Pacemakers. Flashcards

1
Q

almost always on the

A

right side of the heart.

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2
Q

indications for pacing:

A

symptomatic complete heart block, asymptomatic complete heart block, symptomatic sinus bradycardia (sick sinus syndrome), chronic incomplete heart block, persistent advanced heart block in acute MI, symptomatic congenital heart block, complete heart block.

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3
Q

benefits of pacing:

A

healthy heart rhythm = increased cardiac output = improves cerebral and total body perfusion = symptomatic relief = patient benefits.

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4
Q

pacemakers:

A

control discharge, time discharge, and recognize native activity of the heart.

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5
Q

tip electrode:

A

delivers a stimulus to the myocardium and detects native intra-cardiac signals.

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6
Q

unipolar leads

A

negative in heart

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7
Q

bipolar leads

A

positive and negative in heart

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8
Q

voltage:

A

potential (force) capable of doing work; battery voltage is a function of the mounts of charged material placed inside the battery cell by the manufacturer.

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9
Q

higher voltage =

A

stronger push on electrons.

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10
Q

resistance:

A

an opposition to current (tries to stop the flow).

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11
Q

low resistance =

A

high current.

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12
Q

high resistance =

A

low current. fibrosis, scarring.

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13
Q

resistance is:

A

primarily a function of cardiac tissue and electrode position.

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14
Q

current:

A

the flow of electrons leaving the battery (pacemaker); garden hose analogy; measured in milliamperes; program the voltage to get the current.

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15
Q

current vs voltage:

A

current is a result of voltage; it is not controlled or programmed nor can it be changed directly; current is indirectly controlled via programmable voltage (the greater the push, the greater the flow).

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16
Q

Ohm’s law

A

voltage = current x resistance.

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17
Q

stimulation threshold

A

the minimum output voltage that consistently achieves capture outside the heart’s refractory period; the pulse width at which the output voltage achieve capture.

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18
Q

when setting voltage:

A

turn down until you lose stimulation, turn up until consistent, turn up 1.5x that to ensure consistent delivery.

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19
Q

capture:

A

depolarization of cardiac muscle following an electrical stimulus; considered abnormal because it is out of the normal conduction pathway.

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20
Q

sensitivity:

A

the degree that the pacing system “sees” or senses signals; it is controlled by the sensitivity setting which in in graduated millivolts; makes sure it doesn’t fire if it isn’t supposed to.

21
Q

types of generators:

A

asynchronous, demand, and dual chamber.

22
Q

asynchronous:

A

not in sync, just at a fixed rate w/o respect to what the patient is doing; non-demand; hardly used because it is dangerous (pacemaker spike and patients own heart rate).

23
Q

demand:

A

sense natural electrical activity of the heart and fire only when needed. paces when the patient’s heart is slower than the pacemaker; pacing the atria preserves the atrial kick. can be atrial or ventricular.

24
Q

dual chamber:

A

VAT, DVI, VDD, DDD.

25
Q

methods of pacing:

A

transthoracic, epicardial, and transvenous.

26
Q

transthoracic pacing:

A

vests.

27
Q

epicardial pacing:

A

screw into epicardium through the thoracic and into a battery pack (after heart surgery).

28
Q

transvenous pacing:

A

temporary or permanent.

29
Q

biventricular pacing:

A

uses three leads; placed in the RA. RV, and LV (BBB).

30
Q

temporary pacing indications:

A

sick sinus syndrome, heart block, drug-refractory dysrhythmia, cardiovascular surgery, diagnostic uses.

31
Q

sick sinus syndrome:

A

patient must by symptomatic and documented with EKG: symptomatic sinus bradycardia, symptomatic sinus arrest, suppression of ventricular ectopy resulting from bradycardia, Afib, brady/tachy.

32
Q

heart block:

A

type 1 & 2 with second AV block, acute bifascicular or trifascicular block, complete AV block, cardiac arrest with ventricular systole.

33
Q

drug-refractory dysrhythmia:

A

overdrive ventricular pacing to suppress/prevent ventricular ectopic activity; overdrive atrial pacing to ‘brea’ SVT or Aflutter.

34
Q

cardiovascular surgery:

A

coverage for anesthesia and surgery in patients with cardiac history; treatment of complete heart block developed during surgery; augment cardiac output post op.

35
Q

diagnostic uses:

A

sick sinus syndrome pacing studies to determine SA node recovery; stress test for CAD; EP studies.

36
Q

pacemaker code:

A

chamber paced, chamber sensed, mode of response, programmability, anti-iachycardia.

37
Q

chamber paced

A

a, v, d, or 0.

38
Q

chamber sensed

A

a, v, d, or 0.

39
Q

mode of response

A

i, t, or d.

40
Q

programmability

A

p(simple), m(multi), c(communicating), r(rate-modulating), 0.

41
Q

anti-iachycardia functions

A

p(pace), s(shock), d(both).

42
Q

complications:

A

failure to capture, failure to sense.

43
Q

loss of capture

A

dislodged lead, perforation, exit block, insulation break.

44
Q

twiddler’s syndrome:

A

patient will twiddle with pacemaker and dislodge it; shoulder immobilized after surgery. turn up MA, fix the lead.

45
Q

over-sensing

A

inhibition of the pacemaker by events the pacemaker should.

46
Q

under-sensing

A

failure of the pacemaker to sense intrinsic R waves or P waves; if fires too soon, may hit T wave.

47
Q

complications of subclavian puncture

A

pneumothorax, subclavian artery injury, brachial plexus injury, bony spicules on the clavicle, hematoma, air embolism, thrombosis, and infection.

48
Q

electromagnetic interference

A

anything significantly electromagnetic, can’t have MRI, theft detector gate, car engine, jumper cables, defibrillation, electrosurgery, electrocautery, diathermy, u/s therapy; stay 1-2 inches away when defibrillating.