Pt 6 Pacemakers

Question 1

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Used to pace the heart when the normal conduction pathway is damaged

Answer 1

Pacemakers

Question 2

• Pacing circuit consists of
  > Programmable pulse generator (power source)
  > 1 or more conducting (pacing) leads to ___

Answer 2

myocardium

Question 3

Ventricular capture (___) secondary to signal (___ ___) from pacemaker lead in the right ventricle

Answer 3

depolarization

pacemaker spike

Question 4

Most pacemakers are demand pacemakers. This means that they sense the heart’s electrical activity & fire only when the HR drops below a preset rate

Answer 4

2 distinct features:
1. Sensing device that inhibits the pacemaker when the HR is adequate
2. A pacing device that triggers when no QRS complexes occur within a preset time period

Question 5

___ pacing: delivery of a stimulus to the ventricle to terminate tachydysrhythmias

Answer 5

Antitachycardia

Question 6

___ pacing: pacing the atrium at rates of 200-500 impulses/min to terminate atrial tachycardias

Answer 6

Overdrive

Question 7

A permanent pacemaker is implanted totally within the body

• Power source is placed subq, usually over pectoral muscle on pt’s nondominant side
• Pacing leads are placed trans-venously to right atrium and/or 1 or both ventricles & attached to the power source

Answer 7

• Permanent PM’s are inserted to treat pts w/chronic heart problems in which the heart beats too slowly to adequately support the body’s circulation [AV heart blocks, sick sinus syndrome, afib w/slow ventricular response, severe HF, CM, BBB]

Question 8

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• Resynchronizes the cardiac cycle by pacing both ventricles
• Biventricular pacing
• Used to treat pts w/HF
• Can be combined w/ICD for maximum therapy

Answer 8

Cardiac resynchronization therapy (CRT)

Question 9

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A ___ pacemaker is 1 that has the power source outside the body

Answer 9

temporary

! 3 types

Question 10

Power source outside the body

• Transvenous
• Epicardial
• Transcutaneous

Question 11

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A ___ PM consists of a lead or leads that are threaded transvenously to the right atrium and/or right ventricle & attached to the external power source

Answer 11

temporary transvenous

Question 12

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__ pacing involves attaching an atrial & ventricular pacing lead to the epicardium during heart surgery

• Leads are passed through the chest wall & attached to the external power source

Answer 12

Epicardial

! Are placed prophylactically should any brady dysrhythmias or tachy-dysrhythmias occur in the early postop period

Question 13

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For emergent pacing needs

• Noninvasive; bridge until transvenous pacer can be inserted
• Use lowest current that will “capture”
• Pt may need analgesia/sedation

Answer 13

transcutaneous pacemaker (TCP)

Question 14

An alternate option for pad placement = Anterior-Apex

Answer 14

• Temporary PM’s are attached to a programmable external power source

Question 15

Pacemakers

• ECG monitoring for malfunction

Answer 15

• Failure to sense
• Failure to capture

Question 16

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Lack of pacing when needed leads to bradycardia or asystole

→ Pacer lead damage, battery failure, dislodgment of electrode, electrical charge set too low, or fibrosis at electrode tip

Answer 16

Failure to capture

Question 17

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Causes inappropriate firing

→ Pacer lead damage, battery failure, sensing set too high, or dislodgement of electrode

Answer 17

Failure to sense

Question 18

Pacemakers - Monitor for other complications

• Infection
• Hematoma formation
• Pneumothorax
• Atrial or ventricular septum perforation
• Lead misplacement

Answer 18

! Prophylactic IV abx therapy before & after insertion

! Postinsertion cxr to check lead placement and to r/o presence of a pneumothorax

! Carefully observe insertion site

! Continuous ECG monitoring of pt’s rhythm

Question 19

Post-procedure Care

• OOB once stable
• Limit arm & shoulder activity on operated side
• Monitor insertion site for signs of bleeding & infection
• Pt teaching important

Question 20

Pt & Caregiver Teaching

• Follow-up appts for PM function checks
• Incision care, arm restrictions
• Avoid direct blows
• Avoid high-output generator

Answer 20

• No MRI’s unless pacer approved
• Microwaves OK
• Avoid antitheft devices
• Air travel (is not restricted)
• Monitor pulse
• Pacemaker ID card & rx list
• Medic Alert ID/bracelet
• Keep cell phones 6in away; don’t leave directly over