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Israel PM Netanyahu Gets Emergency Pacemaker, Here’s What AV Heart Block Is

If you are told that you require "urgent pacemaker implantation," you should stop what you are doing immediately, regardless of whether you are preparing to go for a trip or are in charge of an entire nation. Israeli Prime Minister Benjamin Netanyahu just experienced that. And early on Sunday morning, medical professionals at Tel Aviv's Sheba Medical Center did implant a cardiac pacemaker in his chest.

Eyal Nof, MD, Head of the Invasive Electrophysiology Service, and Roy Beinart, MD, Director at the Davidai Arrhythmia Center, two of the cardiologists treating Netanyahu at the Sheba Medical Center, reported that the procedure "all went well" after Netanyahu had gotten the pacemaker. Netanyahu is "doing very well this morning," they added. The Medical Center shared the following YouTube video to demonstrate this:


Netanyahu, 73, will be under observation in the hospital for at least the majority of Sunday because having a pacemaker put in isn't exactly like getting your vehicle washed. A pacemaker is an instrument with wires running into the heart's muscles. Periodically, it releases electrical signals to assist regulate the rate at which your heart beats. Doctors will need to ensure sure the pacemaker is operating properly and that there are no after-procedure issues, such as pain or bleeding.

How did the medical staff determine that Netanyahu required "urgent pacemaker implantation"? Even while it is said, "What does your heart tell you," your heart cannot speak because it lacks a mouth. The warning was based on information from a heart monitor that was positioned on Netanyahu's chest approximately a week earlier, after symptoms of dehydration had led to his hospital admission. The heart monitor did just that—it continuously observed his heart's electrical impulses.

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Even while an electrocardiogram (ECG or EKG) can reveal what your heart's electrical signals are doing at any given moment, an EKG is more like a selfie posted on social media. You are unaware of what transpired either before or after the photo was shot. The electrical signals in your heart can fluctuate throughout the day based on what you are doing, so this doesn't provide a complete picture of what might be going on. When you feel thrilled, like when you see avocado toast, or when you push yourself, like when you climb a tree to acquire that bread, you might start to see anomalies.

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With the use of a cardiac monitor, doctors can watch what is going on during the day and night and rapidly spot any irregularities that are cause for concern. Evidently, Netanyahu's heart monitor had at one time detected an AV block. The term "AV block" in this context does not indicate that a professional for audiovisual equipment is refusing to inspect your setup. As opposed to this, AV stands for atrioventricular.

Let's pump in some information about how your heart functions so you can comprehend what an AV block signifies. You might be familiar with the phrase "muscle head." Your heart, however, is primarily made of muscle. In essence, your heart is a muscle pump that keeps blood flowing through your body. One of the four muscle chambers of your heart, the right atrium, is filled with blood that is returning from the rest of your body. The right ventricle, another muscular chamber, is then filled with blood when your right atrium contracts. As blood flows through your lungs to pick up oxygen, your right ventricle squeezes blood into your pulmonary circulatory system. The left atrium, your heart's third muscular chamber, is where the blood returns after that. Blood then flows into your left ventricle as the left atrium contracts. The largest and most powerful cardiac chamber of them all is your ventricle. In order to pump blood to the rest of your body, it then contracts.

This figure illustrates this course:

Flow of Heart Blood
blood passing through the heart. (Image courtesy of Getty) GETTY
Your heart is responsible for pumping the oxygen that red blood cells carry throughout your body and to all of your favorite body parts. Your body suffers from oxygen deprivation and potential cell death if your heart is unable to perform this function for even a little period of time. You cannot perform necessary tasks, such as taking selfies, scrolling through social media, and living, when too many of your cells die. It is crucial that your heart keeps beating in a coordinated manner as a result.

The same way a smartphone is to your heart. For it to function, electricity is required. Your heart's muscles are connected via an electrical conduction system. The natural pacemaker of your heart is thought to be your sinoatrial node, also known as the sinus node or SA node. It is located in the right atrium. The sinus node starts an electrical signal every second or possibly more frequently or less frequently depending on several factors like your age and whether you're excited or tired, like when you're eating some avocado toast. Then, as the signal travelled throughout both of your atria, they both contracted at once, forcing blood into your ventricles.

The atrioventricular (AV) node, which is situated in the tissue wall separating your atria and ventricles, is where the electrical signal also descends from your sinus node. As it passes through your AV node, the signal briefly slows down. This is intentional. It's similar to a bouncer at a club urging you to wait a moment before entering a slightly overcrowded club. Due to the delay, the ventricles have time to fill with blood before contracting. The signal enters your ventricles by the two branches of the His-Purkinje fiber bundle after passing the AV node. Your right ventricle is reached via the right branch of the bundle of His. And as you would have guessed, the left branch goes to your left ventricle. After your atria have forced blood into your ventricles, the electrical impulse there stimulates them to contract. Your heart begins to beat in a synchronized "lub-dub, lub-dub" pattern as a result of all of this. It should, at the very least.

Each electric signal cycle on an EKG or heart monitor typically consists of three progressive phases, as shown in the following illustration:

Isolated heartbeat line icon on a white background. Image in vector format.
(Image courtesy of Getty)GETTY
The signal from the sinus node's beginning is represented by the initial P-wave, which is that tiny upward bump. The so-called QRS complex, which is characterized by a rapid succession of acute spikes that go down, up, and then back down, comes next. The signal passing via the AV node and the bundle of His is represented by this QRS complex. The electrical system returning to its preparedness condition is represented by the last upward spike on the third component of the signal.

This electrical signal cycle typically repeats itself numerous times at predictable intervals as shown here:

Heartbeat line icon for an ECG. Heartbeat logo on a hospital sign. image of a vector illustration. On a white background, alone.
(Image courtesy of Getty)GETTY
This electrical conduction system has a tendency to malfunction, as can be detected on an EKG or cardiac monitor. Electrical signals that are delayed for too long at the AV node or the His-Purkinje system result in an AV block. This can happen if the AV node area develops scar tissue, which would damage the region's structure. Digoxin, amiodarone, beta-blockers, calcium channel blockers, and other drugs can also cause AV block. Various congenital and hereditary conditions as well as anomalies of the nearby cardiac valves are additional potential causes.

AV blocks aren't all created equal, either. Additionally, not all need pacemakers. The severity of the three general AV block degrees increases. The electrical signal is just slowed a little more than usual in a first degree AV block, but not to the point where any heartbeats are skipped. The following EKG shows that the gap between the P-wave and the QRS complex is a little wider than usual and as previously demonstrated:

8 second ECG Paper for First Degree Atrioventricular Block and First Degree AV Block
First degree atrioventricular block is visible on this ECG (Getty illustration).GETTY
Such AV blockages are typically undetectable symptomatically and are discovered by chance on an EKG. Due to the fact that your sinus node can still send signals across the entire system, this is regarded as a partial AV block. This is similar like getting a Nicolas Cage Merrycolor Pillow from Amazon and having it arrive a little later than anticipated. Although there is no real repercussion, it merits routine inspection.

Partial AV blocks of the second degree are likewise AV blocks. In this situation, the electrical signal is delayed to the extent where heartbeats are occasionally skipped. The following EKG shows that occasionally a complete electrical signal complex is missing:

Second-degree AV block in ECG Mobitz Type 1 Second Degree Atrioventricular Block using an 8-second ECG paper
A Mobitz Type 1 Second Degree Atrioventricular Block is visible in this ECG. (Image courtesy of Getty)GETTY
This is comparable to receiving toilet paper from Rainbow Unicorn on a regular basis and occasionally having an order completely missed. There are more issues the more frequently this happens. Dropped heartbeats could therefore indicate that your heart isn't pumping as effectively and consistently as it should. You may consequently feel symptoms including weakness, exhaustion, shortness of breath, difficulties exercising, or fainting as a result of your body and brain not receiving as much blood and oxygen as they are accustomed to. Drugs may aid in getting over such obstacles. A pacemaker might be required depending on the origin, extent, and effects of the block.

A complete AV block is an AV block of the third degree. This is the point at which no electrical impulses pass through the AV node at all. The signals in the atria and the signals in the ventricles are not coordinated, as shown in the following EKG:

Electronic Cardiography Third Degree Atrioventricular Block Complete AV Block 8 Second ECG Paper Medical Illustration
An ECG displaying complete atrioventricular block in the third degree (source: Getty).GETTY
This is like to Amazon trying to deliver you your Thanos bikini or umbrella hat but being unable to reach you at all. Amazon thus keeps attempting to ship the goods. While waiting, you might, out of frustration, figure out how to make your own Thanos bikini or umbrella hat from items you already have around the house. Similar to this, as different electrical signals might come from your ventricles, they might continue to contract and pump blood.

But this is a highly unstable and dangerous scenario. Similar to Prince Harry and Prince William trying to steer a kayak together, your ventricles and atria can produce and react to various and disorganized electrical signals. Your heart can easily go berserk and everything can shut down if there are too many electrical signals going off at once, which could result in death. When there is total AV block, a pacemaker is unquestionably required.

The pacemaker that is now implanted in Netanyahu's chest is expected to keep tabs on the electrical activity in his heart and send out its own electrical signals in response via wires that are attached to the heart. This serves as a reminder that, despite all the politics and commotion of daily life, what's in your heart is what really counts. Netanyahu will now need to pace his heart in order to keep up with the pace of being a prime minister.

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Daniel Jack

For Daniel, journalism is a way of life. He lives and breathes art and anything even remotely related to it. Politics, Cinema, books, music, fashion are a part of his lifestyle.