The search for Nancy Guthrie is in its eighth day, and investigators are still working around the clock to find her—and to find the person (or persons) behind her disappearance. Authorities believe that Guthrie, 84, was abducted from her home in the Catalina Foothills, an area north of Tucson, Arizona.
Over the course of the past week, there have been concerns surrounding Guthrie’s health, as she was said to be on important medications. Moreover, the Pima County Sheriff’s Department has stated that there was a critical issue on the night of Feb. 1, when Guthrie’s pacemaker stopped syncing with her Apple Watch.
In an effort to answer some of the ongoing questions surrounding pacemakers and heart-related medications, Parade spoke with Srihari S. Naidu, M.D., FACC, FAHA, FSCAI, triple board-certified in internal medicine, cardiology, and interventional cardiology. Dr. Naidu, who is a Professor of Medicine at New York Medical College, is not familiar with Guthrie’s medical history, but he was able to answer some important questions about some complicated things that have been in the news this week.
What Is a Pacemaker?
To begin our conversation, I asked Dr. Naidu to tell me about pacemakers—what they do and what kind of patients need them.
“A pacemaker is a mechanical device that’s usually implanted right around the left clavicle or left shoulder, and it usually has one or two wires that are threaded into a vein at that location, and they travel to the heart that way, because all the veins end up in the heart,” Dr. Naidu explains.
Some patients have a fast resting heart rate called tachycardia, while others may suffer from a slow resting heart rate, which is called bradycardia. A pacemaker may be a good option for patients who have bradycardia, Naidu says, adding that pacemakers are fairly common.
“Nancy Guthrie is an elderly woman, so it’s most likely needed due to her age. It’s most likely that she just had a low heart rate, which she’s gotten older, resulting in symptoms, such as shortness of breath, chest pain, or dizziness. And because of that, they’ve put a pacemaker in to make sure that the heartbeat doesn’t go too low,” he added.
Can a Pacemaker Connect to an App on an Apple Watch?
If you’ve been following the Nancy Guthrie case, you’ve probably heard the Pima County Sheriff’s Department say that they have evidence that Guthrie’s pacemaker stopped syncing to her Apple Watch in the middle of the night on Feb. 1.
This is something Dr. Naidu has never heard of before.
“A pacemaker essentially has a remote monitoring system, and so a patient gets a box that is taken to their home and set up, and this box is set up to transmit either through WiFi or radio frequency, or through the internet to a server that goes to the doctor’s office,” Naidu says. He went on to explain that the pacemaker would ping to the box at a certain time of day and send that data to the doctor’s office.
“In this particular case, we know that typically, if you have a pacemaker, a defibrillator, or any type of implantable device that regulates heart rhythm or heart rate, every day, once a day, there’ll be a transmission that is done remotely, spooling all the information from the prior 24 hours, or since the last time it was sent in,” Naidu continues. He mentions that if a patient goes on vacation, for example, they wouldn’t take the box with them, and the data would transmit when the patient is back in their home.
As far as an Apple Watch connection goes, Naidu tells me he isn’t aware of any app that monitors a patient’s pacemaker.
“I have not heard of that, and I certainly have thousands of patients. … I think I would know that. … Apple Watches can do their own evaluation of arrhythmias. And those can record, and then they can be downloaded or sent to your doctor, but not to the pacemaker as far as I’m concerned.”
Can a Pacemaker Send an Alert to a Family Member if Something Goes Wrong? What Happens if the Patient Dies?
One question that’s been floating around the internet seems to be if a pacemaker can alert a family member if things go awry.
“You can set it up so that [your doctor gets a] notification of different arrhythmia. So even though the pacemaker cannot intervene for any type of fast arrthmia, it can detect faster arrhythmias or irregular arrhythmias, some of which are life threatening, and oftentimes happen during heart attacks,” Naidu says.
But what happens if a patient with a pacemaker dies? Does the pacemaker keep working?
“So, we have this in the hospital where patients have a cardiac arrest, they pass away, and then you have to manually turn off the pacemaker, because the pacemaker will notice that the heart’s not beating, and because the heart’s not beating, it’ll send electrical impulses to the top and bottom to try to beat it. But it won’t be able to tell that it’s not actually capturing the heart and making sure the heart beats. It’ll send the signals because it thinks the heart’s not beating, and it won’t really know whether the heart is actually beating from it,” he explains.
“On a monitor, you’ll see these little spikes where the electrical current from the device comes out, but it’s not capturing the heart tissue. So yes, pacemakers will continue to try to beat the heart, even though the patient is [deceased]. Now, these are little micro occurrences, so you can’t see the patient jumping or anything,” he continues, adding that doctors need to turn off pacemakers before sending a body to the morgue.
The pacemaker does not keep the heart going, however, and these micro movements are simply from the pacemaker itself, not actually the heart beating.
What Happens if a Patient Stops Their Heart Medication Cold Turkey?
Without knowing exactly which medications Nancy Guthrie takes, I asked Dr. Naidu to tell me what happens if someone stops taking heart-related medications without weaning off of them. He explained that there are three types of medications related to the heart: one to prevent occurrences of events, others that help the body maintain heart function, and a third type that actively keep the heart going.
He says that medications for high blood pressure or blood thinners can be stopped cold turkey and may not have any immediate side effects to the patient. Stopping these medications, Naidu says, may increase a patient’s chances of having a stroke, but it doesn’t guarantee it.
“In most cases, even in high-risk patients, that risk is about 5 percent per year of a stroke, so it’s not like if you stop that blood thinner, they’re gonna have a stroke the next day. They may not even have a stroke for that whole year, but their risk goes back up…maybe 10 fold,” he says.
“Patients with stents who have a different type of blood thinner, like Plavix, for example, these kinds of medications, if you stop them within a short time, you can definitely have a life-threatening [event],” he adds.
Stopping other medications in patients with a weak heart could cause some symptoms like dizziness or shortness of breath that would prompt medical attention.
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