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Cardiology Exam III > Cardiology 28: Pacemakers > Flashcards

Cardiology 28: Pacemakers Flashcards

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1
Q

Pacemaker

A

Delivers electric pulses that cause a heart to beat

Increases or regulates a rhythm

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2
Q

Implantable Cardioverter Defibrillator

A

Delivers electric shocks to terminate fast rhythms
Can deliver anti-tachycardia pacing (ATP) to overdrive a fast rhythm
Also functions as a pacemaker

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3
Q

Pulse Generator

A

Contains a battery that provides the energy for sending electrical impulses to the heart

Houses the circuitry that controls pacemaker operations

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4
Q

Passive fixation

A

The tines become lodged in the trabeculae of the heart

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5
Q

Active fixation

A 
The helix (or screw) extends into the endocardial tissue
Allows for lead positioning anywhere in the heart’s chamber
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6
Q

The leads are applied directly to the heart by 3 mechanisms

A

Epicardial stab-in
Myocardial screw-in
Suture-on

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7
Q

Unipolar Pacing System

A

Contains a Lead with Only One Electrode Within the Hear

The impulse:

  1. Flows through the tip electrode (cathode)
  2. Stimulates the heart
  3. Returns through body fluid and tissue to the IPG (anode)
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8
Q

Bipolar pacing system

A

Contains a Lead with Two Electrodes Within the Heart.
The Impulse:
1.Flows through the tip electrode located at the end of the lead wire
2.Stimulates the heart
3.Returns to the ring electrode above the lead tip

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9
Q

Class I Indication

A

Conditions for which there is evidence and/or general agreement that permanent pacemakers should be implanted

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10
Q

Class II Indication

A

Conditions for which permanent pacemakers are frequently used but there is divergence of opinion with respect to the necessity of their insertion

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11
Q

Class III Indication

A

Conditions for which there is general agreement that pacemakers are unnecessary

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12
Q

List of Class I indications For SA node dysfunction

A
  1. Documented symptomatic sinus bradycardia, including frequent sinus pauses that produce symptoms. May be due to long-term drug therapy of a type and dose for which there is no accepted alternative
  2. Symptomatic chronotropic incompetence (of the sinus node)
Those include are :
1.Sinus bradycardia (symptomatic !)
   Syncope, passing out , dizziness.
2.Sinus arrest
3.Sinus pause (SA exit block)
   Greater than 3 seconds
4.Brady-tachy syndrome
5.Atrial flutter or atrial fibrillation with symptomatic       
bradycardia
6.Chronotropic incompetence
   Cant get it to increase with activity
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13
Q

List of Class II indications for SA node dysfunction

A

1a. Symptomatic patients with sinus node dysfunction and documented rates of < 40 bpm without a clear-cut association between significant symptoms and the bradycardia
AKS syncope, dizziness etc.
1b. In minimally symptomatic patients, chronic heart rate < 30 bpm while awake

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14
Q

Class III Indications for sinus node dysfunction(AKA not indicated)

A

Asymptomatic sinus node dysfunction or due to unnecessary drug therapy.

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15
Q

3rd degree heart block is a Class I indication for pacemaker in AV Block. what is associated with 3rd degree heart block ?

A

1.Symptomatic bradycardia (including those from arrhythmias and other medical conditions that require drug therapy)
2.Documented periods of asystole > 3 seconds
Escape rate < 40 bpm in awake, symptom free patients
3.Post AV junction ablation
4.Post-operative AV block not expected to resolve
5.Neuromusclar diseases with AV block

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16
Q

Second degree heart block associated with ________ becomes a class I indication for pacemaker in AV block.

A

symptomatic bradycardia

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17
Q

Class IIA indications for AV Block include:

A

Asymptomatic CHB with a ventricular rate > 40 bpm

Asymptomatic Type II 2nd degree AV block with narrow QRS complex

Asymptomatic Type I 2nd degree AV block within the His-Purkinje system found incidentally at EP study

First-degree AV block with symptoms suggestive of pacemaker syndrome and documented alleviation of symptoms with temporary AV pacing

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18
Q

Class IIB indications for AV Block include:

A

First degree AV block > 300 ms in patients with LV dysfunction in whom a shorter AV interval results in hemodynamic improvement

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19
Q

Class III indications for AV Block include

A

Asymptomatic 1st degree AV block

Asymptomatic Type I 2nd degree AV block at supra-His level

AV block expected to resolve and unlikely to recur (e.g., drug toxicity, Lyme Disease)

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20
Q

Class I indication for patients with Bifascicular and Trifascicular Block include

A

Intermittent 3rd degree AV block

Type II 2nd degree AV block

Alternating BBB (goes from right to left)

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21
Q

Class II Indication for Bifascicular and Trifascicular Block include

A

Syncope not proved to be due to AV block when other causes have been exluded, specifically VT

Prolonged HV interval ( >100 ms)
His to ventrical interval

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22
Q

Class III indication for Bifascicular and Trifascicular Block include

A

Asymptomatic fascicular block without AV block

Asymptomatic fascicular block with 1st degree AV block

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23
Q

Class I indications for Carotid Sinus and Vasovagal abnormality inclues

A

Recurrent syncope caused by carotid sinus stimulation; minimal carotid sinus pressure induces a period of asystole > 3 seconds in duration (CSS)

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24
Q

Class II indication for Carotid Sinus and Vasovagal abnormality inclues

A

Recurrent syncope without clear, provocative events (tilt table test) and with a hypersensitive cardioinhibitory response

Neurally mediated syncope with significant bradycardia reproduced by a head-up tilt table testing (VVS)

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25
Class III indication for Carotid Sinus and Vasovagal abnormality inclues
Asymptomatic with a positive response to carotid sinus massage (CSS) Recurrent syncope, lightheadedness, or dizziness without a cardioinhibitory response (CSS/VVS) Situational vasovagal syncope in which avoidance behavior is effective Vague symptoms such as dizziness, light-eadedness, or both, with hyperactive cardioinhibitory response to CS stimulation
26
Class I indications for AV Block Associated with Myocardial Infarction – Pacemaker Indications
Persistent and symptomatic 2nd or 3rd degree AV block Persistent Type 2nd degree AV block in the His-Purkinje system with bilateral BBB or 3rd degree AV block within or below the His-Purkinje system Transient advanced 2nd or 3rd degree infranodal AV block and associated bundle branch block
27
Class II indications for AV Block Associated with Myocardial Infarction
Persistent 2nd or 3rd degree AV block at the AV node level
28
Class III indications for AV Block Associated with Myocardial Infarction
Transient AV block in absence of intraventricular conduction defect Pre-existing 1st degree AV block with bundle branch block
29
Class I indications for Implabatable Cardioversive Defibrilator
Cardiac Arrest Due to VT or VF Not due to transient or reversible cause Spontaneous sustained VT ( > 30 seconds) Structural heart disease must be present Syncope of undetermined origin with: Sustained VT that has clinical relevance and/or hemodynamic significance VF induced during EP study when drug therapy sustained VT is not preferred Nonsustained VT with: Coronary disease Prior MI LV Dysfunction Inducible VF or sustained VT (Non-suppressible by antiarrhythmic drugs) Spontaneous sustained VT Not amenable to other treatments
30
Class IIa indications for Implabatable Cardioversive Defibrilator
LVEF <30% at: 1 month post MI 3 months post coronary revascularization
31
Class IIB indications for Implabatable Cardioversive Defibrilator
``` Cardiac Arrest Assumed due to VF EP test precluded by other medical conditions Symptomatic sustained VT while awaiting cardiac transplant Conditions with life-threatening risk Long QT Syndrome Hypertrophic cardiomyopathy Nonsustained VT with: Coronary disease Prior MI LV Dysfunction Inducible VF or sustained VT Syncope of undetermined origin with: Ventricular dysfunction Inducible ventricular arrhythmias All other causes of syncope excluded RBBB and ST Segment Elevation with: Syncope of unexplained origin, or Family history of SCD Syncope and: Structural heart disease Extensive testing failed to identify cause ```
32
Class III indications for Implabatable Cardioversive Defibrilator
``` Syncope of undetermined origin Without structural heart disease No inducible VT or VF Incessant VT or VF Don’t put them in, they will get shocked constantly VT or VF with an ablatable or surgically treatable cause WPW, LVOT VT, ILVT, Fascicular VT Transient or reversible VT Due to AMI, electrolyte imbalance, drugs or trauma Psychiatric illness that may: Be aggravated by device implantation Preclude follow-up Terminal illness <6 month life expectancy CAD and: LV dysfunction and Prolonged QRS, or Inducible VT in those undergoing bypass ```
33
What are the two things that pacemakers do ?
Pace and Sense
34
What are the three types of Pacemakers ?
SIngle chamber Dual Chamber Biventricular
35
Describe a single chamber pacemaker system
The pacing lead is implanted in the atrium or ventricle, depending on the chamber to be paced and sensed (Pacing and sensing is in the same chamber)
36
Describe a dual chamber pacemaker
One pulse generator with two pacing circuits Circuit 1 for Atrial pacing and sensing Circuit 2 for Ventricular pacing and sensing
37
In pacing mode code, the first letter correlates to ...
The Chamber being PACED (Ventricle, Atrium, Dual)
38
In pacing mode code , the second letter correlates to ...
The chamber SENSED (Ventricle, Atrium, Dual)
39
In pacing mode code, the third letter correlates to
The mode of response (Triggered, Inhibited, Dual, None)
40
In pacing mode code, the fourth letter correlates to...
Program function (Simple, Multi)
41
In placing mode code, the fifth letter correlates to
Antitachyarryhthmia component (Pacing, Shocking,Dual)
42
Intrinsic event
Cardiac events which come from the patient
43
Inhibited
When the pacemaker stimulus is suppressed due to a spontaneous intrinsic event sensed before the end of the sensing (alert) period
44
Pacing interval
The rate at which the pacemaker will pace if the patient does not have their own rhythm
45
How do you calculate the pacing interval? Pacing Rate
Intended pacing rate / 60,000 = Interval (ms) Interval /60,000
46
Appropriate atrial sensing involves
Sensing of intrinsic P waves (restart the pacing interval)
47
Appropriate ventricular sensing involves
Sensing intrinsic QRS waves (these restart the pacing interval)
48
Capture
The depolarization and resultant contraction of the Atria or Ventricles in response to a pacemaker stimulus.
49
What are the characteristics of atrial capture on EKG?
Inverted P wave, thin QRS complex
50
What are the characteristics of ventricular capture on EKG ?
Wide QRS complex, elevated ST segment.
51
Asynchronous Pacing
Pacing without sensing (continous pacing) Often used in the OR *** Often turned on in the presence of magnets **
52
What is the characteristic of Asynchronous Pacing on EKG ?
Non-sensed P waves in-between beats
53
VOO
Paces ventricle, senses none, no response given
54
DOO
Paces atria and ventricles, senses neither, No response given
55
Demand pacing
Pacing with sensing Pacing pulse is inhibited by intrinsic “P” or “R-waves” Sensed events reset the pacing interval ie. Pacing only occurs when a pause occurs....
56
AAI
Paced: Atria Sensed: Atria Response: Inhibited (by P waves)
57
VVI
Paced: Ventricle Sensed: Ventricle Response: Ihibibited (R waves) Pacing with sensing in the Ventricle which causes inhibition of the pacing stimulus and resets the pacing interval. OFTEN DONE WHEN SOMEONE IS APT TO ATRIAL FIBRILLATION ! (Don't give a crap about atria, make sure the ventricle is working correctly
58
DDD
Paced: Dual Sensed:Dual Response: Inhibition in both Ability to track Atrial activity in the Ventricular channel
59
Purpose of dual chamber pacing ?
# fill in the blanks for the patient. In other words, if the patient doesn’t have a P-wave then the pacemaker will pace in the atrium If the patient doesn’t have a R-wave then the pacemaker will pace in the ventricle
60
Four States of Dual Chamber Pacing
AV: Atrial and Ventricular Pace AR: Pace in Atrium, sense in ventricle PV: Atrial sense and Ventricular Pace PR: Sense in atria and Ventricle
61
When would dual Atrial and Ventricular Pacing be needed ?
When paced P waves fail to elicit a QRS complex ventricular pacing will lead to depolarization
62
Complications of Implantation
``` Vascular Compromise Pneumothorax Hemothorax Cardiac Perforation Cardiac Tamponade Sedation ```
63
Post implantation complications
``` Lead Dislodgement Diaphragmatic Pacing Pectoral Muscle Pacing Brachial Plexus Injury Infection Must take out the whole device. Migration Of Device Pacemaker-mediated Tachcardia EMI ```

Cardiology Exam III (12 decks)

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