorbing nutrients from foods (malabsorption syndromes).

The recommended daily amount of folate for adults is 400 micrograms (mcg). Adult women who are planning pregnancy or could become pregnant should be advised to get 400 to 1,000 mcg of folic acid a day.”

National Folic Acid Awareness Month, which was in the beginning of this month! January 10–16, 2016, was National Folic Acid Awareness Week but for those who may have missed the info on it don’t fret striveforgoodhealth is covering Folic acid today and its especially important to women who might become pregnant, as it can help prevent serious birth defects of the brain, neck and spine. Recent studies suggest that it can also help lower the risk of neural tube defects and orofacial clefts (cleft lip and palate). Notably, folic acid has been shown to lower the risk of anencephaly (the absence of a large part of the brain and skull) and spina bifida (an opening in the spinal column) by 50 to 70%.

Much of the baby’s growth and development happens very early in pregnancy, even before most women know they’re pregnant. Experts estimate that women need to start taking folic acid at least one month before they become pregnant for it to prevent birth defects, so it’s important to make folic acid-enriched foods and vitamins a part of your daily routine.

The benefits aren’t limited to your baby: your body needs folic acid, too. The acid helps to create healthy new cells in the body, from hair to nails to skin and blood cells. Without it, blood cells become unstable, and the body is susceptible to disease. The vitamin also protects your liver, allowing it to continue purifying your body. Folic acid is a water-soluble vitamin that your body cannot store, so it should be taken every day to replenish your body’s supply.

Many foods are now being fortified with more folic acid, such as grains, pastas and breakfast cereals. Check the nutritional facts label on your favorite products to see how much they contain. Many cereals now contain as much as 100% of the recommended daily value. Additionally, prenatal vitamins typically contain folic acid. If you’re not yet taking a prenatal vitamin, you can also look for multivitamins with added acid, or buy folic acid pills.

Birth defects are common, costly, and critical conditions that affect one in every 33 U.S. newborns annually. Women can reduce their risk of having a baby born with a birth defect by making healthy choices and adopting healthy habits before and during pregnancy.

Health care providers can encourage parents-to-be to make a PACT for birth defects prevention by taking the following steps: Planning ahead for pregnancy; Avoiding harmful substances like chemicals in the home or workplace (2); Choosing a healthy lifestyle, including eating a healthy diet (3); and Talking with their health care provider before and during pregnancy, particularly about medication use.

Centers for Disease Control and Prevention encourages health care providers to become active participants in National Birth Defects Prevention Month by joining the nationwide effort to raise awareness of birth defects, their causes, and their impact.

CDC urges all women of childbearing age who can become pregnant to get 400 µg of folic acid every day to help reduce the risk for neural tube defects. Health care providers should encourage women of childbearing age to consume folic acid in fortified foods or supplements, or a combination of the two, in addition to a diet rich in folatCDC urges all women of childbearing age who can become pregnant to get 400 µg of folic acid every day to help reduce the risk for neural tube defects. Health care providers should encourage women of childbearing age to consume folic acid in fortified foods or supplements, or a combination of the two, in addition to a diet rich in folate.

An easy way to be sure you’re getting enough folic acid is to take a daily multivitamin with folic acid in it. Most multivitamins have all the folic acid you need. If you get an upset stomach from taking a multivitamin, try taking it with meals or just before bed. If you have trouble taking pills, you can try a multivitamin that is gummy or chewable. Also be sure to take it with a full glass of water.  This medication we said earlier is a water soluble and for it to do its optimal level of action it needs water.  Just like Colace that is a water soluble it needs to be taken also with water for it to do its function in making the stool softer; if not taken with water it will do very little in resolving constipation.  So don’t forget water.

Folic acid has been added to foods such as enriched breads, pastas, rice and cereals. Check the Nutrition Facts label on the food packaging. A serving of some cereals has 100% of the folic acid that you need each day.

In addition to getting 400 mcg of folic acid from supplements and fortified foods, you can eat a diet rich in folate. You can get food folate from beans, peas and lentils, oranges and orange juice, asparagus and broccoli, and dark leafy green vegetables such as spinach, and mustard greens.

Nutritional habits

Although all enriched cereals and grain products in the U.S. are fortified with the B-vitamin folic acid, only one-third of U.S. women of childbearing age consume the recommended amount from their diet. Taking a multivitamin with folic acid every day is a key way that women can get the recommended amount of 400 mcg.

Remember be prepared before pregnancy

Women need folic acid, even if not planning to become pregnant, since 50% of all pregnancies are unplanned. Taking folic acid before pregnancy reduces the risk of birth defects of the brain and spine, called neural tube defects (NTDs), by up to 70%.

Message to the Hispanic community

Hispanic babies are 1.5 to 2 times more likely than others in the U.S. to be born with an NTD. The Centers for Disease Control and Prevention (CDC) report that Latinas in the U.S. consume the least amount of folic acid and have the least knowledge about folic acid among racial or ethnic groups.

“Influenza (flu) and the common cold are both contagious respiratory illnesses, but they are caused by different viruses. Flu is caused by influenza viruses only, whereas the common cold can be caused by a number of different viruses, including rhinoviruses, parainfluenza, and seasonal coronaviruses.”

Centers for Disease Control and Prevention CDC (https://www.cdc.gov/flu/symptoms/coldflu.htm)

“Pacemakers are devices that can be placed in your body, usually by surgery, to support the electrical system in your heart. They can stabilize abnormal heart rhythms and prevent problems that can disrupt or endanger your life.  Your heart has its own electrical system, which tells your heart’s chambers when it’s their turn to squeeze. When your heart’s electrical system malfunctions, your heart’s chambers may squeeze in the wrong order or squeeze too weakly to provide enough blood to your body. Pacemakers use electrical impulses to correct these kinds of malfunctions. 

While it depends on the specific model of pacemaker and how often it has to assist your heart, pacemakers are now available that can last as long as 10 or 15 years. Your healthcare provider can tell you the average lifespan of the device you’ll receive, and will also schedule follow-up appointments to check your pacemaker’s battery level. It’s also usually a simpler process to replace a pacemaker battery than it was to implant the device in the first place.”

Cleveland Clinic

Pacemakers are electronic devices that stimulate the heart with electrical impulses to maintain or restore a normal heartbeat. In 1952, Zoll described an effective means of supporting the patients with intrinsic cardiac pacemaker activity and/or conducting tissue by an artificial, electric, external pacemaker. The pacing of the heart was accomplished by subcutaneous electrodes but could be maintained only for a short period. In 1957, complete heart block was treated using electrodes directly attached to the heart. These early observations instilled the idea that cardiac electrical failure can be controlled. It ultimately led to the development of totally implantable pacemaker by Chardack, Gage, and Greatbatch. Since then, there have been several advancements in the pacemakers, and the modern-day permanent pacemaker is subcutaneously placed device.

There are several different types of pacemakers.

The main types are:

• single-chamber pacemaker – this has 1 wire, which is connected to either the right atrium (upper heart chamber) or right ventricle (lower heart chamber)
• dual-chamber pacemaker – this has 2 wires, which are connected to the right atrium and right ventricle
• biventricular pacemaker – this has 3 wires, which are connected to the right atrium, right ventricle and left ventricle

There are 4 types of artificial pacemakers:

1. Implantable pulse generators with endocardial or myocardial electrodes
2. External, miniaturized, patient portable, battery-powered, pulse generators with exteriorized electrodes for temporary transvenous endocardial or transthoracic myocardial pacing
3. Console battery or AC-powered cardioverters or monitors with high-current external transcutaneous or low-current endocardial or myocardial circuits for temporary pacing in asynchronous or demand modes, with manual or triggered initiation of pacing

All cardiac pacemakers consist of 2 components: a pulse generator which provides the electrical impulse for myocardial stimulation and 1 or more electrodes or leads which deliver the electrical impulse from the generator to the myocardium. This discussion focuses on the indications of pacemaker placement.

The type of pacemaker you need will depend on your specific heart problem.

Indications:

The most common indications for permanent pacemaker implantation are sinus node dysfunction (SND) and high-grade atrioventricular (AV) block. Guidelines for implantation of cardiac pacemakers have been established by a task force formed jointly by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS). The European Society of Cardiology has established similar guidelines.

ACC/AHA/HRS divides indications of pacemaker implantation into 3 specific classes:

• Class I: These are conditions where implantation of a pacemaker is considered necessary and beneficial (benefits much greater than risks).
• Class II: These are conditions where placement is indicated, but there is conflicting evidence or divergence of opinion. In Class IIa weight of evidence is in favor of efficacy (benefits greater than risk), while in class IIb, the efficacy is less well established (benefits ­greater than or equal to the risks).
• Class III: These are conditions in which permanent pacing is not recommended, and in some cases, it may be harmful (risks greater than the benefits).

Complications:

The pacing and CRT are associated with complications. The majority of complications occur in the hospital or during first 6 months. Lead complications are the main reason for the re-implantation of the pacemaker and CRT devices. Other complications include, but are not limited to infections, hematoma formation, pericardial effusion or tamponade, pneumothorax, coronary sinus dissection, or perforation. Some old pacemakers are not MRI safe.

Pacemaker procedures tend to have few complications, which you can discuss with your healthcare provider. In general, the following complications that are possible:

• Allergic reactions: These may happen because of a medication you’re given or you may be allergic to one of the materials used in the pacemaker itself.
• Blood clots: Your healthcare provider may prescribe blood-thinning medications to reduce the risk of developing a blood clot.
• Malfunctions of the pacemaker or its leads: In some cases, a pacemaker lead may get jostled out of position or might break free. Your healthcare provider will recommend limiting your activity for a while after your procedure to avoid this.
• Malfunctions caused by sources outside of your body: Your healthcare provider will give you instructions on devices or machines to avoid so you don’t have pacemaker problems caused by outside electrical interference. Fortunately, advancements in pacemaker technology mean these situations aren’t common.
• Unexpected heart rhythm problems: Some people develop heart rhythm problems — in rare instances — because of the pacemaker. Your healthcare provider can talk to you about these risks and help you avoid them.

Pacemaker implantation has shown a mortality benefit overall.

There are some areas where the indications for a pacemaker are clear, but there are few areas where clinical judgment and expertise plays a greater role. Although the guidelines attempt to define practices that meet the needs of most patients, the ultimate decision for the patient should be based on particular patient presenting scenario, clinician judgment, and discussion with the patient about risks and benefits of the procedure. There are specific pacemaker generators that are used for patients with AV block and sinus node dysfunction depending upon presentation. The different types of generators include a single chamber, dual chamber, and biventricular. A cardiology consult is highly recommended prior to the insertion of a pacemaker.

“Atrial fibrillation (AFib) is an irregular and often very rapid heart rhythm but it can also be a in slow rate for some. An irregular heart rhythm is called an arrhythmia and that is all AFIB patients who are diagnosed with it. AFib can lead to blood clots in the heart. The condition also increases the risk of stroke, heart failure and other heart-related complications.

During atrial fibrillation, the heart’s upper chambers — called the atria — beat chaotically and irregularly. They beat out of sync with the lower heart chambers, called the ventricles. For many people, AFib may have no symptoms. But AFib may cause a fast, pounding heartbeat, shortness of breath or light-headedness due to the rapid heart rate.

AFib can also be bradycardia (a slow heart beat rhythm).

You could have pauses  in that AFIB bradycardia that are called sick sinus syndrome or a longer pauses causing sinus arrest.  Each pt’s heart is unique on how it operates.”

MAYO CLINIC

   TopBox-Normal Sinus Rhythm

Normally, the heartbeat starts in an area in the top chambers of the heart (atria). This area is the heart’s pacemaker. It is called the sinoatrial node, sinus node or SA node. Its role is to keep the heart beat steady and regular. This creates the normal rhythm of the human body call Normal Sinus Rhythm (listed above in pictures in 2nd box call NSR).

Sick sinus syndrome is a group of heart rhythm problems due to problems with the sinus node, such as:

• The heartbeat rate is too slow, called sinus bradycardia
• The heartbeat pauses or stops, called sinus pauses or sinus arrest
• Episodes of a fast heart rate
• Slow heart rhythms that alternate with fast heart rhythms, called bradycardia-tachycardia or “tachy-brady syndrome”  Tachy meaning fast and Brady meaning slow.

Alternative Names

Bradycardia-tachycardia syndrome; Sinus node dysfunction; Slow heart rate – sick sinus; Tachy-brady syndrome; Sinus pause – sick sinus; Sinus arrest – sick sinus

Causes

Sick sinus syndrome most often occurs in people older than age 50. It is often due to scar-like damage to electrical pathways in the heart muscle tissue.

In children, heart surgery on the upper chambers is a common cause of sick sinus syndrome.

Coronary heart disease, high blood pressure, and aortic and mitral valve diseases may occur with sick sinus syndrome. However, these diseases may have nothing to do with the syndrome.

Sick sinus syndrome is uncommon, but not rare. It is the most common reason people need to have an artificial pacemaker implanted. Sinus bradycardia occurs more often than the other types of the condition.

Tachycardias (rapid heart rhythms) that start in the upper chambers, when the SA node can’t work to intiate the person’s rhythm,  atrial rhythms start to take over as the pacemaker of the heart that may be part of the sick sinus syndrome for people who have it. These atrial rhythms include atrial fibrillation, atrial flutter, atrial tachycardia-all are types of upper chamber heart rhythms, where they intiate from. A period of fast heart rates is often followed by very slow heart rates. When there are periods of both slow and fast heart rates (rhythms) the condition often will be called tachy-brady syndrome; this is what makes up atrial fibrillation (a fib) irregular rhythm/slow and fast heart beats and due to this allows pooling of blood in the heart chamber putting it at a potential to clot and could be passed on from the heart into circulation if the clot breaks off and if it reaches the brain puts the patient at risk for stroke.  Or A Fib can cause heart failure or other cardiac problems.

Some medicines can make abnormal heart rhythms worse, especially when doses are high. These include digitalis, calcium channel blockers, beta-blockers, and antiarrhythmics.

Symptoms

Most of the time, there are no symptoms.

Symptoms that do occur may mimic those of other disorders.

Symptoms may include:

• Chest pain or angina
• Confusion or other changes in mental status
• Fainting or near-fainting
• Fatigue
• Dizziness or lightheadedness
• Sensation of feeling the heart beat (palpitations)
• Shortness of breath, possibly only with physical activity like walking

Exams and Tests

The heart rate may be very slow at any time. Blood pressure may be normal or low.

Sick sinus syndrome may cause symptoms of heart failure to start or get worse. Sick sinus syndrome is diagnosed when the symptoms occur only during episodes of arrhythmia. However, the link is often hard to prove.

An ECG may show abnormal heart rhythms related to this syndrome.

Holter or longer term rhythm monitors are effective tools for diagnosing sick sinus syndrome. They may pick up very slow heart rates and long pauses, along with episodes of atrial tachycardias. Types of monitors include event monitors, loop recorders, and mobile telemetry.

An intracardiac electrophysiology study (EPS) is a very specific test for this disorder. However, it is not often needed and may not confirm the diagnosis.

In some cases, a person’s heart rate is observed when walking or exercising to see if it increases enough; a stress test.

Treatment

You may not need treatment if you do not have any symptoms. Your health care provider will review the medicines you take to make sure they are not making your condition worse. Do not stop taking any of your medicines unless your provider tells you to do so.

You may need a permanent implanted pacemaker if your symptoms are related to bradycardia (slow heart rate or with long pauses or rhythm arrest (completely stops).