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Advance Anesthesia II > CARDIAC DEVICES > Flashcards

CARDIAC DEVICES Flashcards

EXAM 2

1
Q

Cardiac implantable electronic devices(CIED) include:

A
  1. Pacemaker
  2. Implantable cardiac defibrillator (ICD)
  3. Pacemaker/ICD combination
  4. Cardiac Resynchronization Device (biventricular cardiac device)
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2
Q

Main components of Pacemaker:

A
  1. Pulse generator
  2. Insulated lead wires
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3
Q

Pulse generator contains:

A
  • Battery
  • Circuitry
  • Connectors
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4
Q

Insulated wires conduct:

A

Energy to and from Myocardium

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5
Q

Reed switch:

A
  • Enables PM to convert from synchronous to Asynchronous
  • In the presence of a magnetic field/magnet
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6
Q

Pacemaker is usually implanted in:

A
  • A pectoral pocket either R+ or L+
  • Contain up to 3 lead wires
  • Wires Placed either RA, RV or both
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7
Q

Biventricular Pacemaker

A
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8
Q

PM lead on RA:

A
  • A spike is follow by a P wave on the ECG
  • Represents atrial depolarization
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9
Q

Pacemaker lead on RV:

A
  • A spike is followed by a QRS complex on the ECG
  • Represents Ventricular depolarization
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10
Q

Dual-Chamber Pacemaker:

A

Spike before the P wave and before the QRS complex

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11
Q

Other Types of Pacemakers:

A
  1. Transcutaneous
  2. Transvenous
  3. Epicardial
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12
Q

Transcutaneous Pacemaker:

A
  • Pads applied anteriorly on the Right upper chest and anteriorly on the left lower chest
  • Pads applied anteriorly mid chest and posteriorly between scapulae
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13
Q

Transvenous Pacemaker:

A
  • Pacing catheter inserted into central circulation into appropiate chamber(s)
  • Connected to external pacemaker generator
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14
Q

Epicardial Pacemaker:

A
  • Lead inserted at the completion of cardiac surgery (onto epicardium)
  • Attached to external pacing device
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15
Q

Indications for the use of Pacemakers:

A
  1. Sinus node dysfunction
  2. Atrioventricular node disease
  3. Chronic bifascicular block
  4. Long QT syndrome
  5. Hypertrophic obstructive cardiomyopathy
  6. Dilated cardiomyopathy
  7. Postacute phase of myocardial infarction
  8. Carotid sinus syndrome
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16
Q

1st Letter of the Pacemaker indicates:

A

Chamber where the pacing electrode is place

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17
Q

2nd Letter of the Pacemaker indicates:

A

Chamber where the sensing electrode is placed

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18
Q

3rd Letter of the Pacemaker indicates:

A
  • PM response to the detection of a spontaneous cardiac depolarization
  • Its effect on subsequent pacing stimuli
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19
Q

4th Letter of the Pacemaker indicates:

A

Rate modulation

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20
Q

5th Letter of the Pacemaker indicates:

A

Multisite pacing

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21
Q

Synchronous Mode:

A

Paced rate matching the underlying rate of one of the heart chambers

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22
Q

Asynchronous Mode:

A

Cardiac pacing mode set independent of the heart’s intrinsic rate

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23
Q

Inhibited Mode:

A
  • When the PT demonstrates an intrinsic heart beat
  • The pacer will not deliver a paced beat
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24
Q

Capture?

A

Depolarization of a heart chamber in response to pacemaker electrical output

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25
Q

Failure to capture

A

When the pacemaker’s electrical output fails to cause myocardial depolarization

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26
Q

Failure to sense:

A

The pacemaker fails to recognize intrinsic cardiac activity

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27
Q

Pacemaker Terminology

Learn the ones in blue

A
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28
Q

Indications for Implantable Cardiac Devices:

A
  1. V-Tach
  2. V-Fib
  3. Post MI with EF < 35% > 40 days
  4. Cardomyopathy from any cause with EF < 35%
  5. Hypertrophic cardiomyopathy
  6. Awaiting heart transplant
  7. Long QT syndrome
  8. Arrhythmogenic RV dysplasia
  9. Braguda syndrome
    10.Syncope or Ventricular tachycardia
    11.Catecholaminergic polymorphic VT and Syncope on B-blocker therapy
    12.Cardiac Sarcoidosis
    13.Giant cell myocarditis
    14.Chagas disease
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29
Q

ICD X-ray KNOW IT!
It was a Hotspot TQ

A
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30
Q

Implantable Cardioverter Defibrillator

A
  • Rialable method to restore a regular and coordinated rhythm from a lethal tachyarrhythmia
31
Q

ICD components:

A
  • Pulse generator
  • Large capacity battery
  • Large voltage capacitor
  • Lead wire
  • Shock coil
32
Q

ICDs Lead/shock coil is positioned in

A

Right atrium and ventricle

33
Q

ICD Lead/schock coil place in RA can:

A
  1. Treat bradycardia through pacing and sensing
  2. Provide rate modulation
  3. Initiate antitachycardic pacing
  4. Cardiovert
34
Q

ICD Lead/schock coil placed in RV can:

A
  • Treat Ventricular arrhythmias
  • Initiate anti-cardiac pacing
  • Cardiovert & defibrillate
  • Treat bradycardia through pacing and sensing
35
Q

ICD codes

A
36
Q

Placing a magnet over a pacemaker will

A

Initiate Asynchronous pacing

37
Q

ICD during V-Tach will:

A

Cardiovert with 1-30 Joules

38
Q

ICD during V-Fib will:

A

Defibrillate with 10-30 J
Six shocks

39
Q

Leadless single chamber intracardiac pacemaker:

A
  • Approximately one-tenth the size of the traditional single chamber PM
  • Implanted directly into the right ventricle via femoral vein catheter
40
Q

Leadless single chamber pacemaker eliminates common complications with:

A

Traditional PMs infection of:

  • SC pocket
  • Lead fracture
  • Hematoma
41
Q

Subcutaneous ICD indications:

A
  • PT with structural or congenital Heart disease
  • Compromised venous access
  • PT at high risk of infections
42
Q

SQ ICD is implanted at :

A
  • Left lateral chest wall
43
Q

Subcutaneous ICD is contraindicated in patients with:

A

Bradyarrhytmias

44
Q

Which device is not senstive to manipulation with a Magnet?

A

Subcutaneous ICD

45
Q

Preop assessment on a patient with ICDs:

A
  • Type of device
  • Location of the pulse generator
  • Type and length of procedure
  • Anticipated use of electrosurgical cautery
  • Patient’s surgical position
46
Q

Information on Device ID card includes:

A
  • Type of device
  • Model number
  • Serial number
  • Name of implanting physician or clinic
  • Contact information for the manufacturer
47
Q

How often is a pacemaker assess?

A

Yearly

48
Q

How oftern is an ICD deviced assses?

A

Every 6 months

49
Q

Device Interrogation information includes:

A
  • Date of last interrogation
  • Type of device
  • Manufacturer
  • Model
  • Indications
  • Battery life
  • Lead integrity
  • PM function and underlying rhythm or ICD therapy
  • Magnet response
  • Any alerts
50
Q

In case of an emergency and the device information is unknown:

A
  • ECG 12 lead reveal paced rhythm
  • CXR: Manufactures identifier on pulse generator
  • PM : presence of lead wires
  • ICD: Presence of 1-2 radiopaque lead/schock coil
51
Q

Electromagnetic Interference (EMI)

A

Any external or nonphysiologic signal that interfers with pacemaker function

52
Q

Most prevalent source of EMI in the OR:

A

Electrosurgical Cautery

53
Q

Monopolar Cautery:

A
  • Produces more energy than bipolar
  • Requires the placement of a grounding pad
54
Q

Bipolar cautery:

A
  • Have the anode and cathode at the tip of the device
  • Grounding pad is not necessary
55
Q

The distance between the electrocautery tip and the grounding pad will determine the:

A

Area in which stray current can be sensed by a CIED and misinterpreted

56
Q

Grounding pad should be positioned away from:

A

The CIED generator

57
Q

EMI Negatively affect the Pacemaker because it may:

A
  1. Be viewed as noise
  2. Initiate asynchronous pacing at rate that may cause R on T phenomena
  3. Damage de myocardium
  4. Decrease battery life
  5. Reset the device
  6. Be interpreted as a P wave
  7. Cause the device to only paced the ventricle
  8. Result in severe bradycardia
  9. Reprogram and alter devive settings
  10. Alter thresholds eliminatering proper capture
58
Q

ICD generator may interpret EMI as a potential:

A

Tachyarrhythmia (VT or VF)

Will deliver an inappropiate shock

59
Q

EMI may affect an ICD because it may:

A
  • Inhibit antitachycardia therapy
  • Be conducted down the lead and damage the myocardium via an endocardial burn
  • Permanently deactivate the device, causing it to enter a “magnet mode” and fail to detect lethal rhythms
  • Change the programming and thresholds
  • Affect the rate adaptive mode
  • Inappropriately increase the heart rate
60
Q

Factors affecting Implantable CV Device function:

A
61
Q

Other potential sources of EMI:

A
  • Transcutaneous electrical nerve stimulators
  • Spinal cord stimulators
  • Extracorporeal shock wave lithotripsy (ESWL)
  • Radiation therapy
  • Electroconvulsive therapy (ECT)
  • Magnetic resonance imaging (MRI)
62
Q

A pacemaker can be programmed to:

A

Asynchronous mode

63
Q

An ICD can have anti-tachycardia therapy

A

Disable

64
Q

Factors that may increase the rate of pacing:

A
  • Hyperventilation
  • Coughing or bucking
  • Mechanical ventilation
65
Q

When is magnet sensitivity assess?

A

During Preop evaluation

Magnet is a 3 inch round/rectangle

66
Q

In some devices the magnet will also suspend:

A

Rate modulation

67
Q

The ICDs Reed Switch is closed by the application of a magnet and suspends:

A

Anti-tachycardia therapy

If programmed to do so.

68
Q

Rate modulation is not suspended after magnet application on:

A

An ICD

69
Q

ICD + PM – magnet will only suspend:

A
  • Shock therapy
  • It will not asynchronously pace the heart
70
Q

Disadvantage to Magnet placement:

A
  • The position of the patient may not be optimal to accommodate the magnet
  • The magnet may not be effectively secured on the CIED
71
Q

In the event of an emergency and the CIED is
malfunctioning:

A
  • Transthoracic defibrillation paddles placed
  • Never directly over the device (paddles)
  • Cardioversion or Defibrillation should be started with the lowest possible energy setting
72
Q

Factors that Inhibits pacing on ICEDs?

A
  1. Shivering
  2. Fassciculations (succinylcholine)
73
Q

Factors that affects capture on ICEDs:

A
  • Electrolyte changes
  • Temperature (hypothermia)
  • pH
74
Q

Which factor can cause loss of capture?

A

Chemotherapy

Advance Anesthesia II (7 decks)

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