Pacemaker Flashcards
1st letter, 3 possible
Paced
A V D
Atria
ventricle
both
2nd letter, 3 possible
A V D
Atria
Ventricle
Both
What does the 2nd letter sense?
Intrinsic electrical activity
3rd letter, 3 possible
Response to sensed signal
I T D
Inhibited by activity
Triggers a contraction (not often used)
Dual- either triggers or inhibited
Describe I in 3rd letter
Inhibited by activity
* if electrical signal is sensed, PM will not fire
Fourth and fifth letter?
Fourth- programmability
Fifth- anti-tachycardia features
DDD description
Both chambers sensed
Sensed atrial signal causes PM to inhibit the atrial output
If QRS occurs naturally, the PM will inhibit the ventricular output
4th code?
Rate modulation
Fourth code letters
P
M
C
R
Simple programmability
Multi programmable- HR, sensing, output, etc
Communicating by telemetry
Rate response- can respond to physical activity
What is the fourth code based on physiologically
Minute ventilation
Pros and cons of rate modulation
For activity based
Activity based-
HR response slow with movements that are smooth (biking)
Pros and cons of rate modulation
For physiologic based
Physiologic- requires longer warmup
Aka slight delay to activity
What shows up in failure to capture
Spikes of firing are not followed by depolarization complexes
What shows up in failure to sense
Fires in complete disregard to pt’s own rhythm
May compete with heart for control
- Under sensing
- Oversensing
What is Rx for failure to one
New battery
6 Symptoms of PM when it isn’t meeting demands?
- SOB
- fatigue
- Syncope or near syncope
- Vertigo***
- Chest pain
- Confusion**
- CHF symptoms**
- Dizziness***
2 simple PT consideration for pacemaker
Take BP often
Note change in PM firing rate with activity
difficult PT implications for PM
In Tachy dysrhythmia
If PM for Tachy dysrhythmia
Note cut off rate
10 beats below cut off rate = max HR for activity
difficult PT implications for PM
In Brady dysrhythmia
Note if induces symptoms
If atrial rate is fixed, what may show up? *****
pt. may have blunted HR response to exercise
Indicates longer warm up and cool downs
If ventricles are paced what may happen on ECG?
ECG may not pick up ischemia
PT consideration exercise
No lifting x 6 weeks
No over head exercise until Md clears
Avoid contact sport
ICD monitors what
Heart RHYTHM
What dangerous rhythms does ICD detect and amend?
- V tach
- V fib
- Previous cardiac arrest
- Uncontrolled dysrhythmia with medication
- Cardiomyopathy with dysrhythmia
- CAD, low LVEF and an episode of V Tach
What does ICD do?
Prevent sudden cardiac death
Battery lifespan of ICD
7 years
ICD can reset what kind of V yacht problem?
Cardio version
Aka V tach
Shocks QRS to reset rhythm
When does ICD defibrillate?
V fib
When ICD fails to correct the V tach
What’s stronger shock from ICD? V fib or V tach?
V fib, because ICD fails to correct the V tach
Other functions of ICD?
Anti tachycardia pacing
Gently shocks to decrease heart pace
Anti bradycardia pacing
Mild strong thump of ICD indicates what?
Cardio version or defibrillation
Define ICD Storm
Two or more shocks in 24 hrs
When can pt do low to moderate intensity competitive sports?
If no dysrhythmia in 6 months
How long should pt avoid over head activity?
1 month
What position of exercises increase RPP via higher HR response?
Supine exercises
How long no driving after implantation or shock?
6 months no driving
If at airport how long avoid mania scanner?
No more than 30 seconds
2 Psychosocial issue with ICD
Anxiety
Depression
What is associated with Pm increase anxiety?
Younger than 50 years old
High number of discharge
Poor understanding of ICD
Poor social support
Poor overall health
3
Classification
Chambers paced
Chambers sensed
Response to sensed impulse
