66. ICD Flashcards
(31 cards)
How many letters are derived for PM tech?
5
Traditional PM set up
pulse generator with battery (typ Li), lead system, connecting pulse gen to endocardium
Permanent PM - where are leads positioned?
endocardium of RV<br></br>and if dual chamber - RA
Where are biventricular PM typically placed?
RA and vent leads and add LV lead in LV epicardial location via coronary sinus
Pacemaker leads: bipolar configuration vs unipolar
negative/distal and +/proximal electrodes separated by 1cm in heart<br></br><br></br>vs uni: neg electrode within endocardial surface, + pole is metallic casing of pulse generator
Is a unipolar configuration compatible with ICD?
no
Name 8 class I indications for permanent pacing in adults
- Sx directly attributable to sinus node dysfunction <br></br>2. Pt with sx sinus node dysfunction or AV block secondary to guideline directed therapy - no alt therapy and cont therapy necessary<br></br>3. Pt with permanent AF and symptomatic bradycardia<br></br>4. Symptomatic AV block secondary to reversible cause like Lyme, but despite tx no reversal <br></br>5. Mobitz type II AV block, high grade AV block, or 3rd deg AV block not reversible<br></br>6. NMdisease with conduction disorders with evidence of 2nd/3rd AVB<br></br>7. Syncope and BBB with HV interval >70ms or infranodal block<br></br>8. Alt BBB<br></br>9. Postop sinus node dysfunc or AV block with persistent sx or HD instability following CABG, afib surgery, valvular surg/replacement<br></br>10. Adult CHD and symptomatic sinus node dysfunc, symptomatic brady from AV block or chronotropic incompetence, daytime HR <50, complex ventricular ectopy, ventricular dysfunction<br></br>11. Mobitz type II AV block, high grade AV block, or 3rd deg AV, alt BBB post MI following waiting period
Key hx q to ask someone with a PM
- what device<br></br>- indication for placement<br></br>- pacing modality<br></br>- sx prompted PM<br></br>-sx of infection<br></br>-Sx of weakness/dyspnea/palpitations (indicating PM dyssynchrony)
Seeing someone with PM - PE
vitals<br></br>PM infection assessment<br></br>PM <60 or >100 = altered pacing parameters - consider battery depletion or PM med tachycardia<br></br>Cannon A wave on JVP = AV dyssynchrony <br></br>HF sx
Five letter PM Code: Letter 1 meaning
chamber paced<br></br>A, V, D = dual, 0 = none
Five letter PM Code: Letter 2 meaning
chamber sensed <br></br>A, V, D = dual, 0 = none
Five letter PM Code: Letter 3 meaning
Sensing response<br></br>T= triggered<br></br>I = inhibited<br></br>dual - A and V nhibited<br></br>0 = none
Five letter PM Code: Letter 4 meaning
programmability<br></br>P = simple<br></br>m = multiprogrammable<br></br>R - rate adaptive<br></br>C - communicating<br></br>0 - none
Five letter PM Code: Letter 5 meaning
antitachycardia functioning<br></br>p = pacing<br></br>s = shock<br></br>d = dual (shock pace)
Why is QRS wide post PM spike on ecg?
similar LBBB as spread of excitation does not follow N pathway
VVI - where are PM spikes?
spike then immediate QRS - only one pcae
Dual chamber - where are PM spikes?
<div>
<div>
<div>
<div> Each QRS complex is preceded by two pace-
maker spikes. The first spike results in atrial depolarization, and the second produces a wide QRS complex.
The QRS complex is conducted with a left bundle branch morphology, which is expected with endocardial
pacing at the right ventricular apex. </div><div><br></br></div><div>HOWEVER - if normal function, may only see one spike as inhibit can be function</div>
</div>
</div></div>
PM lifetime infection rate
0.02
RF of PM infection
CRT or repeated manipulation of device<br></br>chronic renal insufficiency<br></br>copd<br></br>chronic steroid use<br></br>DM<br></br>malignacy<br></br>adv age
How many patient with PM infection have + bl cultures? (%)
20-25%
Dx of PM infection
needle aspiration of pocket under fluoroscopic guidance
MC bugs PM infection
s aureus<br></br>s epidermidis
Abx for Pm infection - general
vanco 20-35mg/kg actual body weight (not beyond 3g) then 15-20mg/kg q8-12h
Abx for Pm infection - if unable to tolerate vanco OR if HD instability
a. cannot tolerate: daptomycin 6-10mg/kg IBW q24h<br></br>b. HD - Piptazo for Pseumonas/cefepime
pocket infection
blood cultures with pathogenic bacteria
subclavian
innominate veins
SVC
-tx?
endovascular repair
coronary vein or coronary sinus perforation
Cardiac tamponade
Dislodgement of LV electrode with resultant loss of pacing occurs as early complication
