Pacemakers

Question 1

what are some indications for a pacemaker?

Answer 1

dysrhythmias - a-fib (pause of 5 seconds or greater), symptomatic brady, any block or dysrhythmia causing a heart rate of less than 40 in symptom-free patients, AICD for v-tach, AV blocks (mobitz 2 and complete)

Prolonged QT interval

HF

neurogenic syncope

BBB

excessive carotid sinus stimulation (causing more than 3 seconds of asystole)

Question 2

capture?

Answer 2

depolarization due to a pacer stimulus.

Question 3

how long do pacemakers last usually?

Answer 3

6-12 years

Question 4

what are the different types of pacemakers?

Answer 4

Single chamber

dual chamber

automatic internal cardiac defibrillator

Question 5

Describe a single chamber pacemaker.

Answer 5

one lead is inserted into either the right atrium or right ventricle, senses and paces chamber it is in.

Question 6

Describe a dual chamber pacemaker.

Answer 6

two leads, one goes into right atrium the other the right ventricle, has the ability to sense and pace both chambers.

Question 7

Describe an AICD.

Answer 7

not only can pace for bradycardias, but can overdrive pace for tachycardias.

can also defibrillate

used for people at risk for sudden cardiac death

Question 8

What are the different types of temporary pacemakers?

Answer 8

transdermal or transcutaneous

epicardial

transvenous

Question 9

describe transdermal or transcutaneous pacing. when is this used? How is it placed?

Answer 9

pacing through the heart through pads placed on the chest. usually used for emergency situations (usually a bridge to transvenous pacing, common for asystolic arrest) VERY PAINFUL

negative anterior, positive directly posterior

Question 10

describe epicardial pacing. when is it used?

Answer 10

wires placed in the atrium, ventricle, or both during and after cardiac surgery usually

done via a thoracotomy or subxiphoid incision

Question 11

describe transvenous pacing.

Answer 11

Pulse generator is external and has one lead wire (usually bipolar) that is inserted in a superficial vein (brachial, internal or external jugular, subclavian, and femoral) and goes to the endocardial surface that needs to be paced usually the right ventricle. the leads are fixed to the skin by sutures and is covered with antiseptic ointment and an adhesive semipermeable dressing.

Question 12

What do the five pacemaker codes mean?

Answer 12

I - chamber paced

II - chambers sensed

III - response to sensing

IV - rate modulation

V - multisite pacing