Pacemaker Questions: new idea 3/21/14

thisismydesign · Mar 19, 2014

I'm looking for a "perfect storm" situation of sorts, but so far, nothing I'm finding online even begins to address what I'm going for.

My MC has had his pacemaker for 11 years now, it's safe to say the battery's gonna go pretty soon.

Say it's about to die. My MC is a city cop and at this time, he's going after the unsub. After a fairly long chase, the unsub's accomplice will do something to get my MC on the ground, and from there, the combination of the dead pacemaker and that something will either cause heart failure, or whatever's realistic that's closest to that.

If it'd be necessary for something more serious, like a wound of any sort, to go along with this, I'm not object to adding that in.

Anything you can tell me will be of tremendous help. Thanks in advance!

melindamusil · Mar 19, 2014

Well, if he's got a pacemaker, his heart isn't in great condition to begin with. So the combination of exertion plus adrenaline should easily result in a (poorly timed) heart attack.

Of course, if he's got a pacemaker, I'm wondering how he qualified to be a police officer and why he's not on light duty...

Bing Z · Mar 20, 2014

I thought the same, too, Melinda, until Google led me to this page on the pacemaker club. So they do exist (learn something new everyday.) But as a layman, my instinctive concern is that the pacemaker is life and death to this cop. If he knows his pacemaker will run outta battery in 10 years, why won't he get a new one before it's too late? I'd think using a dead battery is too melodramatic plot-wise. Getting shot in the right place may be more convincing.

asroc · Mar 20, 2014

In this fair city a pacemaker isn't necessarily an automatic disqualifier, but you need to get medical clearance like if you're a diabetic. Patient compliance is an important part of getting clearance, though. Letting your battery run dry is not a good indicator of that...

It's hard to mess with a modern pacemaker. Blunt force trauma could do it. I once had a patient whose leads broke because he got hit with a baseball bat. The pacemaker stopped working, he got bradyarrhythmia and had to have a temporary transvenous pacemaker put in. It's not common though, and the effect may be different if the officer is wearing body armor.

(Incidentally, "unsub" is going to immediately identify you as someone whose entire knowledge of police work comes from TV.)

thisismydesign · Mar 20, 2014

To be fair, that is how I got interested a few years back, but now I'm majoring in criminal justice at my university. Kind of a habit that's stuck with me for casual conversation, I'll admit.

So if we're taking a dead battery out of the picture, is a poorly times heart attack the best way to go about it?

ap123 · Mar 20, 2014

The battery in my father in law's pacemaker was recalled a few years ago due to a defect, maybe something like that?

MDSchafer · Mar 20, 2014

Supposedly pacemakers are hackable. I think they used it on Homeland, but theoretically it's possible to hack pacemakers and insulin pumps

Kregger · Mar 20, 2014

A pacemaker regulates the heartbeat. Typically, to speed up a slow heartbeat or to initiate a contraction through an electrically blocked node. A pacemaker, as far as I know, will not slow a racing heart from over exertion. Usually the underlying heart failure will do that.

If you want fireworks, make it a pacmaker/difibrillator. Have your LEO go into fib and have your accomplice be touching LEO. Whammo!

or

Now here's something that seems to be in the realm of urban legend, so take it with a grain of salt. There is something with small electrical motors and dysfunctioning pacemakers. My Father-in-law (King of misinformation) worried about using an electric razor with his pacemaker. In his case, his pacemaker only worked when he was bradycardic. He did have the difib aspect. I told him the only worry he had was if his heart quit working, while he was shaving, and he fell with the razor running and sitting over the pacemaker. This would make his P/D stopworking. Of course, for my in-law's family, that was enough to throw away his electric razor.

Point being, your LEO could have his defib made defunct at a critical moment by having your acommplice hold a big motor on his chest. Say an electric leaf blower?

Could that be a Sue Grafton novel? L is for leafblower?

thisismydesign · Mar 20, 2014

Kregger said:
A pacemaker regulates the heartbeat. Typically, to speed up a slow heartbeat or to initiate a contraction through an electrically blocked node. A pacemaker, as far as I know, will not slow a racing heart from over exertion. Usually the underlying heart failure will do that.

By underlying heart failure, are you talking about the reason he has the PM, or the condition he'd experience in this scenario?

Kregger said:
Could that be a Sue Grafton novel? L is for leafblower?

Hah, I'd read it.

So I've been digging around and a new question came to mind; would some sort of cardiac arrest work better, since it seems a little more related to the PM? (That being said, my 'digging' was on my phone while I was tacking my horse, so I definitely didn't read enough. I'm researching more now, but still...)

thisismydesign · Mar 21, 2014

New idea; I'd have to work out some details leading up to this, but what about using a taser?

On someone with a pacemaker, could a stun gun trigger a heart attack/heart failure/cardiac arrest?

asroc · Mar 21, 2014

According to a con-ed class I took a while ago, this has been studied and it was found that Tasers have no effect on implanted devices.

ETA: This appears to be the study (full text PDF).

thisismydesign · Mar 21, 2014

Ah. I actually just read something on the AHA Journals that gave me the same answer.
Crap. So I guess sticking to blunt force trauma is my best bet. Which I'm cool with; there's a lot of options from there.

Now, in that case, is heart failure, cardiac arrest, or a heart attack most likely? My one professor is collecting some resources for me on Monday, but I still want to do a little casual digging around until then.

Edit: I've also been considering cardiovascular collapse, or V-Fib, so if either of those are plausible, I'd appreciate a little more detail on how that would go down.

asroc · Mar 21, 2014

Probably not a heart attack. That means the cardiac muscle isn't getting enough oxygen because it's not receiving blood, usually due to a blockage in a coronary artery.

Now, if it's just the pacemaker failure chances are he's going to experience the arrhythmia he had it put in for in the first place. Those can lead to cardiac arrest, including v-fib (one of the four cardiac arrest rhythms). Heart failure means the heart isn't putting out enough blood to meet the body's needs. Cardiac arrest is similar, it means the heart isn't pumping any blood at all.

Blunt trauma to the chest can also cause arrhythmias and cardiac trauma by itself. For example it can cause cardiac tamponade, which means fluid, such as blood, accumulates in the pericardium, a membrane that surrounds the heart. There's also the possibility of commotio cordis where trauma to the chest causes cardiac arrest. As a note though, most people who suffer a cardiac arrest stay dead.

So yeah, lots of options. What do you want to happen to the MC? Do you want him to be okay in the end?

thisismydesign · Mar 21, 2014

asroc said:
Blunt trauma to the chest can also cause arrhythmias and cardiac trauma by itself. For example it can cause cardiac tamponade, which means fluid, such as blood, accumulates in the pericardium, a membrane that surrounds the heart. There's also the possibility of commotio cordis where trauma to the chest causes cardiac arrest. As a note though, most people who suffer a cardiac arrest stay dead.

So yeah, lots of options. What do you want to happen to the MC? Do you want him to be okay in the end?

More or less okay; it's not particularly going to be a happy-ending deal for him.

He's not going to be returning to the force after this; there'll definitely be some lasting effects, but since he does already have the pacemaker, that probably goes without saying.

I'll be looking into those last two suggestions -- seems like one of those can definitely work out. If I have any other questions, I'll be sure to post again.

Thanks for your help, by the way.

Kregger · Mar 21, 2014

If you want LEO to survive and the scene to seem realistic you will need something less lethal.
Any type of V-fib or arrest will take an EMT to shock LEO's heart back to rhythm. Anything longer then four minutes of asystole will cause brain damage.
What you need is good old angina attack, just short of a heart attack.
The underlying heart failure is why LEO has a pacemaker, be it electrical or plumbing.
You can have an accomplice give LEO an old fashioned smackdown while he's writhing in pain from angina.
I believe that is insult to injury.

Good luck.

thisismydesign · Mar 21, 2014

Kregger said:
If you want LEO to survive and the scene to seem realistic you will need something less lethal.
Any type of V-fib or arrest will take an EMT to shock LEO's heart back to rhythm. Anything longer then four minutes of asystole will cause brain damage.
What you need is good old angina attack, just short of a heart attack.
The underlying heart failure is why LEO has a pacemaker, be it electrical or plumbing.
You can have an accomplice give LEO an old fashioned smackdown while he's writhing in pain from angina.
I believe that is insult to injury.

Good luck.

I'm liking this. Thank you! I'll look at what I can do.

Pacemaker Questions: new idea 3/21/14

thisismydesign

melindamusil

practical experience, FTW

Bing Z

illiterate primate

asroc

Alex

thisismydesign

ap123

Twitching

MDSchafer

Kregger

Shortening People's Lives, daily

thisismydesign

thisismydesign

asroc

Alex

thisismydesign

asroc

Alex

thisismydesign

Kregger

Shortening People's Lives, daily

thisismydesign