Pacemaker question

[Lyn2]

Hi, I am a small framed woman 32 yrs.  I received a pacemaker a year and a half ago.  My cardiologist said because of my size my pacemaker and leads protrude more.  He said that the leads may break through my skin.  
My question is:
If it does break through, would it be an emergency that needs to be attended to right away?  Would I be at a high risk for developing infection , if the leads were exposed?  Or would it be something I would just make an appointment for?  

I know this hasn't even happened yet, but the leads are so close to the surface of my skin that you can see the color of the leads.  If they do break through, what do the doctors do to fix it?

Another concern.  I recently had my potassium checked, because I'm on lasix and was not feeling well.  Several weeks ago it was 4.5, but now it is 2.9.  Is that low? And if it is, what should be done to treat it?  I only found out because I called and asked what it was and the secretary told me, but I've not heard from a doctor or anyone.  I have been getting more palpatations lately and I'm wondering if this could be a cause?  I also take coumadin and amiodarone, and cartia.

Thank you so much.  This service is invaluable.

[oma]

Hi,

First of all..........I got a pacemaker when I was 130 and 5'9. I have had 3 now in 4 years and so many leads I can't count them all.  I am very thin on top and I don't have leads showing through and my leads are on the outside of the venous system,(epicardial).  The doctor who placed it is nuts when they said that it is because you are thin!  I have also seen implants being done and it all depends on the doctor doing the implant.  If it was placed by a "cardiologist" and not an EP doctor that is half the problem.  I had my pacemaker doctor, an "EP" tell me that he always places the device lower down and makes sure the leads are done right in the pocket so that it is cosmeticly good looking for the woman.  If the pocket is to tight or small it can cause the leads and device to stick out.  If the pocket is to tight it can cause the can or device to ahere to the skin and cause erosion of the skin too.  Also if t is not placed low enough it can stick out.  If the leads became unwound in the pocket and sprung loose, this can cause them to appear closer to the skin surface.  Since you are young, your skin is still very "thick".  Where as older patients have thinner skin and it may work it's way through sooner.  

The doctor here is correct in saying that you need to avoid hitting the area as to cause the leads to break.  This can cause an insulation break or a wire break and then your impedance on interrogation will be high or low depending on which happens. Also watch it very carefully to make sure it is not having any type of scabbing over the area and then this can be a concern that there is to much irritation over this site.  

You can and should talk to your doctor about maybe having the leads redone if this is a concern. I would think it would be better to have a small bit of discomfort from a revision then to have the area get infected and then have to have the leads all pulled out and have an infection in the heart.  BUT BUT BUT if this doctor is not an EP who has a vast knowledge of placing pacers then get to one that does!  If it was an EP doctor that did it, then I would find a new one!  Please feel free to mail me for a great way to find an great EP doctor in your area.  ***@****

[CCF-M.D.-DLB]

If the leads broke through, that would be a major risk for serious infection -  you would want to let your doctor know right away. Treating this situation would not be easy. You should try to avoid even minor trauma to the area that might cause the leads to be exposed. If this does happen, you would need surgery to try to put everything back in place.
Yes a potassium of 2.9 is low (and can predispose to arrhythmia, including serious ones) and requires correction with potassium and a recheck. You need to check with your doctor right away and if this is not feasible, should get a recheck and treatment in your ER.

[Been down that road......]

I thought I'd write before the doctor comments.  3.5-5.5 are normal levels for potassium.  2.9 is low and can cause arrhythmia not to mention possible cardiac arrest.  I would call your doctor now or go to the ER especially if you are symptomatic.  Your medications are probably making you lose your potassium and you will need potassium supplements- or med adjustments.   good luck!