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EKG > Lecture 9 (Pacemakers) > Flashcards

Lecture 9 (Pacemakers) Flashcards

1
Q

Symptoms that may require a pacemaker

A

syncope or presyncope, dizziness, light-headness, fatigue, mental confusion, palpitations (sick-sinus rhythm) excercise intolerance

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2
Q

Non-Invasive Testing

A

12 lead EKG, ambulatory monitor, exercise testing, autonomic testing (tilt table for neurocardiogenic syncope)

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3
Q

Holter Monitor

A

worn for 1-2 weeks

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4
Q

Event Recorder

A

worn for 1 month

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5
Q

Implantable Loop Recorder

A

outpatient surgery worn for longer durations

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6
Q

Invasive Testing

A

Electrophysiology testing and Implantable loop recorder

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7
Q

Electrophysiology study can find:

A

spot of an unusual heart rhythm

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8
Q

Class 1 Pacemaker indication

A

beneficial, useful, effective, acceptable and necessary

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9
Q

Class2 Pacemaker indication

A

evidence/opinion in favor for use; usefullness and efficacy have been proven

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10
Q

Class 3 Pacemaker Indication

A

Not useful or effective; may be harmful; DO NOT PUT PACEMAKERS IN THESE PATIENTS!

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11
Q

Pacemaker Considerations

A

1-association of SYMPTOMS with an arrhythmia
2-LOCATION of conduction abnormality likelihood of progression
3-Risk of arrhythmia (bifascicular block)

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12
Q

Pacemaker Considerations-Symptoms

A

Correlate SYMPTOMS with rhythm esp important for bradycardia (use ambulatory monitor or careful hx or log book)

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13
Q

Bradycardia Symptoms

A

most common symptoms we see: dizziness, light-headedness, syncope, fatigue, poor exercise tolerance

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14
Q

Pacemaker considerations-Location

Disease within AV Node

A

Significant PR prolongation, mobitz type 1 (wenckebach) normal QRS

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15
Q

Pacemaker considerations-Location

Disease below AV Node

A

-potentially more unstable; normal or minimally prolonger PR Interval, mobits type 2-secondary AV block, QRS abnormal-bundle branch/fascicular blocks

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16
Q

Most common indication for pacemaker implantation

A

Sinus node dysfunction (#1), AV block

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17
Q

Sinus node dysfunction definition

A

periods of bradycardia, tachycardia, prolonged pauses or alternating bradycardia and tachycardia

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18
Q

Sinus Node Dysfunction pacemaker indication Class 1

A

1st-correlate symptoms w/ bradycardia; class 1: HR less than 40 (symptomatic), symptomatic chronotropic incompetence (with exercise);

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19
Q

Acquired AV Block pacemaker indication class 1

A

severe conduction regardless of symptoms: complete AV block (3rd degree), advanced 2nd degree AV Block, Symptomatic mobitz type 1/2, mobitz type 2 with wide QRS or chronic bifascicular block, exercise induced 2nd or 3rd degree block

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20
Q

Sinus Node Dysfunction pacemaker indication Class 2

A

class 2 (may need it)-sinus brady w/o clear correlation with symptoms, sinus node dysfunction in pt with unexplained syncope

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21
Q

Acquired AV Block pacemaker indication class 2

A

consider pacemaker-asymptomatic mobitz type 2 block, 1st degree block with symptoms, bifascicular block with syncope possibly related

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22
Q

Other pacemaker indications

A

neurogenic syncope, post-MI conduction abnormalities, long QT syndrome(more commonly ICD w pacer), hypertrophic cardiomyopathy(affects LVOTO), CHF(CRT/BiV Pacer), s/p cardiac transplant (denervation/bradycardia), bradycardia induced ventricular (suppress), anti-tachycardia pacemakers

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23
Q

Post MI Conduction abnormalities class 1 criteria for pacemaker

A

3rd degree block, persistent 2nd degree block in HIS bundle, transient infranodal AV block with BBB

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24
Q

contains battery that provides the energy for sending impulses to the heart

A

pulse generator

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25
Q

houses the circuitry that controls pacemaker options

A

pulse generator

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26
Q

Complete circuit of pacemaker

A

pacemaker components combine with body tissue to form complete circuit; pulse generator, leads or wires, cathode, anode, body tissue

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27
Q

delivers electrical impulses from pulse generator to the heart and senses cardiac depolarization

A

leads (insulated wires)

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28
Q

Passive fixation

A

the tines become lodged in the trabeculae (fibrous meshwork) of the heart

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29
Q

Active fixation

A

the helix (or screw) extends into the endocardial tissue which allows for lead positioning anywhere in the hearts chamber

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30
Q

leads applied directly to the heart

A

Myocardial and Epicardial leads

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31
Q

Fixation mechanisms for myocardial and epicardial leads

A

epicardial-stab in, myocardial-screw in, or suture on

32
Q

During pacing the impulse (how does it start and travel)

A

begins in the pulse generator and flows through the lead and the cathode(-) stimulates the heart and returns to the anode (+)

33
Q

Pacing lead implanted in the atrium or ventricle, depending on the chamber to be paced and sensed

A

single chamber system

34
Q

Two leads -one implanted in both the atrium and the ventricle

A

dual chamber systems

35
Q

four functions of most pacemakers

A

stimulate cardiac depolarization, sense intrinsic cardiac function, respond to increased metabolic demand by providing rate responsive pacing, provide diagnostic information stored by the pacemaker

36
Q

Pacing modes 1st letter

A

chamber paced V-ventricle A-atrium D-dual

37
Q

Pacing modes 2nd letter

A

Chamber Sensed: V,A,D

38
Q

Pacing modes 3rd letter

A

Repsonse to sense I-inhibited, O-neither, D-both

39
Q

paces regardless at set rate

A

VOO

40
Q

paces at rate unless native is sensed

A

VVI

41
Q

paces atrium unless sense native

A

AAI

42
Q

paces atrium and ventricle at set rate

A

DOO

43
Q

paces atrium at set rate and ventricle at set rate and both can be inhibited if senses atrium or ventricle at adequate rate

A

DDD

44
Q

Rate response pacemakers provide patients with

A

the ability to vary HR when the sinus node cannot provide the appropriate rate

45
Q

Rate responsive pacing indicated for

A

pts who are chronotropically incompetent (HR cannot reach appropriate levels during exercise or to meet metabolic demands; pts in chronic a fib w/ slow ventricular response

46
Q

when the need for oxygenated blood increases the pacemaker ensures that the HR increases to provide additional CO (type of pacing)

A

rate responsive pacing

47
Q

Failure to capture undersensing definition

A

pacemaker does not see the intrinsic beat and therefore does not respond appropriately

48
Q

assumed pacemaker setting

A

minimum of 60

49
Q

Ventricular dysynchrony electrical definition

A

inter or intraventricular conduction delays typically manifested as LBBB

50
Q

Ventricular dyssynchrony mechanical definition

A

abnormal ventricular conduction resulting in mechanical delay and dysynchronous contraction

51
Q

Pacemaker/ICD complications seen earlier or at implantation

A

INFECTION, pneumothorax, hemothorax, vascular injury, valve injury, cardiac perf, thromboembolism, arrhythmia, cardiac arrest, lead dislodgement, wound erosion

52
Q

Pacemaker/ICD chronic complications

A

INFECTION, TRICUSPID VALVE problem, vascular thrombus, embolism, perforation, lead fracture, lead dislodgement, increased threshold, inappropriate pace/sense, arrhythmia

53
Q

What leads to infection after pacemaker or ICD

A

poor wound healing and erosion

54
Q

What do you always want to compare to an old chest film

A

lead fracture and/or dislodgement

55
Q

Electromagnetic Interference cautions with pacemakers

A

MRI, antitheft systems, metal detectors, cell phones, mp3s, extracorporeal shock wave lithotripsy, power generating equipment, radiofrequency ablation, tens units
most are mannageable with precautions

56
Q

Interference is caused by an electromagnetic energy with a source that is outside the body

A

electromagnetic interference

57
Q

waves most frequently associated with pacemaker interference

A

50-60Hz

58
Q

electromagnetic fields that may affect pacemakers are

A

radiofrequency waves

59
Q

most common place to find sources of electromagnetic interference devices and what are they

A

hospitals, surgical and therapeutic equipment esp ELECTROCAUTERY

60
Q

How do pacemakers respond to a magnet

A

by switching to an asynchronous pacing mode at a programmed AV delay and a fixed magnet rate depending on the manufacturer, device model, and the status of the battery; DDD->DOO, VVI->VOO, AAI->AOO

61
Q

Acute and emergency pacing options

A

esophageal pacing (left atrium) and external (zoll-similar to defibrillator)

62
Q

Leading cause of death in US

A

sudden cardiac arrest

63
Q

caused by heart electrical system problem

A

SCA

64
Q

occurs when one or more of the arteries that supply blood to the heart muscle becomes blocked and ischemia causes damage to heart tissue

A

MI

65
Q

what percentages of acute MI has SCA as initial presentation

A

20-25%

66
Q

average survival rate of Sudden cardiac arrest

A

8%

67
Q

how to prevent SCA

A

Refer high risk pts to electrophysiologist

68
Q

what can improve survival rates from SCA

A

increased access to automated external defibrillators

69
Q

Risk factors for SCA

A

hx of SCA, prior v tach episode, MI, CAD, HF, Hypertrophic cardiomyopathy, long QT syndrome, a combo of these further increase risk

70
Q

What is an ICD

A

implantable cardioverter defibrillator-medical device that automatically detects and treats ventricular and sometimes atrial arrhythmias

71
Q

What do ICDs detect

A

v fib, v tach, atrial arrhythmias; designed to discriminate between true ventricular arrhythmias and rapidly conducting supraventricular tachyarrhythmias

72
Q

designed to terminate VF by shocking the heart

A

defibrillation shock

73
Q

designed to terminate VT by pacing the patient out of the arrhythmia

A

antitachycardia pacing

74
Q

Ventricle therapies provided by dual chamber ICDs

A

antitachycardia pacing, cardioversion, defibrillation

75
Q

Ventricle and atrial therapies provided by dual chamber ICDs

A

bradycardia sensing and pacing

76
Q

Best person to call

A

pacemaker reps

77
Q

what is hard to read if V paced

A

BBB or ischemia

EKG (5 decks)

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