Pacemaker, by Chris Carr

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Background

Figure 1. Diagram of a heart and it's nodes [1]
Figure 1. Diagram of a heart and it's nodes [1]

The heart is one of the most vital organs in the body responsible for the circulation of blood throughout the whole body. The heart is made up of four chambers and separated into two sides, left and right. These chambers are the left atrium, left ventricle, right atrium and right ventricle. The separations between these chambers are made up of four different valves. These four valves consist of the tricuspid, pulmonary, mitral and aortic valves (1, pg 472).

The flow of blood goes in the order from right to left alternating between atrium and ventricle. The flow consists of two main steps; bringing the deoxygenated blood to the lungs and bringing the oxygenated blood to the rest of the body. Starting with the collection of the deoxygenated blood in the right atrium, it then passes by the tricuspid valve into the right ventricle. From here it can then pass through the pulmonary valve to the pulmonary artery into the lungs where CO2 can be released. Next the now oxygenated blood flows from the lungs into the left atrium and through the mitral valve to the left ventricle. Lastly, the blood can then flow through the aortic valve into the aorta to the rest of the body (1, pg 472).

This whole process is made possible by the initial electrical signal from the sinoatrial node (SAN) and the depolarization of cardiac myocytes. This is because the electrical impulse causes the depolarization of the cardiac myocytes which then causes the contraction of the heart’s chambers. After the SAN creates its initial impulse, it flows through both of the atria causing them to contract. It then reaches the second node, atrioventricular node (AVN). From here the electrical impulse can then spread through the ventricles creating the second contraction (1, pg 483).

A pacemaker is a small implanted device that sends electrical impulses to your heart in order to create an adequate heart rate. These devices replace the SAN’s signal and create a small 2-4 mA current in order to contract the heart. Currently there are more than half a million people in the United States with a pacemaker with an average of over 150,000 new ones implanted every year (1, pg 483).

History

Figure 2. Willem Johan Kolff (1911-2009) [5]
Figure 2. Willem Johan Kolff (1911-2009) [5]
Figure 3. Kolff's first dialysis machine on a Dutch stamp [6]
Figure 3. Kolff's first dialysis machine on a Dutch stamp [6]


1854 - Thomas Graham developed an apparatus that held urine and water separated with a membrane. After several hours, sodium chloride and urea were found to have transported across the membrane. Set the basis for dialysis. [4]

1924 - Georg Haas performed first human hemodialysis on a uremic patient. [4]

1937 - First flat hemodialysis membrane made of cellophane produced. [4]

1940 - Willem Kolff takes interest in acute renal failure. [4]

1943 - Kolff created dialysis machine using sausage casings, washing machine, and orange juice cans. Treated 15 patients with little to no success. [4][5][6][7]

1945 - Kolff treated a 67 year old woman with longer dialysis time and she survived for another seven more years. [5]

1947 - Kolff donates his dialysis machines to other hospitals, allowing other doctors to learn the design of the machine and improve upon it. [5][7]

1948 - First hermodialysis machine constructed in the US to be used at Peter Bent Brigham Hospital. [5]

1954 - First kidney transplant. [7]

1960 - Belding Hibbard Scribner invented the Scribner shunt, preventing the numerous incisions required for dialysis. [7]

1962 - Scribner opened the first outpatient dialysis facility. [7]

Health Issues

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