Heart Problems: Living With an ICD

An implantable cardioverter-defibrillator (ICD) is a small electrical device that can stop a possibly deadly heart rhythm (arrhythmia).

An ICD is implanted under the skin in your chest. A wire threaded through a large vein connects the device to your heart. It is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it tries to slow the rhythm to get it back to normal. If the dangerous rhythm doesn't stop, the ICD sends an electrical shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode.

If your heart is beating too slowly, the ICD acts as a pacemaker, sending mild electrical pulses to bring your heart rate back up to normal.

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To be sure that your device is working right, you will need to have it checked regularly. ICDs can stop working because of loose or broken wires or other problems. Your doctor will also make sure your ICD settings are right for what your body needs.

You may need to go to your doctor’s office, or you may be able to get the device checked over the phone or the Internet.

ICDs run on batteries. In most cases, ICD batteries last 5 to 15 years. When it's time to replace the battery, you'll need another surgery, although it will be easier than the surgery you had to place the device. The surgery is easier, because your doctor doesn't have to replace the leads that go to your heart.

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When you have an ICD, it's important to avoid strong magnetic and electrical fields. The lists below show electrical and magnetic sources and how they may affect your ICD. For best results, follow these guidelines. These safety tips also apply to devices that combine an ICD and a pacemaker. If you have questions, check with your doctor.

Following safety tips

Safety guidelines for pacemakers and ICDs

Stay away from:	CB or ham radios High-voltage power lines. Stay at least 25 ft (7.5 m) away. Large magnets MRI machines. An MRI uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body.
Use with caution:	Cell phones: Do not carry a cell phone in a pocket directly over the pacemaker or ICD. Hold the phone to the ear on the side away from your device. Keep a phone at least 6 in. (15 cm) away from the pacemaker or ICD. MP3 player headphones: Do not keep headphones in a chest pocket. Do not drape headphones over your chest. Keep the following devices at least 12 in. (30.5 cm) away from the pacemaker or ICD: Arc welders Battery-powered cordless power tools Industrial power generators Magnets Magnetic wands used at airports Stereo speakers Radio transmitters (including those used in toys)
Safe to use:	Kitchen and bathroom equipment: Bathroom appliances (electric razors, curling irons, and hair dryers) Kitchen appliances (such as toasters, blenders, electric can openers, and refrigerators) Microwave, gas, and electric ovens Other household items: Electric tools (such as drills and table saws) Lawn and garden equipment (such as mowers and leaf blowers) Heating pads and electric blankets Washing machines and dryers Phones (land-line phones including cordless models) Remote controls TVs, VCRs, CD players, DVD players Office equipment: Computers Copy machines Fax machines Printers

When to call your doctor

Follow the plan you set up with your doctor. In general, your plan depends on how you feel after you get a shock and how many times you get a shock.

After one shock:

• Call 911 or other emergency services immediately if you feel bad or have symptoms like chest pain.
• Call your doctor soon if you feel fine right away. Your doctor may want to talk about the shock and schedule a follow-up visit.

After a second shock within 24 hours:

• Call your doctor right away, even if you feel fine right away.

Call your doctor right away if you think you have an infection near your device. Signs of an infection include:

• Changes in the skin around your device, such as swelling, warmth, redness, and pain.
• An unexplained fever.

Having medical tests and procedures

Most medical tests and procedures won't affect your ICD, except for MRI, which uses strong magnets. To be safe:

• Let your doctors, dentists, and other health professionals know that you have an ICD before you have any test, procedure, or surgery.
• Have your dentist talk to your doctor before you have any dental work or surgery.
• If you need physical therapy, have the therapist contact your doctor before using ultrasound, heat therapy, or electrical stimulation.

Traveling

You can travel safely with a cardiac device. But you'll want to be prepared before you go.

• Bring a list of the names and phone numbers of your doctors.
• Bring your cardiac device identification card with you.
• Know what to do when going through airport security.

Driving

If you have an arrhythmia or an ICD that makes it dangerous for you to drive, your doctor might suggest that you stop driving, at least for a short time. You probably don't have to stop or limit driving if your arrhythmia doesn't cause bad symptoms. For more information, see Heart Rhythm Problems and Driving.

Letting others know

• Carry an ICD identification card with you at all times. The card should include manufacturer information and the model number. Your doctor can give you an ID card.
• Wear medical alert jewelry stating that you have an ICD. You can buy this at most drugstores.

Going to follow-up visits

• Go to all your appointments with your doctor to make sure that your device is working right.
• Your doctor and/or the device maker will contact you about what to do if your device is recalled.
• If you take heart rhythm medicines, take them as prescribed. The medicines work with your ICD to help your heart keep a steady rhythm.

Exercising safely

Ask your doctor what sort of activity and intensity is safe for you. ICDs are set to shock at a specific heart rate. So your target heart rate during exercise will probably be at least 10 to 15 beats below the ICD discharge heart rate.

You doctor can help you learn how to use a rating of perceived exertion (RPE) as a way to tell how hard you are exercising. This can help you keep your heart rate at a safe level during exercise. For more information, see Monitoring Your Rating of Perceived Exertion (RPE).

Stop exercising and call your doctor if you have:

• Pressure or pain in your chest, neck, arm, jaw, or shoulder.
• Dizziness, lightheadedness, or nausea.
• Unusual shortness of breath or tiredness.
• A heartbeat that feels unusual for you: too fast, too slow, or skipping a beat.
• Other symptoms that cause you concern.
• A shock from your ICD.

Coping with worry about ICD shocks

You may feel nervous about living with an ICD, and you may worry about getting shocked.

The shock can be uncomfortable. It may feel like you are being kicked in the chest. For many people, getting a shock can cause anxiety and depression.

It's common to be worried about living with an ICD. After all, you don't know when a shock might occur, and a shock could be a reminder that your heart is not as healthy as it could be. But if you take a few simple steps, you can feel better about having an ICD.

• Try to replace a negative thought about the ICD with a positive one. For example: When you start to worry about getting a shock, remind yourself that the ICD is there to help save your life. Or try to focus on the positive things in your life, such as loving relationships, pleasant activities, or good friends. For more information, see:

  Positive Thinking: Stopping Unwanted Thoughts.

  Anxiety: Using Positive Thinking.

• Talk to your doctor about making an action plan for what to do if you get shocked.
• If you get a shock, do some breathing exercises. They may help you relax.
  • Sit or lie in a comfortable position. Put one hand on your belly just below your ribs and the other hand on your chest.
  • Take a deep breath in through your nose, and let your belly push your hand out. Your chest should not move.
  • Breathe out through pursed lips as if you were whistling. Feel the hand on your belly go in, and use it to push all the air out.
  • Breathe in and out like this until you feel more relaxed.
• Don't make changes in what you do. You may want to avoid an action because you think it caused the shock. But a shock can occur at any time, and you can't prevent shocks by your actions alone. Don't stop doing things you enjoy to try to avoid a shock.

Continue to Where?

Now that you have read this information, you know more about living with an ICD.

If you have questions about this information, print it out and take it with you when you visit your doctor. You may want to make notes on pages where you have questions.