Management of Bradyarrhythmias

Question 1

treatment of SA node dysfunction

Answer 1

demand ventricular paceer, AV sequential pacing

Question 2

Etiology of AV conduction disturbances

Answer 2

Nurologic, toxic (drugs- digoxin, B-blockers, CCA), Acute MI, Infection (Rheumatic fever, infectious mononucleosis, lymes, sarcoidosis) Degenerative disease (Lev’s Disease, ,Lenegre’s Disease)

Question 3

Lev’s Disease

Answer 3

calcification of the cardiac skeletom, aortic and mitral valve. Can lead to AV conduction disturbance

Question 4

Lenegre’s Disease

Answer 4

degeneration of the conduction system. Can lead to AV conduction disturbance

Question 5

what causes PAT with block

Answer 5

digoxin toxicity

Question 6

Adams Stokes Syndrome

Answer 6

histroy of blackout, syncope, convusion. Classic indication for pacemaker

Question 7

Guidelines for temporarary pacing in AMI

Answer 7

1.) Sinus bradycardia unresponsive to drugs 2.) Mobits II 3.) 3rd degree block 4.) Bilateral BBB (regardless of age) 5.) BBB with first degree AV block 6.) Asystole

Question 8

Guidelines for permanent pacemaker after MI

Answer 8

1.) Persistent 2nd degree AV block in His purkinje system with bilateral BBB 2.) Complete heart block 3.) Symptomatic AV block 4.) Transient advanced (2nd or 3rd degree) AV block at AV node level

Question 9

Device therapy for Bradycardia

Answer 9

Atrioventricular pacing preferred

Question 10

Device therapy for Cardiomyopathy

Answer 10

Atrioventricular pacing and Biventricular pacing

Question 11

Device therapy for autonomic nervous system dysfucntion

Answer 11

Atrioventricular pacing

Question 12

Device therapy for Atrial Fibrillation

Answer 12

Dual site atrial pacing

Question 13

tretment of bradyarrythmias

Answer 13

first thing = Atropine (0.5-2.0) then pacemaker (temporart or permanent)

Question 14

Pacemaker Syndrome

Answer 14

Due to competition with patients own beat. Fatigue, dizziness, syncope, neck pulsation (Canon A-waves)

Question 15

Management of Pacemaker Syndrome

Answer 15

Correct with atrial pacing with synchrony

Question 16

How is Pacemaker Syndrome prevented

Answer 16

dual chamber pacing- maintaining AV synchrony

Question 17

Risk Factors for Pacemaker Syndrome

Answer 17

1.) Preimplantation slow heart rate 2.) VA condcution, VVI pacemaker, noncompliant ventricles (diastolic dysfunction, cardiomyopathies)