Medical Devices & Technology Archive

Automating this task could yield more accurate blood pressure readings.

Doctors are notoriously bad at measuring their patients' blood pressure. Nurses are better but many still don't use the correct method. And clinicians who do follow the proper procedure often get a reading that is higher than the person's usual blood pressure. This is called white-coat hypertension — blood pressure that is high when a doctor or other clinician measures it but normal the rest of the time.

ICDs save lives, but sometimes medications and other options make more sense.

The heart's ability to beat steadily for a lifetime is a testament to tough muscle and an amazing electrical system. Sometimes, though, the heart veers into an abnormal rhythm. Two potentially deadly ones are ventricular tachycardia and ventricular fibrillation. One effective way to abort these rhythms and restore a normal one is with an electrical shock.

Q. One day while I was gardening, I either slipped, hit my head, and passed out, or I passed out, fell, and hit my head. Since we couldn't tell, my doctors recommended I get a defibrillator as "insurance" in case a heart rhythm problem was the cause. I have had the defibrillator for eight years now, and it has never gone off. The battery is almost done and my doctor wants to put in a new battery. At age 86, I'd rather not have the procedure, the routine checkups are a hassle, and all of this is expensive. Could I just let the battery run down, then either leave the device in place or have it taken out?

A. Your question about continued use of an implantable cardioverter-defibrillator (ICD) is an important one that patients and doctors across the country are grappling with.

Many people say they would shy away from using a defibrillator.

If you were in a public place and saw someone suddenly collapse, would you use a nearby defibrillator to revive him or her? In a survey of 1,000 adults, more than half answered "no."

Q. A hospital in the area is advertising robotic surgery. Is it really any better than having a surgeon do the operation?

A. The first robotic surgery was performed over in the mid-1980s. Now thousands of operations are being done with the assistance of robots. A better term might be robotic instrumentation because, ultimately, there's always a human surgeon with his or her hands on the controls.

Q. I recently had a nuclear stress test and the contrast agent got stuck in my gut, so the image couldn't be read. Is this a common problem, and is there anything that can be done about it?

A. The purpose of a stress test is to identify problems with blood supply to the heart muscle or the coronary arteries that supply it with blood. The standard test involves measuring the heart's electrical activity with an electrocardiogram (ECG) while the patient "stresses" his or her heart with exercise, which usually means walking on a treadmill or pedaling a stationary bike.

What happens to a perfectly functioning pacemaker or implantable cardioverter-defibrillator (ICD) when its owner dies? Some end up in the grave. Others are removed in a funeral home so they won't explode during cremation, and then sit in a drawer or are discarded as medical waste. A few get new life when they are cleaned, sterilized, and implanted in someone in a low-income country who could never have afforded such a device.

Over the years, ad-hoc programs have recycled a small number of pacemakers and ICDs for use in low-income countries. Now an ambitious program aims to expand the number of devices that will have an afterlife. Project My Heart–Your Heart is a collaboration between the state of Michigan's citizens, physicians, and funeral directors, along with the University of Michigan Cardiovascular Center and World Medical Relief, a nonprofit organization that distributes donated medical goods in low-income countries. The group plans to work with a hospital in Manila and one in Hanoi, both of which have met the project's strict standards as implant centers. Recipients of the donated devices would not be charged for them.

Q. You have said that alcohol can cause heart rhythm problems. I have an implanted defibrillator. Is it okay for me to drink alcohol?

A. Alcohol can, indeed, cause heart rhythm problems in people who drink too much or who are extra-sensitive to the effects of alcohol. It can trigger atrial fibrillation, which can make an implantable cardioverter-defibrillator (ICD) deliver a shock when it shouldn't.

Women tend to develop heart disease about 10 years later than men — in part, it's believed, because of the heart-protective effects of ovarian estrogens, which are around until menopause. But the female advantage seems to end there. Because women develop heart disease later, they're more likely to have coexisting conditions, like diabetes, which can complicate treatment and recovery. And because they have smaller hearts and coronary vessels, surgery can be more difficult for them. Women are more likely to die after procedures such as bypass surgery and angioplasty.

But now a study suggests that one treatment for heart failure actually works better in women than men (Journal of the American College of Cardiology, Feb. 15, 2011).

They can shock a heart back into rhythm and save a life. But are too many of these heart devices being implanted?

Each month, about 10,000 Americans have implantable cardioverter-defibrillators (ICDs) put into their bodies. The main function of these devices is to sense fast or irregular heart rhythms that can be potentially fatal and then to shock the ventricles, the heart's two main pumping chambers, back into a regular, healthy heartbeat. The shock can be quite painful and may feel like a hard punch or kick in the chest. In essence, the ICD is an automated, in-the-body version of the defibrillator paddles used in cardiac emergencies.