Lecture 9 (Pacemakers) Flashcards Preview

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Flashcards in Lecture 9 (Pacemakers) Deck (77)
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1

Symptoms that may require a pacemaker

syncope or presyncope, dizziness, light-headness, fatigue, mental confusion, palpitations (sick-sinus rhythm) excercise intolerance

2

Non-Invasive Testing

12 lead EKG, ambulatory monitor, exercise testing, autonomic testing (tilt table for neurocardiogenic syncope)

3

Holter Monitor

worn for 1-2 weeks

4

Event Recorder

worn for 1 month

5

Implantable Loop Recorder

outpatient surgery worn for longer durations

6

Invasive Testing

Electrophysiology testing and Implantable loop recorder

7

Electrophysiology study can find:

spot of an unusual heart rhythm

8

Class 1 Pacemaker indication

beneficial, useful, effective, acceptable and necessary

9

Class2 Pacemaker indication

evidence/opinion in favor for use; usefullness and efficacy have been proven

10

Class 3 Pacemaker Indication

Not useful or effective; may be harmful; DO NOT PUT PACEMAKERS IN THESE PATIENTS!

11

Pacemaker Considerations

1-association of SYMPTOMS with an arrhythmia
2-LOCATION of conduction abnormality likelihood of progression
3-Risk of arrhythmia (bifascicular block)

12

Pacemaker Considerations-Symptoms

Correlate SYMPTOMS with rhythm esp important for bradycardia (use ambulatory monitor or careful hx or log book)

13

Bradycardia Symptoms

most common symptoms we see: dizziness, light-headedness, syncope, fatigue, poor exercise tolerance

14

Pacemaker considerations-Location
Disease within AV Node

Significant PR prolongation, mobitz type 1 (wenckebach) normal QRS

15

Pacemaker considerations-Location
Disease below AV Node

-potentially more unstable; normal or minimally prolonger PR Interval, mobits type 2-secondary AV block, QRS abnormal-bundle branch/fascicular blocks

16

Most common indication for pacemaker implantation

Sinus node dysfunction (#1), AV block

17

Sinus node dysfunction definition

periods of bradycardia, tachycardia, prolonged pauses or alternating bradycardia and tachycardia

18

Sinus Node Dysfunction pacemaker indication Class 1

1st-correlate symptoms w/ bradycardia; class 1: HR less than 40 (symptomatic), symptomatic chronotropic incompetence (with exercise);

19

Acquired AV Block pacemaker indication class 1

severe conduction regardless of symptoms: complete AV block (3rd degree), advanced 2nd degree AV Block, Symptomatic mobitz type 1/2, mobitz type 2 with wide QRS or chronic bifascicular block, exercise induced 2nd or 3rd degree block

20

Sinus Node Dysfunction pacemaker indication Class 2

class 2 (may need it)-sinus brady w/o clear correlation with symptoms, sinus node dysfunction in pt with unexplained syncope

21

Acquired AV Block pacemaker indication class 2

consider pacemaker-asymptomatic mobitz type 2 block, 1st degree block with symptoms, bifascicular block with syncope possibly related

22

Other pacemaker indications

neurogenic syncope, post-MI conduction abnormalities, long QT syndrome(more commonly ICD w pacer), hypertrophic cardiomyopathy(affects LVOTO), CHF(CRT/BiV Pacer), s/p cardiac transplant (denervation/bradycardia), bradycardia induced ventricular (suppress), anti-tachycardia pacemakers

23

Post MI Conduction abnormalities class 1 criteria for pacemaker

3rd degree block, persistent 2nd degree block in HIS bundle, transient infranodal AV block with BBB

24

contains battery that provides the energy for sending impulses to the heart

pulse generator

25

houses the circuitry that controls pacemaker options

pulse generator

26

Complete circuit of pacemaker

pacemaker components combine with body tissue to form complete circuit; pulse generator, leads or wires, cathode, anode, body tissue

27

delivers electrical impulses from pulse generator to the heart and senses cardiac depolarization

leads (insulated wires)

28

Passive fixation

the tines become lodged in the trabeculae (fibrous meshwork) of the heart

29

Active fixation

the helix (or screw) extends into the endocardial tissue which allows for lead positioning anywhere in the hearts chamber

30

leads applied directly to the heart

Myocardial and Epicardial leads