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Personal CV > Pace Makers > Flashcards

Pace Makers Flashcards

1
Q

2 ways in which diseased heart tissue blocks normal impulses.

A
  • Prevent impulse generation in SA node

- Inhibit impulse conduction

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2
Q

2 components of pacemaker?

A
  • Implantable pulse generator

- Lead wires

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3
Q

Cathode is the _______ electrode and Anode is the _______ electrode.

A
  • Negative

- Positive

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4
Q

Describe passive lead fixation?

A

-Tines lodge in the trabeculae (fibrous meshwork) of heart

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5
Q

Describe active fixation of leads?

A

-Helix (screw) extends into endocardial tissue

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6
Q

What is the most common frequency associated with pacemaker interference?

A

-50-60hz

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7
Q

EMI may result in what 3 things?

A
  • Oversensing
  • Mode changing
  • Reprogramming
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8
Q

When will rates accelerate as a result of EMI?

A

-If sensed as P waves in dual chamber system

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9
Q

When will rates be inhibited as a result of EMI?

A
  • Single chamber system

- or ventricular lead in dual chamber

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10
Q

What is noise reversion?

A
  • refractory sensing will cause pacing at lower rates.

- sensed “noise” will initiate new refractory period

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11
Q

EMI may lead to _________ ___________ of pacing parameters and device may revert to ______ on ______ mode.

A
  • Inadvertent Reprogramming

- Power on Reset

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12
Q

7 Sources of EMI in hospitals.

and which is most common?

A
  • Electrocautery (most common)
  • Lithotripsy
  • Defibrilation
  • radiation
  • RF ablation
  • TENS unit
  • MRI
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13
Q

What 4 things can occur with electrocautery EMI?

A
  • Oversensing
  • Undersensing
  • Power in reset
  • Loss of output
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14
Q

6 precautions for electrocautery EMI?

A
  • Reprogram to VOO/DOO
  • Place Magnet
  • Grounding plate
  • 1 sec bursts every 10 secs
  • Bipolar electrocautery
  • Keep positioned so that current does not intersect the PM
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15
Q

How to avoid pacemaker damage with defibrillation.

A

Position paddles as far away from pacemaker as possible.

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16
Q

MRI with pacemaker potential outcomes.

A
  • High pacing

- asynchronous pacing

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17
Q

How to avoid MRI pacemaker problems?

A
  • Program output low enough for non capture

- ODO/OVO mpde

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18
Q

Lithotripsy pacemaker precautions.

A
  • VVI/VOO mode

- Focal point >6 inches from pacemaker

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19
Q

Lithotripsy problems w/ dual chamber? adaptive?

A
  • Inhibits ventricular pacing

- High pacing, piezoelectric crystal damage

20
Q

What type of radiation and for what cancers can cause pacemaker damage? RADs should be kept to what?

A
  • Ionizing radiation
  • Breast and lung cancer
  • <500
21
Q

Describe rate response pacing.

A

-Give patients ability to vary HR when SA node cannot provide appropriate rate.

22
Q

When is rate responsive pacing indicated?

A
  • Chronotropically incompetent (HR cant reach appropriate levels)
  • Afib w/ slow ventricular response
23
Q

SV x HR = ?

A

Cardiac output

24
Q

_________ reserves can account for increases in CO up to 50%.

A

-Stroke volume

25
Q

What reserves can triple CO in response to metabolic demands?

A

HR

26
Q

2 types of rate responsive sensors

A
  • Detect movement and increase HR according to activity

- Minute ventilation sensors detect changes in RR and tidal volume

27
Q

Class 1 (Strongest evidence that therapy is beneficial) indications for pacemaker.

A
  • Sinus node dysfunction w/ brady

- Symptomatic chronotropic incomptence

28
Q

Class 2A (Evidence in favor) indications for pacemaker

A

-Symptomatic patients w/ SA node dysfunction w/o association between symptoms and brady

29
Q

Class 2B (less well established) indications for pacemaker

A

-Chronic HR <30

30
Q

Class 3 (Therapy is unnecessary) indications for pacemaker

A

-Asymptomatic sinus node dysfunction

31
Q

Describe 1st degree block

A

-Prolonged P-R interval (no drop)

32
Q

Describe 2nd degree Mobitz type 1

A

-P-R that lengthens then drops

33
Q

Describe 2nd degree Mobitz type 2

A
  • Regularly dropped ventricular beats

- 2:1 block (2 P’s for 1 QRS)

34
Q

Describe 3rd degree heart block

A
  • Complete heart block

- Atria and ventricle contract independent of each other

35
Q

6 pacemaker indications.

A
  • AV block
  • Sinus node dysfunction
  • Bi/trifasciular block
  • Hypersensitive carotid sinus
  • Vaso-vagal syncope
  • Cardiac transplant
36
Q

What is the 1st letter of NBG code?

A

-Chamber paced

37
Q

What is the 2nd letter of NBG code?

A

Chamber sensed

38
Q

What is the 3rd letter of NBG code?

A

Response to sensing

39
Q

What are the 5 setting for NBG code 1 and 2?

A 
V=Ventricle
A=Atrium
D=Dual
O=None
S=Single
40
Q

What is NBG setting for the 3rd letter (response to sensing)

A

T=triggered
I=Inhibited
D=Dual
O=None

41
Q

NBG code 4 settings

A 
P=Simple programmable
M=Multi programmable
C=Communicating
R=Rate modulating
O=None
42
Q

NBG code 5 (antitachy) settings

A

P=Pace
S=Shock
D=Dual
O=None

43
Q

Name 6 class 1 sinus node dysfunctions

A
  • Sinus Brady
  • Sinus arrest
  • Sinus pause
  • Brady - tachy syndrome
  • Atrial flutter
  • Chronotropic incompentence
44
Q

indications for ICD

A
  • Cardiac arrest
  • VT (sustained & non-sustained)
  • Syncope
  • Ejection fraction <30
45
Q

_______ and _______ pose no threat to pacemakers or ICDs

A
  • Microwaves

- Ultrasound

46
Q

What will a magnet place over a pacemaker do?

A

-Convert to VVI

47
Q

What will a magnet placed over a AICD do?

A
  • Suspend EMI detection

- Should be removed should VF occur

Personal CV (8 decks)

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