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Z 3rd Exam Exercise Cardiology > PowerPoint Chapter 13 > Flashcards

PowerPoint Chapter 13 Flashcards

1
Q

What is a pacemaker?

A

Any device which sends electrical impulses to the heart to stimulate cardiac contraction when its intrinsic electrical system is not functioning normally.

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2
Q

In the event of missing electrical activity the pacemaker does what?

A

Sends an appropriate pulse of energy through electrodes to heart.

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3
Q

A pacemaker is 1 or more ____ placed in heart and connected to the ____ and activity ____?

A

A pacemaker is 1 or more leads placed in heart connected to the pacemaker and activity sensor

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4
Q

What is a CIEDs?

A

Cardiac Implantable Electronic Device

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5
Q

What is the dual purpose of a CIED?

A

Delivers a shock to the heart through the electrodes
Also functions as pacemaker

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6
Q

What are the three locations leads can be placed for a pacemaker?

A

Atrial lead (right atrium)
Left ventricular lead
Right ventricular lead

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7
Q

What are nine indications for a pacemaker

A
  1. Symptomatic pronounced 1deg (or type 2 av block)
  2. Mobitz type 2 AV block
  3. Third Degree Heart Block
  4. Symptomatic Bradycardia
  5. Symptomatic Chronotropic incompetence
  6. Permanent A-Fib with symptomatic Bradycardia
  7. Heart Failure
  8. Hypertrophic Obstructive Cardiomyopathy
  9. Syncope of unknown etiology with sinus node dysfunction uncovered or proved during Electrophysiology study.
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8
Q

What type of pacemaker will be used if someone has heart failure?

A

Biventricular Pacemaker

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9
Q

What device will be used if someone has Hypertrophic Obstructive Cardiomyopathy?

A

Implantable cardioverter defibrillator

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10
Q

What is Symptomatic Chronotropic incompetence?

A

Heart rate does not increase with exercise aka Exercise intolerance

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11
Q

What are the 2 general components of a pacemaker?

A

-Pulse Generator aka “the Can”
-Electrodes

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12
Q

What are the two parts of the Pulse Generator aka “the Can”?

A

Pulse Generator aka “the Can”
-Battery (lasting about 5 years)
-Control center (Circuitry)

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13
Q

What are the two parts of the electrodes in a pacemaker?

A

Electrodes
-Wires running from pulse generator to heart
-At the end of the electrode is a screw or hook for fixation

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14
Q

What are the general four types of pacemakers?

A

-External Pacemaker (Transcutaneous)
-Temporary Epicardial
-Temporary Endocardial (Transvenous)
-Permanent Pacemaker (subcutaneous)

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15
Q

What is a External Pacemaker and when is it used (another name and when used)?

A

External Pacemaker (Transcutaneous) – wires connected to pads on skin
Mainly used during emergencies

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16
Q

What is a temporary epicardial pacemaker (wires and when used)?

A

Temporary Epicardial – used during Heart surgery, wires going to outer heart wall
Assisting heart when irritated bc of surgery

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17
Q

What is a temporary endocardial pacemaker (another name, wires, and when used)?

A

Temporary Endocardial (Transvenous) – pulse generator outside wires implanted through subclavian vein to endocardial tissue inside heart
Temp abnormality- drug induced bradycardia, recreational drugs. Chest contusion, waiting for permanent Pacemaker

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18
Q

What is a permanent pacemaker (another name and when used)?

A

Permanent Pacemaker (subcutaneous)
Heart block 3rd deg or adv 2nd degree
Symptomatic Sinus bradycardia

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19
Q

What are the four types of pacemaker administrations?

A

-Single Chamber: RA or RV
-Dual chamber: RA + RV
-Biventricular: RA + RV + LV (triple chamber)
-Implantable Cardioverter Defibrillator

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20
Q

Describe a single chamber pacemaker?

A

Single Chamber: RA or RV
Right Atrium – AV conduction is normal. SA node is not
Right Ventricle – AV conduction is abnormal. Bypassing atrium for Vent. Contraction

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21
Q

Describe a dual chamber pacemaker?

A

Dual chamber: RA + RV
Right Atrium and Right Ventricle
Synchronizing contractions

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22
Q

Describe a biventricular pacemaker?

A

Biventricular: RA + RV + LV (triple chamber)
Right atrium, Right ventricle, Left Ventricle
Severe heart Failure
Synchronizing all chambers and improve heart function

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23
Q

Describe an implantable cardioverter defibrillator?

A

Implantable Cardioverter Defibrillator
Continually monitoring rhythm and able to shock when needed

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24
Q

What general feature appears on a pacemaker ECG?

A

Note the sharp vertical line on all leads.

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25
Q

What appears on an atrial pacemaker ECG?

A

Atrial Pacemaker
Line before P wave

26
Q

What appears on a ventricle pacemaker ECG?

A

Ventricle Pacemaker
Line before QRS

27
Q

What appears on a dual chamber ECG?

A

Dual chamber
Line before P wave and QRS

28
Q

What are the four positions of a pacemaker chart?

A
  1. chamber paced
  2. Chamber sensed
  3. Response to sensed events
  4. Rate modulation
29
Q

Describe position 1-chamber paced?

A

A(Atrium), V (Ventricle), D (Dual/both)

30
Q

Describe position 2-chamber sensed?

A

A, V, D, O (if sensing is temporarily disabled)

31
Q

Describe position 3- response to sensed events?

A

I – inhibits pulse in response to sensed event
T – triggers pulse in response to sensed event (no clinical purpose)
D – Pulses can be either inhibited or triggered
O – no response to sensed events

32
Q

Describe position 4-rate modulation?

A

R – paced rate changes based on perceived physiological need

33
Q

Describe VVI?

A

V Paced
V Sensed
I Response

Typical indications
AV block
Chronic Atrial Fibrillation
Not to be used with patients with normal sinus rhythm

34
Q

Describe AAI?

A

A Paced
A Sensed
I Response
Sensing and pacing P waves

Typical indications
Sinus Node dysfunction without AV Block
This configuration doesn’t protect against AV node dysfunction worsening
If Heart block develops the pacemaker cannot help.

35
Q

VDD (typical indications)?

A

V Paced
D Sensed
D Response

Typical indications
AV block without sinus node dysfunction

36
Q

Describe DDD?

A

D Paced
D Sensed
D response
Both A + V leads sensed and paced

Typical Indication
Combination of Sinus node dysfunction and AV block in sinus rhythm

37
Q

What are the seven different way a pacemaker can be programmed?

A

-Lower rate limit
-Upper rate limit
-AV delay
-Post-Ventricular atrial refractory period
-Sensitivity
-Output
-Mode switching

38
Q

What is typical lower rate limit for a pacemaker?

A

50-60bpm

39
Q

What is typical upper rate limit for a pacemaker?

A

120-130bpm

40
Q

What is AV delay?

A

AV delay
Period of time pacemaker waits before pacing after sensing
150-200ms

41
Q

What is PVARP?

A

Post-Ventricular atrial refractory period (PVARP)
Time after V depol during which an atrial impulse sensed by the atrial lead will be ignored for timing cycle purposes
Safety feature
250-300ms

42
Q

What is sensitivity in pacemaker programming (and numbers)?

A

Sensitivity
Voltage a lead must measure in order to responds to an intrinsic depol
0.5mV Atrial lead
2mV for Ventricle lead

43
Q

What is output for pacemaker programming?

A

Output
Voltage the pacemaker delivers to myocardium to initiate depol
1.5-2x capture threshold

44
Q

What is mode switching in pacemaker programming?

A

Mode switching
Mode can automatically change with changes in heart rhythm
DDD –> VVI or DDI in Afib, Aflutter, or SVT

45
Q

What are six implanted related pacemaker complications?

A

Implantation - Related
Pocket Hematoma
Pocket infection
Pneumothorax
Hemothorax
Lead dislodgement
Cardiac perforation/ tamponade

46
Q

What are seven delayed pacemaker complications?

A

Delayed
-Electrode Lead Fracture
-Insulation Break
-Infection (pocket or lead causing Endocarditis)
-Thrombosis / stenosis
-Pacing induced cardiomyopathy
-Pacemaker Syndrome
(Palpitations, Chest pain, neck fullness)
-Pacemaker – mediated tachycardia
(Heart tissue recognizes paced rhythm as native causing stimulation of tissue.)

47
Q

What are the contraindications to pacemakers (3)?

A

MRI (Modern Pacemakers are MRI compatible)
TENS units
Diathermy (surgery)

48
Q

Pacemaker are okay with ____ and ____?

A

Ok with cellular phones and wearables

49
Q

What should be done if a person with a pacemaker dies?

A

If Patient dies, Pacemaker should be removed prior to Cremation
The Crematory will blow up!

50
Q

What are ICD’s?

A

Implantable Cardioverter-Defibrillators

51
Q

What are ICD’s used for (What specific condition do they terminate)?

A

ICD’s used to terminate VT/VF in high risk patient

52
Q

What do ICD’s contain?

A

Contain both pacing/sensing electrodes and 1-2 defibrillation electrodes/ coils

53
Q

What are indications for ICD’s?

A

Secondary prevention of cardiac arrest or sustained VT in absence of completely reversible cause

Primary prevention of sudden cardiac death (SCD)
-Heart Failure + Ejection Fraction < 35%
-Post MI + Ejection Fraction <35%
-High risk pts with congenital Long QT syndrome, Channelopathies, Hypertrophic Cardiomyopathy

54
Q

ICD’s also have an ____-____ ____ function?

A

ICD’s also have an anti-tachycardia pacing (ATP) function

55
Q

How does an ICD’s prevent tachycardia?

A

-Attempts to stop reentrant VT
-Paces ventricles at rate slightly faster than VT
-ATP (anti-tachycardia pacing) is delivered in a burst of 8 paced impulses
-2 attempts before shocking

56
Q

____ ____ ____ can occur from either RV pacing and/or from an underlying cardiomyopathy?

A

Symptomatic ventricular desynchrony can occur from either RV pacing and/or from an underlying cardiomyopathy

57
Q

Specific way to restore synchrony to the heart from symptomatic ventricular desynchrony?

A

Insertion of an additional lead into the LV can restore synchrony

58
Q

Referral for cardiac resynchronization therapy (CRT) based on what four things?

A

-LV EF
-QRS Width
-QRS morphology (LBBB vs other)
-New York Heart Association functional class (1-4)

59
Q

What will placing a strong magnet over a pacemaker do?

A

Placing a strong magnet directly over a conventional pacemaker will switch its mode to asynchronous:
AAI –> AOO
VVI –> VOO
DDD –> DOO

60
Q

What are indications for using a magnet on a pacemaker?

A

Indications
-Temporary use during electrocautery
-Termination of pacemaker-mediated tachycardia

61
Q

What will placing a magnet on an ICD do?

A

Placing a strong magnet directly over an ICD will NOT switch its mode, but will instead turn off the defibrillation and anti-tachycardia pacing function

62
Q

What are 3 indications for using a magnet on an ICD?

A

Indications
-Temporary use during electrocautery
-Repeated inappropriate shocks
-Patients on comfort care

Z 3rd Exam Exercise Cardiology (6 decks)

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