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6902 - Kronus > Part II Cardiac Devices > Flashcards

Part II Cardiac Devices Flashcards

1
Q

Asynchronous pacing modes

A

AOO
VOO
DOO

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2
Q

Single chamber atrial pacing modes

A

AAI

AAT

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3
Q

Single chamber ventricular pacing modes

A

VVI

VVT

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4
Q

Dual chmaber AV Sequential

A

DDD
DVI
DDI
VDD

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5
Q

What is pacemaker syndrome

A

result of deleterious hemodynamics of ventricular pacing

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6
Q

symptoms of pacemaker syndrome

A

hypotension, syncope, vertigo, fatigue, exercise intolerance, weakness, dyspnea, CHF, pts are aware of beat to beat variations in co

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7
Q

Pathophysiological changes with pacemaker syndrome

A
  • complex interaction of hemodynamics, neurohumeral and vascular changes induced by loss of AV synchrony
  • common in pts with intact AV conduction pathways
  • retrgrade VA conduction insures a constate state of AV dys-synchrony
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8
Q

First two weeks after intracardiac device placement a ________ _______ in pacing threshold is seen/

A

sharp increase

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9
Q

In patients with an intracardiac device, an acute increase in potassium results in

A

increases the resting membrane threshold to less negative and makes capture easier

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10
Q

In patients with an intracardiac device, an acute decrease in potassium results in

A

decreases the resting membrane potential to a more negative value, making capture more difficult

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11
Q

General considerations of intracardiac device

A
  • k+
  • myocardial infarction scar tissue
  • antiarrhythmic therapy increase pracing threshold
  • acid base imbalance
  • hypoxia
  • anesthetic drugs have little effect on pacing function.
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12
Q

Antiarrhythmic therapy

1a, 1b, 1c

A

1a (quinidine, prcainamide) 1b (lidocaine, phenytoin) and 1c (flecanide, enacainide)

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13
Q

Preop evaluation of the patient with a cardiac device includes

A
  • underlying cardiac conditions
  • bruits, signs of CHF, original indication for pacing or ICD placement
  • routine labs (min: ECG,CXR,K+)
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14
Q

Evaluation of the cardiac device

A
  • cardiac consult or device rep
  • function properly?
  • battery good?
  • reprogram rate responsive pacemakers
  • disable ALL AICDs (AHA guidleines)
  • Secure alternative pacing and defibrillation routes
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15
Q

Effect of magnet on the pacemaker

A
  • reed switch closes to induce non-sensing, asynchronous, fixed rate
  • variability in newer models: check with manufacturer
  • ECG before, during and after magnet application
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16
Q

Risks of magnet application

A
  • asynchronous mode may trigger ventricular asyncrony in pts with myocardial ischemia, hypoxia and K imbalance
  • New PM do not respond to magnet
  • magnet could alter pacemaker programming
  • device consult (except for emergencies)
17
Q

Intraoperative management of cardiac device patients

A
  • monitor electrical and mechanical function of the heart
  • central lines with caution (arrhythmias and potential for dislodgement of wire if freshly placed, 2 weeks)
  • defasiculate for suxxs
  • avoid etomidate and ketamine
  • deactivate rate responsive mode
  • evaluate PM function after mechanical ventialtion
18
Q

Why are skeletal myopotentials a concern for pts with cardiac devices

A

skeletal mypotentials from fasciculations, ect, myoclonic movements can inappropriately trigger the pacemaker or AICD

19
Q

What type of electrocauter y is safer?

A

bipolar

20
Q

Where should the ground plate for unipolar cautery be placed>

A

as far away from the pacer as feasible

21
Q

Rules for electrocautery and PMs

A
  • do not use within 15 cm of pacer
  • pulse cautery to 1 sec bursts every 10 sex
  • reprogram with magnet to asynchronous
  • have alt pacing and defib available
22
Q

Emergency considerations with device?

A
  • positive chronotropic drugs available
  • external defib - place paddles or patches as far away as possible from PM
  • recheck program after operation
  • resetting of stimulation threshold has been reported post defibrillation
23
Q

Challenges with TURP or uterine hysteroscopy and cardiac devices

A
  • Coagulation current reported to interfere with pacer function
  • use magnet to asynchronous mode
24
Q

Challenges with ECT and cardiac devices

A

myoclonic movements can trigger inappropriate dischange, use asyncronous mode

25
Q

Challenges with radiation therapy and cardiac devices

A

can damage the device casing

26
Q

Challenges with tens units and cardiac devices

A

cause a field potential that can interfere with PM function

27
Q

Challenges with SSEPs and cardiac devices

A

can interfere with PM function

28
Q

Challenges with lithotripsy and cardiac devices

A
  • electrical interference from shock waves
  • vibrations can close reed switch
  • rate responsive PM can be damaged by energy waves
  • ventricular extrasystoles if not synched
29
Q

considerations for lithotripsy pts and cardiac devices

A
  • cardiology consult to weight risk/benefits
  • focal point > 6 in from PM
  • not for patients with abdominal PM
  • DUal chamber demand should be reprogrammed to VVO or VVI
30
Q

MRI considerations

A
  • static magnetic field present even when not scanning can close feed switch and place torque on pocket
  • RF field swtiches on and off during scanning and can cause pacing at 300-600 bpm
  • can also cause heatting at the metal/patient interface
  • gradient magnetic field can also close read switch
31
Q

Post-opeartive management

A

ECG monitoring as the magnet is removed and originial settings resume
-best to have cardiology interrogate the device and confirm proper functioning

32
Q

What does the programmability feature mean?

A

provides flexibility to correct abnormal device behavior and provides flexibility that can adapt device to pt’s changing needs. there are various sensors that respond to physiological parameters or other stimulation like vibration, CVP, resp rate, acceleration, MV, etc

33
Q

Single chamber atrial pacing increases CO what %?

A

25

34
Q

Newer, AV sequentlal pacing increases CO what %?

A

35

35
Q

Atrial systole increases _________ and decreases __________?

A

coronary blood flow; coronary resistance

36
Q

Most common cause of electromagnetic interference w PMs?

A

electrocautery

6902 - Kronus (8 decks)

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