How To Know if You Need a Pacemaker

Pacemakers speed up a slow heartbeat — and normalize irregular rhythms — when needed. These tiny devices provide life-saving support for millions of people, from newborns to 90-year-olds.

Cardiologist Niraj Varma, MD, explains how to know if you need a pacemaker and what it’s like living with one.

7 signs you need a pacemaker

Only a healthcare professional can diagnose you with a heart condition, as well as decide if you need a pacemaker. But Dr. Varma says it’s still good to be aware of your symptoms. These include:

1. Bradycardia (slow heart rate)

You have a slow heart rate (bradycardia) if your heart beats fewer than 60 times a minute.

A slow pulse isn’t always a cause for concern. It’s normal when we sleep. Your heart tends to beat more slowly as we get older. And if you’re extremely physically active? Well, your heart may just be really efficient!

Bradycardia may require treatment when:

• You’re experiencing heart-related symptoms.
• Your medical history includes conditions that raise your risk of cardiac complications.
• You have an acute condition, like an infection.

If you’re experiencing slow heart-rate symptoms regularly, your healthcare provider may conduct diagnostic tests, like an electrocardiogram (ECG or EKG), to assess your heart’s electrical activity. That information will help them know if a pacemaker is the right choice for you.

2. Fainting or near-fainting spells

Fainting is often the clearest sign of a dangerously slow heartbeat — and a top reason people need pacemakers.

If you hit the decks and don’t have any other symptoms, call your provider and let them know. They’ll advise you whether to seek immediate medical attention.

If you do have other symptoms, call 911 or emergency services or have someone drive you to the nearest emergency room.

3. Fatigue

Ongoing fatigue or weakness may be another sign that your heartbeat is too slow and might need a pacemaker. But what counts as fatigue, exactly?

“Pay attention to how you feel after walking up or down the stairs,” Dr. Varma suggests. “If you feel out of breath and tired after just one flight of stairs, that could be a sign that something’s off.”

4. Dizziness

Feeling dizzy or lightheaded, especially when standing up or during physical activity, might be a sign of an irregular heartbeat that a pacemaker could treat. Either way, it’s worth a discussion with a provider.

5. Heart palpitations

Heart palpitations are common and often harmless. But if your heart feels like it’s racing, fluttering, skipping or pounding often, talk to a provider. They may want to run tests to determine whether an arrhythmia is causing your palpitations. If that’s the issue, you may be a candidate for a pacemaker.

6. Shortness of breath

Difficulty breathing or shortness of breath, especially when you’re physically active, can be another sign of a slow heart rate. If you’re winded or your chest feels tight when doing everyday tasks, mention it to your healthcare provider.

Shortness of breath has many causes. One of them is heart failure, a condition that some pacemakers can treat.

7. Chest pain

Always take chest pain or discomfort seriously. If it comes on suddenly and is accompanied by other symptoms, treat it as a medical emergency.

Chest pain can be a sign of all sorts of medical issues, including certain heart rhythm disorders that call for a pacemaker. But sudden, intense chest pain could also point to a serious problem like a heart attack, aortic dissection or pulmonary embolism.

Dr. Varma’s advice? When in doubt, get checked out.

What’s it like having a pacemaker?

Getting a pacemaker might sound intimidating, but the process is simpler and more routine than you might expect.

Pacemakers are usually inserted beneath the skin of your upper chest near your shoulder. In most cases, wires — also known as leads — run from the device into your heart. You may need one, two or three leads depending on your condition. People are usually discharged from the hospital the same day after receiving one.

Pacemakers operate automatically. Little antennas in the pacemaker allow doctors to collect data about your heart’s rhythm and the pacemaker’s function during follow-up. They can then customize your pacemaker’s activity to fit your needs as necessary.

Some of the newest pacemakers are leadless and work wirelessly. Talk to your provider to find out what kind of pacemaker they’re considering for you.

Going into the procedure, it’s helpful to know that:

• The technology is long-lasting and reliable. “A pacemaker’s battery can last for 10 to 15 years,” Dr. Varma reports. (He also notes that replacing the battery is a lot simpler than the initial implant.)
• Most people don’t notice their pacemakers. The electrical impulses pacemakers use to stabilize your heart rhythm are usually imperceptible. The devices don’t deliver shocks like an implantable cardioverter defibrillator (ICD) does.
• They’re surprisingly small. “Today’s pacemakers are about the size of a big tablespoon,” Dr. Varma says. That’s small enough that you’ll rarely feel it.
• They’re resilient. External devices, like microwaves, don’t affect pacemakers.

Final thoughts

A slow or irregular heart rhythm can disrupt your everyday life in many ways. When your organs aren’t getting the blood, oxygen and essential nutrients they need to function properly, it can make everything from breathing to thinking harder.

Which leads us to the last thing you need to know about getting a pacemaker: You’ll likely feel the benefits immediately.

After the procedure, you’ll quickly realize that your resting heart rate has increased. You’ll get used to your “new normal” quickly. And as you do, you’ll also notice improvement in your functioning across the board.

So, if there’s even a small chance that a pacemaker could help you live a fuller, happier life, it’s worth a discussion with a healthcare provider.