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Exercise is Great!

But, not early after a pacemaker implantation!


A young male from a far off city walks into my clinic with symptoms attributable to slow heart rate or inadequate cardiac output. He had a PM implanted just a month ago at his place. However, he now has the same symptoms as before the procedure.

His ECG showed very slow heart rates like before and told us the diagnosis!

We evaluated him further and found the pacemaker lead (wire that connects the battery to the heart and passes small currents needed to make the heart beat) was dislodged and was not in touch with the heart at all times. So despite delivering high energy (automatic safety feature in some pacemakers) there was loss of capture and his heart rates intermittently fell low causing giddiness and fatigue.

What could be the cause? Could this explain the complication?

He confessed he did not give rest to his arm in the immediate post-operative period and continued to lift weights and stretch after discharge as he felt very normal once home.

Pacemaker patients are advised to be aware of their implant and take care not to overdo things (either outdoor or indoor exercises) in the immediate post implantation phase till the body tissue holds it in a matter of days to weeks. One of the commonest causes for dislodged leads is heavy exertion.

It is indeed normal for the patients to feel energetic post implantation as their cardiac output (a product of heart rate and stroke volume) increases owing to the increased heart rate.

There are some precautions one needs to take after a PM implant.

Wound site care is very important to avoid infection. To this effect advice is given as to how to take care of the site and what to do about the sutures and when to return for follow-up wound care.

Likewise, strenuous activity is proscribed in the first few weeks.

Regular follow up to check the functioning of the device is highly recommended and could help avoid dangerous complications by managing the issues (if any) early.

There’s as exponential rise in mobile phone usage. It is advised to use these mobile phones at a safe distance from the device to prevent interference with its proper functioning.

Pacemaker implantation is the beginning of a journey- often very smooth if your doctors’ instructions are followed!


Marathon Magic could sometimes

turn Tragic!



Who does not want to be fit enough to run a marathon?

It is a great opportunity to socialize no doubt, a matter of pride to some, , a matter of well-being to many and a feeling of accomplishment to those who have marathon running on their bucket-list!

All is well for most runners, while the others suffer from injuries and transient aches and pains in their bones and muscle not to forget some permanent damage on repeated injuries which are peculiar to marathon runners and is out of this article.

Can you imagine the long term effects on the pump that allows you to log such distances, repeatedly? Yes, I am referring to that tireless bundle of muscle lump which normally pumps about 5 liters of blood per minute at rest, and supports runners with up to 25 liters per minute. The HEART. Like any other machine has a wear and tear, our hearts too take a toll during such intense efforts.

Human heart beats within a range during normal activity. This range keeps the heart muscle also fit and fine. It is necessary to have a regular physical exercise regimen to keep our heart and body in shape. Like many things in life, excessive exercise too can be detrimental to the sole sustainer of our soul, the Heart.

With excessive stress on the heart, subtle changes occur initially at the cellular level and when repeatedly challenged could lead to macroscopic structural changes including stiffening of the heat muscle or myocardium. This results from Fibrosis which is replacement of the normal muscle fibers with strings of dead cells, something akin to coir.

Some runners may have silent underlying cholesterol plaques in their coronary arteries which could rupture under severe exertion and cause myocardial Ischemia/ infarction and endanger life.

The generator of the heart beats about 50- 100 times a minute. With repeated exertion, the neural output from the brain to the heart gets altered and also changes in the upper chambers of the heart called the Atrium. This could lead to persistent slowing of the heart’s generator in some causing Bradycardia (heart rate < 50 beats per minute while awake), while in others the atria can develop rapid electrical activity going above 350bpm resulting in Atrial Fibrillation.

Though rare, genetic abnormalities do lead to serious abnormalities in the hearts’ electrical circuit and muscle. These unknown and absolutely asymptomatic could first manifest as sudden loss of consciousness and even death during or after a marathon. Sudden Cardiac Death (SCD) is a very real occurrence in marathon runners.

The first documented case of SCD being of a herald in Athens, Pheidippides, who ran to Athens to announce the victory of the Greek in the Battle of Marathon, covering a distance of approximately 26 miles. That is where the marathon gets its name and distance from. Pheidippides unfortunately announced the victory to the king and collapsed to be no more.

It is advisable to undergo a cardiac health evaluation for all those planning marathon, and for those with a sedentary lifestyle and plan to start a regular rigorous exercise regimen. It is also preferable for established marathoners to be evaluated on a regular basis. Mind you, Marathons no doubt give us a kick on the mental plane, but on the physical plane cannot beat the benefits of regular moderate exercise.


Get yourself checked before planning a marathon.

Train yourself for marathons, preferably with experienced runners to guide.

Get your body’s exercise capacity and metabolic state assessed in specialized centers like Apollo Hospitals.


It is advisable to RUN a MARATHON only if:

·      You are free from a recent bout of respiratory infection,

·      Your nagging chest pain is evaluated,

·      Your BP is well controlled if you are a Hypertensive,

·      Your sugars are well controlled in case you are a Diabetic,

·      You have trained to cover such distances, and finally,

·      You feel you are prepared for it!



You have just learnt how to stay safe while you RUN and say ALL is WELL!

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