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CARD 1101 > Mod11 Defibrillation > Flashcards

Mod11 Defibrillation Flashcards

1
Q

SA node

A

located in RA; has the highest rate of spontaneous depolarization therefore is considered the native pacemaker

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2
Q

AV node

A

small subendocardial structure composed of atrial conduction fibers; within interatrial septum; receives ANS innovation

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3
Q

3 functions of AV node

A

provides a delay btw atrial and ventricular contraction; regulates number of impulses that reach ventricles and acts as pacemaker when SA node fails

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4
Q

Purkinje fibers

A

forms Bundle of His that comes from AV node; bifurates within muscular septum and divides into R and L bundle branches; the branches terminate in the Purkinje fibers; very little ANS innovation

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5
Q

Pacemaker

A

responsible for initiating and self-propagating wave of depolarization; myocardium has ability to exhibit excitability when stimulated; BUT excitability is NOT directly related to strength of stimulus

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6
Q

Excitability at cellular level

A

maintained by electrical transmembrane potential where chemical gradient are imperative in generation of potential

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7
Q

Rate of depolarization of myocardium depends on

A

presence of ischemia/infarct, electrolyte imbalances, some drugs

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8
Q

Artificial pacemaker

A

device used to temporarily external, temporarily transvenous or permanently (in vitro/implantable) to treat arrhythmias; does this by supplying heart with pulse of energy

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9
Q

Artificial pacemakers are composed of:

A

one+ pacing leads (thin wires advanced into heart), pulse generator (supplies the power)

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10
Q

Pacing leads composed of;

A

electrode, conductor, insulation, and connector pin

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11
Q

Active fixation

A

1/2 methods to hold lead in place; leads have barb or screw that is fixed or retractable and embeds into myocardium

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12
Q

Passive fixation

A

1/2 methods to hold lead in place; leads have fins at tip that get entangled into trabeculation of ventricle; tip leads are corticosteroid eluding to try and reduce high pacing thresholds shortly after implantation due to the hyperacute injury to the myocardium

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13
Q

Pulse generator includes:

A

power source (battery), output circuit, and header with connector (to connect leads to generator)

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14
Q

New technology are advanced:

A

have rate adaptive sensors, have telemetry, and microprocessors that allow storage of diagnostic info

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15
Q

External Telemetry

A

allows generator to receive info from programmer and to send info back via radiofrequency waves (each manufacturing company uses their own wave freq)

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16
Q

Info retrieved through telemetry:

A

battery status, lead impedance, current, pulse amplitude, pulse duration and occurrence of arrhythmia

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17
Q

Stimulation threshold

A

minimum amount of energy a device is required to deliver to produce depolarization of myocardium; DEPENDENT ON pulse duration and pulse amplitude

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18
Q

Sensing

A

endocardial electrode is responsible for sensing any native heart rhythm; if HR is below/above programmed rate; the PM will be activated

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19
Q

Unipolar leads

A

has one conductor and one electrode; lead tip that functions as cathode and the pulse generator functions as anode; have larger diameter lead wire and don’t offer as many functions as bipolar

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20
Q

Bipolar leads

A

2 conductors and 2 electrodes; uses lead tip as cathode but lead ring functions as anode; can be run in unipolar mode; advantage include reduction in intracardiac stimulation and more specific sensing

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21
Q

Single Chamber PM lead configuration

A

may have lead in just the RIGHT atrium or just the RIGHT ventricle (Depends on conduction disturbance)

22
Q

Dual chamber PM lead configuration

A

may have pacing electrodes (leads) in RIGHT atrium AND RIGHT ventricle (allows control over AV delay during exercise (rate response)

23
Q

Biventricular PM lead placement

A

leads placed in RIGHT atrium and RIGHT AND LEFT ventricle; used to treat HF

24
Q

Pacemaker nomenclature

A

five letter code to describe the basic function of a pacing device; developed by north american society of pacing and electrophysiology AND the british pacing and electrophysiology group)

25
Q

First position (for coding system)

A

describes chamber(s) wehre stimulation occurs (CHAMBERS PACED)

26
Q

second position (for coding system)

A

describes chamber(s) where sensing occurs (CHAMBERS SENSED)

27
Q

Third Position (For coding system)

A

describes response to a sensed event (RESPONSE TO SENSING)

28
Q

Fourth Position (for coding system)

A

indicates programmability and rate modulation (PROGRAMMABILITY AND RATE MODULATION)

29
Q

Fifth Position (for coding system)

A

describes anti-tachycardia treatment functions

30
Q

VVIR (common pacemaker)

A

this device would PACE in the ventricle, SENSE in the ventricle, INHIBIT response to sensed event and be rate modulated

31
Q

Permanent Pacing

A

pulse generator is implanted subcutaneously or submuscularly in upper right/left pectoral region; replaced every 8-9 years; leads are inserted permanently via cephalic or subclavian vein

32
Q

Sites of Lead implantation

A

endocardial (most common) or epicardial

33
Q

Procedure of implanting permanent PM (endocardial)

A

loca anesthetic; small incision just below right/left clavicle; lead wires advanced into heart through subclavian or cephalic vein; small pocket created in upper chest to house generator; test leads for electrical patency, connect them to generator, insert into pocket and stitch

34
Q

Implanting Permanent PM (epicardial)

A

small incision at base of sternum to access epicardium; attach leads to epicardium; and implant generator in small abdominal pocket (**more commonly used with children)

35
Q

Broad Indication for permanent pacing implantation

A

Bradycardia due to Sinus AV node dysfunction: SA node dysfunction, acquired AV block, chronic bifascicular block, AV block with assoc MI, hypersensitive carotid sinus syndrome and neurocardiogenic syncope

36
Q

Specific conditions leading to permanent PM implantation

A

cardiac transplant, neuromuscular disease, sleep apnea syndrome, cardiac sarcoidosis

37
Q

Prevention and Termination of Arrhythmia by pacing:

A

cardiac resynchronization therapy, obstructive hypertrophic cardiomyopathy (HCM)

38
Q

Temporary Pacemakers

A

can be transvenous or by external patch

39
Q

Transvenous temporary PM

A

via jugular, subclavian or femoral vein; standard approach for temporary pacing; pacing catheter is placed into RIGHT VENTRICLE

40
Q

External Patch (transthoracic) temporary PM

A

pacing is suitable ONLY for emergency standby or brief pacing (ie. AED)

41
Q

Temporary Pacing Procedure

A

position temporary pacing catheter at apex of RV; tie catheter to skin, place sterile dressing over catheter site; pacing lead wires are connceted to external generator by connecting cable; *** often used after open heart surgery when heart block occurs but is expectd to be temporary

42
Q

Procedure for External Pacemakers

A

set of pads stuck firmly to patients chest; pads connected to external generator controlling amount of energy delivered and rate of pacing

43
Q

Reason to have Temporary PM

A

transient inadequate rhythm, clinical situation with high risk of transient inadequate rhythm, situations in which a permanent PM is required but not readily available

44
Q

Transient

A

inadequate rhythm is temporary and will go away; an adequate rhythm will be restored

45
Q

Inadequate rhythm

A

indicates temporary pacing; usually bradycardia

46
Q

Biventricular Pacing (resynchronization therapy (CRT))

A

treatment for CHF patients; placement of lead in right and left ventricle and sometimes the right atrium; synchronized pacing of R and LV can improve mechanics and hemodynamics of failing heart that has uncoordinated contractions

47
Q

Long term therapy with CRT (cardiac resynchro therapy) results:

A

improved clinical symptoms, increased exercise capacity, improve quality of life, cessation/reversal of chronic chamber remodeling

48
Q

Implantable cardioverter defibrillator (ICDs)

A

implantable device that continously monitors cardiac rhythm and delivers defibrillating shock in the event of ventricular arrhythmias; used to prevent premature arrhythmic death

49
Q

Primary prevention for ICDs

A

determine risk of future ventricular arrhythmic episode (Detailed history, physical exam, assessment of cardiac function complete with ejection fraction)

50
Q

Secondary prevention for ICDs

A

refers to cardiac arrest due to VF or VT that is NOT caused by transient or reversible cause

51
Q

Diseases where ICD would be used:

A

CAD (MI with decreased systolic function and non-sustained VT), HCM, Long QT syndrome, Brugada syndrome, VF, arrhythmogenic RV dysplasia

52
Q

Reasons not to use ICD therapy (contraindications)

A

uncontrollable arrhythmias by traditional therapeutic methods, arrhythmias due to transient or reversible disorders, significant psychiatric illness, terminal illness, syncope of undetermined cause without inducible arrhythmia

CARD 1101 (14 decks)

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