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Know this! Flashcards

1
Q

S1 heart sound is caused by?

A

Atrial-Ventricular (AV) valve closure (tricuspid/bicuspid)

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2
Q

Where is S1 heard the loudest?

A
  • at the apex of the heart
  • midclavicular, 5th intercostal space
  • mitral area
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3
Q

Which heart sound marks the end of diastole and beginning of systole?

A

S1 heart sound

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4
Q

S2 heart sound is caused by?

A
  • closure of semilunar valves (aortic/pulmonic)
  • aortic valve (A2), pulmonic valve (P2)
  • A2 closes B4 P2, but to close so sounds like one sound
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5
Q

Where is S2 heard the loudest?

A
  • at the base of the heart
  • right sternal border, 2nd intercostal space
  • aortic area
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6
Q

Which heart sound marks the end of systole and beginning of diastole?

A

S2

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7
Q

When does S2 split normally?

A
  • during inspiration
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8
Q

A wide, fixed splitting of S2 is caused by?

A

Right Bundle Branch Block

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9
Q

A pulmonary embolism causes which heart sound to be heard more loudly?

A
  • S2
  • causes an increase in back pressure in pulmonary artery and pushes back on pulmonic valve causing stronger closure and louder sound
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10
Q

What are the auscultatory points of the heart?

A
  • Aortic
  • Pulmonic
  • Erb’s point
  • Tricuspid
  • Mitral
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11
Q

S3 heart sound is caused by?

A
  • caused by the rapid rush of blood into a dilated ventricle

- occurs early in diastole, right after S2

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12
Q

Where is S3 heard the loudest?

A
  • heard best at the apex of the heart with the bell of the stethoscope
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13
Q

S3 is associated with?

A
  • heart failure
  • pulmonary HTN
  • cor pulmonale
  • mitral, aortic, or tricuspid insufficiency
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14
Q

S4 heart sound is caused by?

A
  • atrial contraction of blood into noncompliant ventricle

- occurs right after S1

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15
Q

Where is S4 heard the loudest?

A
  • at the apex with the bell of the stethoscope
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16
Q

S4 is associated with?

A
  • myocardial ischemia
  • infarction
  • HTN
  • ventricular hypertrophy
  • aortic stenosis
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17
Q

What BP changes are seen with severe hypovolemia or a severe drop in cardiac output?

A

severe hypovolemia or a serve drop in cardiac output

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18
Q

Systolic blood pressure is an indirect measurement of which hemodynamic measurement?

A

cardiac output and stroke volume

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19
Q

Diastolic blood pressure is an indirect measurement of which hemodynamic measurement?

A

systemic vascular resistance

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20
Q

The coronary arteries are perfused during which cardiac phase?

A

diastole

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21
Q

Why does inspiration cause an S2 split?

A
  • inspiration causes increased venous return to heart
  • increased volume = RV takes longer to empty
  • longer empty = SL valve stays open longer
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22
Q

Where is the aortic area located on the chest?

A

2nd ICS along the left sternal border

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23
Q

Where is the pulmonic area located on the chest?

A

2nd ICS along the right sternal border

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24
Q

Where is Erb’s point located on the chest?

A

3rd ICS along the left sternal border

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25
Q

Where is the tricuspid area located on the chest?

A

4th ICS along the left sternal border

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26
Q

Where is the mitral area located on the chest?

A

5th ICS, mid-clavicular

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27
Q

Where is the S2 split and P2 sound heard the best?

A

upper left sternal border

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28
Q

Pts with documented symptomatic bradycardia fall under what recommendation class for placement of a permanent pacer?

A

Class I

implantation is indicated

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29
Q

Pts with chronotropic incompetence fall under what recommendation class for placement of a permanent pacer?

A

Class I

implantation is indicated

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30
Q

Pts with drug induced symptomatic bradycardia fall under what recommendation class for placement of a permanent pacer?

A

Class I

implantation is indicated

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31
Q

Pts with SND w/ HR <40 and significant brady-like symptoms but with no documented association with the presence of bradycardia fall under what recommendation class for placement of a permanent pacer?

A

Class IIa

implantation is reasonable

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32
Q

Pts experiencing syncope of unexplained origin and the discovery of clinically significant abnormalities of SN function fall under what recommendation class for placement of a permanent pacer?

A

Class IIa

implantation is reasonable

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33
Q

Pts with minimally symptomatic patients w/ chronic HR <40 while awake fall under what recommendation class for placement of a permanent pacer?

A

Class IIa

PM may be considered

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34
Q

Term referring to a broad array of abnormalities r/t sinus node and atrial impulse formation and propagation?

A

Sinus Node Dysfunction

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35
Q

What are the anatomic locations an AV block may occur?

A
  • supra-His
  • intra-His
  • infra-His
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36
Q

What is the normal value for the PR interval?

A

120-200 ms

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37
Q

Which type of heart block has a constant, prolonged PRI (> 200ms) with no dropped or non-conducted beat?

A

1st degree AV block

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38
Q

What is a the defining characteristic of a 1st degree AV block?

A

Constant, prolonged PRI (> 200ms) with no dropped or non-conducted beat

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39
Q

What is the difference between 2nd degree type I and type II AV block?

A
  • type I: progressive prolongation of the PRI until a beat is dropped
  • type II: fixed, prolonged PRI with dropped beat, and is usually associated with a wide QRS
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40
Q

Which type of 2nd degree block is usually associated with a wide QRS?

A

Type II

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41
Q

Advanced 2nd degree AV block is described as?

A

2 or more consecutive P waves w/ nonconducted beats

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42
Q

In A-Fib, with a pause greater than 5 seconds should be considered to be d/t which type of heart block?

A

Advanced 2nd degree AV block

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43
Q

Type II 2nd degree AV block usually occurs intra-, infra- or supra-His?

A

block usually occurs intra- or infra-His, especially when the QRS is wide

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44
Q

3rd degree and advanced 2nd degree AV block associated w/ symptomatic bradycardia fall under what recommendation class for placement of a permanent pacer?

A

Class I

PM is indicated

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45
Q

Pts with ventricular arrhythmias that are presumed to be d/t 3rd degree and advanced 2nd degree AV block fall under what recommendation class for placement of a permanent pacer?

A

Class I

implantation is indicated

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46
Q

Pts with symptomatic bradycardia r/t required drug therapy and 3rd or advanced 2nd degree AV block fall under what recommendation class for placement of a permanent pacer?

A

Class I

implantation is indicated

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47
Q

PM implantation is indicated for awake, asymptomatic pts in sinus rhythm with documented periods of asystole of what duration?

A

greater than or equal to 3 seconds

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48
Q

PM implantation is indicated in awake, asymptomatic pts with A-fib and bradycardia (tachy-brady) with ____ or more pauses lasting _____?

A
  • 1 or more pauses

- lasting 5 or seconds

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49
Q

Pts with 2nd degree AV block and associated symptomatic bradycardia fall under what recommendation class for placement of a permanent pacer?

A

Class I

implantation is indicated

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50
Q

Pts with persistent 3rd degree AV block and avg awake HR of ___ BPM are a Class I for PM placement.

A

HR < 40 BPM

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51
Q

Pts with persistent 3rd degree AV block and avg awake HR of > 40 BPM with what conditions are a Class I for PM placement?

A

if cardiomegaly or LV dysfunction is present

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52
Q

Pts with 2nd or 3rd degree AV block during exercise with no myocardial ischemia fall under what recommendation class for placement of a permanent pacer?

A

Class I, indicating that a PM is needed

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53
Q

Asymptomatic pts with persistent 3rd degree AV block and an escape rate >40 without cardiomegaly fall under what recommendation class for placement of a permanent pacer?

A

Class IIa

PM may be considered or is reasonable

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54
Q

2nd degree AV block at the intra- or infra-His level fall under what recommendation class for placement of a permanent pacer?

A

Class IIa

PM may be considered or is reasonable

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55
Q

Pts with 1st or 2nd degree AV block w/ symptoms similar to _____ or ______ are Class IIa indications for PM placement.

A

pacemaker syndrome symptoms or hemodynamic compromise

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56
Q

When does type II 2nd degree AV block with a wide QRS become a Class I recommendation for PM placement?

A

when the pt has isolated right bundle branch block

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57
Q

Term for impaired conduction below the AV node in the right and left bundle branches?

A

Bifascicular block

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58
Q

Bifascicular block is the term for which type of impaired conduction?

A
  • when the impaired conduction is located below the AV node in the right and one of the two fascicles of the left bundle branches
  • Right and left bundle blocks
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59
Q

How many cardiac fascicles are there and what are they called?

A
  • 3 total
  • RV x 1: Right Bundle Branch
  • LV x 2: anterior and posterior fascicle
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60
Q

What type of pacing is indicated for a pt w/ persistent 2nd degree AV block in the His-Purkinje system w/ alternating BBB or 3rd degree block w/in or below the His-purkinje system after a STEMI?

A

permanent ventricular pacing is indicated

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61
Q

What type of pacing is indicated for a pt with transient advanced 2nd or 3rd degree infranodal AV block and associated BBB?

A

permanent ventricular pacing

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62
Q

What is hypersensitive carotid sinus syndrome?

A

syncope or presyncope resulting from an extreme reflex response to carotid sinus stimulation

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63
Q

What are the 2 components of hypersensitive carotid sinus syndrome?

A
  • cardioinhibitory d/t increased parasympathetic tone

- vasodepressor effect, secondary to above

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64
Q

What are the cardioinhibitory manifestations of hypersensitive carotid sinus syndrome?

A
  • asystole d/t either slowing of the sinus rate (sinus arrest) or prolongation of the PR interval
  • pauses up to 3 secs during carotid sinus massage are WNL
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65
Q

What are the manifestations of the vasodepressor component of hypersensitive carotid sinus syndrome?

A

loss of vascular tone and hypotension

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66
Q

Neurocardiogenic syncope or syndrome is characterized by?

A

self-limiting episodes of systemic hypotension d/t both bradycardia and peripheral vasodilation

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67
Q

Pacing is indicated for pauses lasting _____ in patients with recurrent syncope r/t to hypersensitive carotid sinus syndrome and neurocardiogenic syncope.

A

pauses lasting longer then 3 seconds

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68
Q

When is permanent pacing a reasonable (class IIa) tx for symptomatic recurrent SVT?

A

when catheter ablation and/or drugs fail to control the arrythmia or produce intolerable side effecgts

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69
Q

Pts w/ sustained pause-dependent VT w/ or w/o QT prolongation fall under what recommendation class for placement of a permanent pacer?

A

Class I

PM is indicated

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70
Q

CRT is indicated for pts with LVEF 1, sinus rhythm, LBBB with a QRS 2, and NYHA 3.

A

1) less than or equal to 35%
2) greater than or equal to 150ms
3) NYHA class II, III or ambulatory IV

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71
Q

What are the pathological causes of abnormal bradycardia?

A
  • SSS
  • drugs
  • SA block
  • sinus arrest and AV block
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72
Q

What is overdrive suppression r/t the heart?

A

The slower AV node (40-60) is suppressed by the faster SA node (60-80)

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73
Q

What mode would be set for a patient with normal SA node conduction and AV block?

A
  • Dual chamber pacemaker with VAT or DDD mode

- Pace (V), Sense (A), Triggered

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74
Q

What are the steps of VAT mode starting with the firing of the SA node?

A
  • Steps:
    1) SA node fires = atrial PM inhibition and start of AVD
    2) AV delay expires = ventricular PM fires = restarts atrial escape interval
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75
Q

The AV delay is equivalent to what normal physiologic cardiac interval?

A

PR interval

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76
Q

What is the atrial escape interval (AEI)?

A

time from begging of QRS or firing of ventricular PM to the next QRS or vent pace

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77
Q

What are the modes for a pt with afib or SSS with no hx of AV block with a single chamber pacemaker?

A
  • VVI for A-Fib

- AAI for SSS and no hx of AV block

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78
Q

What does TPS stand for?

A

Transcatheter Pacing System

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79
Q

What type of lead polarity would produce large pacing spikes and pectoral/pocket stimulation?

A

unipolar leads

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80
Q

What is Ohm’s law?

A

V = IR

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81
Q

Current is measured in what units and represented by which letter?

A

milliamps (mA) and represented by I

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82
Q

Voltage is is measured in what units and is aka?

A

Volts (v) and amplitude

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83
Q

Amplitude is aka?

A

voltage

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84
Q

Which values of Ohm’s law can be programmed using the programmer?

A

voltage (v) and impedence (R)

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85
Q

Impedence is measured in what units and represented by which letter?

A

ohms and represented by (R)

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86
Q

What is the term meaning the force that moves the current?

A

voltage

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87
Q

What is the term for the opposition of current flow?

A

impedence or resistance

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88
Q

What are the types of insulation used in leads?

A

silicon and polyurethane

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89
Q

What is the normal acceptable lead impedence range:

1) low power lead
2) high power lead

A

1) 200 - 2000 Ohms

2) 20 - 200

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90
Q

What impedence trend or change is cause for concern and further investigation?

A

appx 30% increase or decrease in impedence from last interrogation or abrupt change

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91
Q

A decrease in impedence could signify?

A

a decrease in impedence could mean a break or leak in the insulation of a lead

92
Q

An increase in impedence could siginify?

A
  • an increase in impedence could mean:
    1) a break or fracture in the lead conductor or wire
    2) or lead is not seated properly in the header
93
Q

What is lead crush?

A
  • lead damage d/t crushing motion of clavicle and 2nd lead
94
Q

What is a possible solution to lead crush?

A

reprogram bipolar setting to unipolar sensing and pace if inner conductor is intact

95
Q

What is the term for the minimum stimulus needed to capture the cardiac tissue?

A

capture threshold

96
Q

Capture threshold is a function of which values?

A

Amplitude and pulse width

97
Q

What is pulse width?

A

the duration of the impulse generated, measured in milliseconds (ms)

98
Q

What is the acceptable amplitude threshold safety margin?

A

2x the calculated amplitude threshold

99
Q

What is the acceptable pulse width threshold safety margin?

A

3x the calculated pulse width threshold

100
Q

What is shown on the strength duration curve?

A
  • it shows the relationship between amplitude and pulse width
  • plots min voltage needed to capture myocardium at various pulse widths
101
Q

What graphical structure shows the relationship between amplitude and pulse width??

A

the strength duration curve

102
Q

What are the types of therapy an ICD can deliver?

A

1) bradycardia pacing
2) cardioversion
3) defibrillation
4) antitachycardia pacing (ATP)

103
Q

What component multiplies the voltage, which is then store in the capacitor?

A

the transformer

104
Q

The transformer multiplies the voltage of an ICD up to what value?

A

up to 800 volts

105
Q

Which component of an ICD stores the multiplied voltage from the transformer?

A

the capacitors

106
Q

Which lead configuration in an ICD is known as true bipolar?

A

Right Vent tip (cathode), Right vent ring (anode)

107
Q

Which lead configuration in an ICD is known as integrated bipolar?

A

Right vent tip (cathode), Right vent coil (anode)

108
Q

What are the detection zones on an ICD?

A

V-fib, fast VT (FVT), V-tach

109
Q

What do the following marker channels mean:

1) TS
2) TD
3) FS
4) FD

A

1) TS - sensed beat in VT detection zone
2) TD - VT detected or redetected
3) FS - sensed beat in VF detection zone
4) FD - VF detected or redetected

110
Q

What do the following marker channels mean:

1) TP
2) CE
3) CD

A

1) TP - antitachycardia pacing
2) CE - charge end
3) CD - charge delivered

111
Q

How many detection zones can be programmed into an ICD?

A

up to 3 detection zones can be programmed

112
Q

What type of counter is used by an ICD to detect sustained VT?

A

consecutive counter

113
Q

What type of counter is used by an ICD to detect sustained VF?

A

probabilistic counter

114
Q

When is a combined count NID calculated and use in an ICD?

A
  • used when rhythms go back and forth between the VT and VF zones
  • looks back 8 beats
115
Q

What are the types used when programming ATP?

A

1) Burst - stimuli delivered at equal intervals

2) RAMP - calculated % of detected rate with each sequence

116
Q

What is the purpose of antitachycardia pacing?

A
  • to overdrive pace tissue in excitable GAP area to interrupt the reentry circuit
  • sequence should be faster than tachy rate
117
Q

What are the steps to program ATP in an ICD?

A

1) chose therapy type (burst, RAMP)
2) select # of pulses per sequence
3) rate ATP is delivered
4) # of ATP sequences before moving to next therapy (shock)

118
Q

What rhythms are ATP recommended for?

A

VT and FVT

119
Q

What rhythms are cardioversion recommended for?

A

VT and FVT

120
Q

What is important to remember regarding the administration of a cardioversion?

A

need to synch so shock can be delivered on R-wave to prevent shocking on the T-wave

121
Q

What does the wavelet feature on the ICD do?

A
  • stores NSR template for comparison

- template should be evaluated at every visit

122
Q

How does the wavelet feature determine if a rhythm is not NSR?

A
  • at NID, compares the median interval of the last 12 to the S T Limit
  • if the median interval slower than the SVT Limit, wavelet is applied
  • algorithm them compares 8 QRS complexes to the stored template
  • if 2 or more are < 70% match = not NSR
123
Q

What is the Onset feature on the ICD do?

A

evaluates the acceleration of the rate to determine SVT vs VT

124
Q

Placing a magnet on a pacemaker defaults the setting to what BPM?

A
  • 85 bpm

- 65 bpm if battery has entered RRT/ERI

125
Q

Which nerve innervates the diaphragm?

A

the phrenic nerve

126
Q

What is the normal cardiac conduction pathway?

A
  • SA node
  • AV node
  • common bundle
  • R and L bundle branches
  • perkinje fibers
127
Q

What is the normal value for cardiac output?

128
Q

What is the normal value for the QRS complex?

129
Q

How do you convert from BPM to ms?

130
Q

How do you convert from ms to BPM?

131
Q

What are the 2 main underlying mechanisms responsible for causing arrythmias?

A

1) abnormal automaticity - impulse formation issues

2) conduction issues - blocked or slowed impulse

132
Q

What is the atrial rate seen during A-Flutter?

A

250-400 bpm

133
Q

What is the atrial rate during A-fibrillation?

A

400 bpm or greater

134
Q

What are the rates for the following:

1) SA node
2) AV node/junctional
3) perkinje/ventricular escape

A

1) 60-100 bpm
2) 40-60 bpm
3) 20-40 bpm

135
Q

What is the rate seen during an Idioventricular rhythm?

A 
ventricular = 20-40
atrial = 0
136
Q

What is the rate seen during accelerated IVR

A 
ventricular = 50-100
atrial = 0
137
Q

What are the Class I PM indications for Sinus Node Dysfunction/ (are 4 answers)

A
  • symptomatic bradycardia
  • required medicine induced bradycardia
  • symptomatic sinus pause (>3 secs)
  • chronotropic incompetence
138
Q

What are the Class IIa PM indications for Sinus Node Dysfunction?

A
  • symptoms w/ HR <40 and syncope with no known cause
139
Q

What are the Class I PM indications for 3 deg AV block? (6 answers)

A
  • HR < 40 (symptoms or asymptomatic)
  • asystole > 3 secs
  • occurs even after an ablation
  • occurred post-op
  • block r/t neuromuscular disease
  • intermittent 3rd block w/ BBB (wide QRS)
140
Q

What are the Class I PM indications for for 2nd deg AV block?

A
  • HR < 40 (symptoms or asymptomatic)
  • asystole > 3 secs
  • occurs even after an ablation
  • occurred post-op
  • block r/t neuromuscular disease
  • 2nd deg type II block w/ BBB (wide QRS)
141
Q

What are the Class IIa PM indications for 2nd deg AV block?

A
  • asymptomatic w/ type II and narrow QRS
  • intra or infra-HIS type I w/ narrow/wide QRS
  • symptoms like pacemaker syndrome
142
Q

What are the Class I PM indications for 1st deg AV block?

143
Q

What are the Class IIa PM indications for 1st deg AV block?

A
  • atrial systole occurs close to preceding vent systole
  • hemodynamic issues/instability
  • symptoms like pacemaker syndrome
  • premature atrial contractions resulting in incomplete filling
  • ventricular filling is compromised
  • decreased CO
144
Q

What is the term for syncope or presyncope r/t to an extreme reflex response to carotid sinus stimulation/

A

Hypersensitive Carotid Sinus Syndrome (HCSS)

145
Q

What are the components of the neurocardiogenic reflex r/t to HCSS?

A

1) cardioinhibitory - decreased HR r/t increased parasympathetic tone
- increased PRI and/or advanced AV block
2) vasodepressor - loss of vascular tone = BP drop

146
Q

What specific conditions are indications for PM placement?

A
  • acquired AV block in adults
  • chronic bifascicular and trifascicular block
  • AV block associated with MI
  • SND
  • HCSS
  • hypertrophic obstructive or idiopathic dilated cardiomyopathy
  • heart transplants
  • children, adolescents with congenital heart diseases
  • prevention and termination of tachyarrhythmias
147
Q

Pacing after valve surgery is recommended when the patient experiences __1__ occurring __2__ postop and lasting __3__ postop and will be unlikely to resolve within __4__.

A

1) complete AV block
2) < 24 hrs
3) >48 hrs
4) < 2 wks

148
Q

What are the 3 pacemaker management strategies?

A

1) rate support
2) AV synchrony
3) manage comorbidities

149
Q

NYHA Class I?

A

no symptoms

150
Q

NYHA Class II?

A

symptoms with moderate activity

151
Q

NYHA Class III?

A

symptoms with minimal activity

152
Q

NYHA Class IV?

A

symptoms at rest

153
Q

ACC/AHA Stage A?

A

high risk, no damage or symptoms

154
Q

ACC/AHA Stage B?

A

structure damage, no symptoms

155
Q

ACC/AHA Stage C?

A

structural damage, with current or previous symptoms

156
Q

ACC/AHA Stage D?

A

end stage, needs specialized tx (refractory HR)

157
Q

CRT stands for?

A

Cardiac Resynchronization Therapy

158
Q

What is the most common type of PM battery?

A

lithium-iodine (2.8 volts)

159
Q

What is the most common type of ICD battery?

A

silver-vanadium-oxide

160
Q

Cathode has what type of charge?

A

negative - delivers impulse

161
Q

Anode has what type of charge?

A

positive - receives impulse and completes the circuit

162
Q

What does IPG stand for?

A

Implantable Pulse Generator

163
Q

What is the term for the min rate a PM device will pace?

A

Lower Rate Interval (aka pacing interval)

164
Q

Convert the Lower Rate of 60 BPM to ms?

A

60,000 / 60 BPM = 1000ms

165
Q

What is the interval showing the max time before ventricular pacing occurs?

A
  • Paced Atrial Interval (PAV)
  • Sensed AV
  • AV Delay
166
Q

Question:

If PAV = 200ms and the LRI is 60 BPM, what is the VA interval going to be?

A
  • LRI = PAV + VA inteval
  • 60 BPM or 1000ms = 200ms + VA interval
  • VA interval = 800ms
167
Q

What is the Chronaxie?

A

point on strength duration curve where amplitude is 2x the value of the rheobase

168
Q

What is the Rheobase?

A

the lowest point of capture on strength duration curve

169
Q

What is the recommended R-wave amplitude at implant?

A

≥ 5.0 mV (the bigger the better)

170
Q

What is the recommended P-wave amplitude at implant?

A

≥ 1.5 mV (the bigger the better)

171
Q

What is the recommended sensitivity safety margin?

A

at least half of the sensing value

172
Q

What are the 3 types of threshold tests?

A

1) amplitude threshold test
2) pulsewidth threshold test
3) Strength duration curve

173
Q

How do conduct an Amplitude threshold test?

A
  • pulse width held constant (0.4ms)
  • look at ACM threshold value
    Set:
    • V -> VVI rate 10-15 higher
    • A -> DDD rate 10-15 higher and extend AVD to 350m
  • don’t do atrial if pt is in afib
  • note 1st loss of capture
174
Q

How do conduct a pulsewidth threshold test?

A
  • test => threshold => pulse width
  • set voltage (held constant)
  • set pulse width
  • pulse width decreases automatically
  • note 1st loss of capture
  • threshold = value prior to loss of capture
  • safety margin = 3x pulse width
175
Q

What part of the strength duration curve denotes the optimal settings for battery longevity?

176
Q

During the R-wave amplitude test at implant, what is the required R-Wave amplitude value to ensure all R-waves are detected?

177
Q

Which type of insulation allows for a smaller lead diameter and lower friction coefficient?

A

polyurethane

178
Q

What are the indications for a Pacemaker?

A
  • sinus node dysfunction (brady, sinus pause)
  • conduction block
  • syncope
179
Q

Why would patients taking digoxin require a pacemaker?

A

digoxin slows AV conduction and a ventricular PM may be necessary if AV conduction is slowed to much

180
Q

CRT is considered in what stage of the HF treatment continuum ladder?

A

Stage C, if BBB is present

181
Q

What are the classes of A-Fib?

A
  • paroxysmal
  • persistent
  • permanent
182
Q

Definition of paroxysmal A-Fib?

A

≥ 2 A-fib episodes that self-terminate within 7 days

183
Q

Definition of persistent A-Fib?

A

recurrent episodes lasting > 7 days

184
Q

Definition of permant A-Fib?

A

A-Fib lasting > 1yr

185
Q

Which rhythm is often associated or seen in patients with bradycardia?

186
Q

What are the treatment options for A-Fib?

A
  • meds (BB, CCB, antiarrhythmics)
  • cardioversion
  • ablation
  • pacemaker
187
Q

AHA suggests that what EF value is an indication of HF?

188
Q

What are the different types of lead fixation options?

A
  • active
  • passive
  • epicardial
189
Q

Large pacing spikes and extra cardiac stimulation are seen in which type of pacing system?

A

these are pacing characteristics of a unipolar system

190
Q

In a unipolar system, what components act as the cathode and anode?

A
  • cathode = conductor coil

- anode = can or IPG

191
Q

A unipolar lead system is susceptible to over or undersensing?

A

oversensing d/t distance between the cathode and anode

192
Q

In a bipolar system, what components act as the cathode and anode?

A
  • cathode = tip

- anode = ring or coil

193
Q

What happens to the current flow as the voltage increases?

A

current flow will increase by the same amount

194
Q

What happens to the current flow as the impedence increases?

A

current flow will decrease

195
Q

An increase in impedance values is indicative of what?

A

possible lead fracture or conductor break

196
Q

An decrease in impedance values is indicative of what?

A

possible break in the insulation

197
Q 
Question:
If voltage (v) = 5v; impedance (R) = 500 ohms
Find current (I)?
A

(5v / 500 ohms) x 1000 = 10 mA

198
Q 
Question:
If voltage (v) = 10v ; current (I) = 0.8 mA
Find impedance (R)?
A

(10v / 0.8 mA) x 1000 = 1250 ohms

199
Q

Once the battery has reach RRT/ERI, the device switches to what mode and rate and for how long?

A

VOO at 65 BPM for up to 3 months

200
Q

What does PBL-STOP stand for?

A
  • Presenting rhythm, rate and % paced
  • Battery status
  • Lead impedance
  • Sensing thresholds
  • Threshold (amplitude, pulse width, SD curve)
  • Observations
  • Print
201
Q

When does the Lower Rate Interval start?

A
  • starts with the atrial event

- is the A-A interval

202
Q

Pacing capture is a function of?

A

amplitude and pulse width

203
Q

What is the definition of cross-talk?

A

when the lead in one chamber senses the paced event from another, resulting in inappropriate inhibition of needed pacing

204
Q

What feature is designed to prevent pacing inhibition d/t cross-talk?

A

the ventricular safety period

205
Q

What is the purpose of the ventricular safety period (VSP)?

A
  • to prevent pacing inhibition d/t cross-talk

- prevents pacing on t-wave

206
Q

What are methods of managing cross-talk?

A

1) reduce atrial output
2) decrease ventricular sensitivity
3) program to bipolar (if possible)
4) increase PAVB period (only as last resort)

207
Q

How long is the ventricular safety period (VSP)?

A

110 ms interval that starts after atrial paced event

208
Q

Why is the Paced AV (PAV) interval longer (appx 30ms) than the Sensed AV (SAV) interval?

A
  • the PAV interval is longer then the SAV to account for the slower cell to cell propagation pathway
  • pacing site may no be near the conduction p-way so time is needed to allow signal to reach the p-way
209
Q

What are the methods for preventing or correcting Pacemaker Mediated Tachycardia (PMT)?

A

1) PVC response program
2) PMT Intervention
3) auto-PVARP

210
Q

Why would PMT Intervention be turned on?

A
  • atrial over/undersensing

- atrial noncapture

211
Q

What does the PVC response program do?

A
  • extends the Post Ventricular-Atrial Refractory Period (PVARP) to 400ms following a PVC
212
Q

How does the Pacemaker Mediated Tachycardia intervention work?

A
  • extends the Post Ventricular-Atrial Refractory Period (PVARP) to 400ms after PMT detection
213
Q

How long is the PVARP extended in the treatment in response to a PVC or detected PMT?

214
Q

What is the upper tracking rate or upper tracking interval (UTI)?

A
  • is the fasted rate the pacemaker will pace the ventricles

- starts after ventricular sensed/paced event

215
Q

What are the criteria for pacemaker Wenckebach behavior?

A
  • UTI < AR < TARP
  • Upper tracking rate < atrial rate
    AND
  • atrial rate < Total Atrial Refractory Period (TARP)
216
Q

What are the criteria for pacemaker mediated 2:1 block?

A

Total Atrial Refractory Period (TARP) < atrial rate

217
Q

What intervals make up the Total Atrial Refractory Period (TARP)?

A

SAV or PAV + PVARP = TARP

218
Q

Question:
UTR = 120 BPM; SAV = 200ms; PVARP = 350ms
What will be seen, 1:1 tracking, PM Wenckebach, or 2:1 block?

A

1) UTI = 60K / 120 bpm = 500ms
2) TARP = SAV (200ms) + PVARP (350ms) = 550ms
3) TARP (550ms) > UTI (500ms) = 2:1 block

219
Q

Triple Chamber pacemakers are also known as?

A
  • Bi-Ventricular

- Cardiac Resynchronization Therapy (CRT-P)

220
Q

Which type of pacemaker is used for Cardiac Resynchronization Therapy (CRT-P)?

A

triple chamber or Bi-Ventricular

221
Q

When is a magnet used on a cardiac device?

A
  • check battery status
  • presence of EMI (surgery)
  • device troubleshooting
222
Q

Applying a magnet temporarily changes the mode of the pacemaker to what?

A
  • asynchronous pacing (DOO, AOO, VOO)
223
Q

When does lead dislodgement usually occur?

A

within 6 weeks of implant, will see increase in lead impredances

224
Q

What is the normal impedance value for an ICD lead?

A

20-200 ohms

225
Q

What are acceptable chronic P-wave amplitude values?

A

≥ 0.1 mV

226
Q

What are acceptable chronic R-wave amplitude values?

A

≥ 3.0 mV

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