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I & M II > Pacemakers and Defibrillators > Flashcards

Pacemakers and Defibrillators Flashcards

1
Q

Define CRMD

A

Cardiac Rhythm Management Device

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2
Q

Where are pacing leads placed within the heart?

A

Right atrium and right ventricle

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3
Q

What are indications for a pacemaker? (5)

A
  • Sinus node disease–failure to form impulse
  • AV node disease–failure to conduct impulse
  • Long QT syndrome
  • Hypertrophic obstructive cardiomyopathy
  • Dilated cardiomyopathy

Note: Most pts fall into first 2 indications listed.

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4
Q

What conditions require 100% ventricular pacing?

A

hypertrophic obstructive cardiomyopathy

dilated cardiomyopathy

Note: Short AV delays (120-150msec) are programmed.

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5
Q

What are 3 pacemaker classification systems?

A

NASPE - North American Society of Pacing and Electrophysiology

BPEG - British Pacing and Electrophysiology Group

NBG - Naspe and Bpeg Generic

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6
Q

NBG classification of Bradycardia Support Pacemakers

What does each number represent?

A

Position 1: Pacing chamber

2: Chamber sensed
3: Responses to sensing (directly tied to position 2, if no value for 2, no value for 3 is possible)
4: Programmable functions
5: Anti-tachycardia functions

Note: Directly from NBG Code website because notes don’t make sense o/w.

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7
Q

What are modes of response to sensing?

A

I (inhibited) – withhold a pacemaker output in response to a sensed event.

D (dual) choices: inhibit PM, track the sensed event, inhibit output on sensed channel and trigger output to maintain synchrony

T (triggered) – produces output spikes coincident with the sensed signal (diagnostic only)

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8
Q

What are programmability functions?

A

R (rate responsive) – device is capable of a rate responsive function

C (communicating) – capable of transmitting or receiving data for informational or programming purposes.

M (multi-programmable) – device can be programmed in more than 3 parameters: Rate, sensing, output, refractory periods, mode, hysteresis (means history vs. current condition essentially)

P (simple programmable) – limited to 3 or fewer programmable parameters

O (none) – not programmable

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9
Q

What are anti-tachycardia functions?

A

P (paced) – pace the patient out of tachycardia
S (shocks) – deliver a defibrillating shock
D (dual – paced and shocks)
O (none)

Note: This is position 5.

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10
Q

For anti-tachycardia functions, most bradycardia devices are ___ and most ICDs are ____.

A

O, none

D, dual

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11
Q

What are asynchronous modes?

A

AOO – Fixed rate atrial pacing

VOO – Fixed rate ventricular pacing

DOO – Fixed rate AV sequential pacing, paces both atria and ventricles

Note: When a magnet is placed on the PM, asynchronous mode initiates and goes into a fixed pacing mode despite heart activity.

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12
Q

What is DDD mode?

A

Paces Atrium and Ventricles
Senses Atrium and Ventricular signals

Sensed atrial signal will cause the device to inhibit the atrial output, a timer starts that will cause a triggered ventricular output after a certain interval but, if the patient has an R wave during the triggering interval the ventricular output will be inhibited.

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13
Q

In the event of high atrial rates and heart block, DDI will most resemble what pacemaker setting?

A

VVI

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14
Q

What is AAI mode?

A

atrial-inhibited pacing

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15
Q

What is VVI mode?

A

ventricular inhibited pacing

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16
Q

What is VAT mode?

A

Atrial-triggered, ventricular pacing

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17
Q

What is VDD mode?

A

It is atrial triggered, ventricular inhibited pacing

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18
Q

What is DVI mode?

A

Dual-sequential pacing, ventricular inhibited.

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19
Q

What is DDI mode?

A

Dual-chamber, sequential inhibited pacing

Note: Does not trigger where a signal is sensed.

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20
Q

The implantable PM is placed in the pectoral region. The lead enters the ___________ immediately superior to the ______________________.

A

right external jugular vein

medial end of the clavicle

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21
Q

Transvenous pacing leads may be:

A

unipolar

bipolar

Note: Leads are placed endocardially.

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22
Q

What is depicted here?

A

Epicardial and unipolar PM

Lead A is a space if B should fail.

Lead B is connected to the generator.

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23
Q

What is AOO mode?

A

asynchronous pacing of atria–regardless of atrial activity

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24
Q

What PM mode would generate this ECG?

A

AAI

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25
Q

What PM mode would generate this ECG?

A
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26
Q

What PM mode would generate this ECG?

A
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27
Q

What PM mode?

A
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28
Q

What PM mode?

A
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29
Q

What PM mode?

A
30
Q

What PM mode?

A
31
Q

What PM mode?

A
32
Q

What PM mode?

A
33
Q

What PM mode resembles unifocal PVCs?

A

VOO

34
Q

What is depicted?

A

atrial pacing

35
Q

What is depicted?

A

AV sequential pacing

36
Q

What is depicted?

A

failure to capture

37
Q

What are the types of endocardial leads(transvenous)?

A

active fixation –metal screw-in

passive fixation –rubber fins or tines

38
Q

What are the types of epicardial leads?

A

screw-in

sew-on

39
Q

What are the different polarities of pacing leads?

A

unipolar –highest reliability

bipolar –improved rejection for better sensing

multipolar –special purpose leads

40
Q

What are the different lead tips?

A

steroid eluting –believed that scarring is decreased

non-steroid eluting

carbon–least scarring but tend to take more current

41
Q

What is depicted?

A

PA catheter with bipolar ventricular pacing wire

42
Q

What is depicted?

Label

A

Pacing Swan-Ganz

43
Q

What is depicted?

Where is the pacing probe located?

A

Chandler V-pacing probe

19 cm from distal end

44
Q

What rate modulation sensors are currently approved in the US?

A

Vibration sensor

Motion sensor

Minute ventilation (bioimpedance sensor)

RV pressure

45
Q

What sensors are very sensitive to stray electromagnetic interference where pts have been inappropriately treated for pm driven tachycardias?

A

Minute ventilation sensors

46
Q

What setting is recommended for the perioperative period for PMs?

A

Rate modulation set to “OFF” to prevent confusion of intrinsic tachycardia with PM induced tachycardia.

47
Q

Which rate modulation sensors have little perioperative issues?

A

RV pressure sensors

48
Q

What are activity sensors that adjust heart rate to activity?

A

Motion sensor

Minute ventilation sensor

49
Q

What is an example of pacemaker magnet behavior?

A

Asynchronous “high-rate” pacing

50
Q

What should you do if performing upper body surgery with PM pt?

What should you do if performing lower body surgery with PM pt?

A

Set PM to asynchronous activity if not emergent.

If lower body surgery, PM should be OK as is.

51
Q

Which type of cautery is better used with a PM patient?

A

Bipolar is safer (current passes between forceps) than monopolar since this current has to pass through the patient.

52
Q

What situations require PM reprogramming?

A

Any rate responsive device

Special pacing indication (eg. hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy, pediatric patients)

Major surgery in chest or abdomen

Special procedures like:

  • immersion lithotripsy
  • transurethral resection
  • hysteroscopy
  • electroconvulsive therapy
  • MRI
  • Sux use
53
Q

What does the horizontal line after shock delivery show?

A

The cardiograph was blocked or disconnected for its protection during the period of shock.

54
Q

Identify the defibrillation positions.

A

A. Correct positioning in a patient with a permanent PM. Also considered the best position for paddles. Less current needed.

B. Placement recommended by the American Heart Association. Note: Place below sternal notch.

55
Q

What is synchronized defibrillation also known as?

A

cardioversion

56
Q

When should a synchonized defibrillation take place?

What point is considered the vulnerable period?

A

M designates when a shock should be applied in the cardiac cycle.

VP is the vulnerable period and shock delivery may result in ventricular fibrillation.

57
Q

Label

A

In other words:

  1. Shock chamber
  2. Anti-tachycardia pacing
  3. Tachycardia sensor
  4. Anti-bradycardia pacing
58
Q

What is depicted?

A

Pacemaker and defibrillator

59
Q

What is an AICD or ICD?

A

automatic implantable cardio-defibrillator

60
Q

What are the functions of an AICD?

A
  • Antitachycardia Pacing
  • Cardioversion
  • Defibrillation
  • Bradycardia Pacing
61
Q

What pts are considered for an ICD?

A

Hx of VF or VT with or without syncope

EF <= 40%

62
Q

What are pharmaceutical therapies to prevent arrhythmias? (2)

A

Sotelol

Amiodarone

Note: Usually given in conjuction to placement of ICD.

63
Q

What is depicted?

A

Antitachycardia pacing

64
Q

What is depicted?

A

Cardioversion from an ICD

65
Q

What is depicted?

A

Defibrillation of ICD

66
Q

In ICDs, which waveform is more prevalent because it requires less energy and results in less myocardial damage when defibrillating?

A

Biphasic

67
Q

What is depicted?

A

Lown biphasic defibrillator waveform

68
Q

Label

A
69
Q

Label:

A
70
Q

Before surgical procedures in a pt with ICD, what should you do?

A

Place in asynchronous mode or place magnet on it.

Bovie is misinterpreted as actual HR.

I & M II (21 decks)

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