Pacemaker

Question 1

Indications for a pacemaker

Answer 1

[Bang Me 2 (you) Twat Hugging Hussy] Bradycardia (Symptomatic) Mobitz Type 2 AV block Third degree heart block Heart Failure HOCUM

Question 2

Types of pacemakers

Answer 2

Single Chamber Dual Chamber Biventricular / Triple chamber Implantable Cardioverter Defibrillator

Question 3

Single Chamber pacemaker Where? Why?

Answer 3

Single-chamber pacemakers have leads in a single chamber, either in the right atrium or the right ventricle. RIGHT ATRIUM if normal AV conduction and SA node issue - so they stimulate depolarisation in the right atrium which then passes to the left atrium and through the AV node to the ventricles in the normal way. RIGHT VENTRICLE if abnormal AV conduction in the patient so they stimulate the ventricles directly.

Question 4

Dual Chamber pacemaker Where?

Answer 4

Leads in both the right atrium and right ventricle This allows the pacemaker to synchronise the contractions of both atria and ventricles

Question 5

Biventricular or Triple chamber Where? Who? AKA

Indications

Answer 5

Biventricular pacemakers have leads in: - right atrium - right ventricle - left ventricle Very good for patients with heart failure

AKA Cardiac Resynchronisation Therapy pacemaker

Indications in heart failure for it:

• LBBB
• Ejection Fraction of less than 30%
• Class III

Question 6

ICD What do they do?

Answer 6

Implantable Cardioverter Defibrillators continually monitor the heart and apply a defibrillator shock to cardiovert if they identify a shockable arrhythmia: - pulseless VT - Ventricular Fibrillation

Question 7

ECG changes

Answer 7

The pacemaker intervention can be seen as a sharp vertical line on all leads on the ECG trace. A line before each p-wave indicates a lead in the atria. A line before each QRS complex indicates a lead in the ventricles. Therefore: - A line before either the P or QRS but not the other indicates a single-chamber pacemaker - A line before both the P and QRS indicates a dual-chamber pacemaker