Pacemaker

Question 1

1st letter, 3 possible

Answer 1

Paced

A V D

Atria
ventricle
both

Question 2

2nd letter, 3 possible

Answer 2

A V D

Atria
Ventricle
Both

Question 3

What does the 2nd letter sense?

Answer 3

Intrinsic electrical activity

Question 4

3rd letter, 3 possible

Answer 4

Response to sensed signal

I T D

Inhibited by activity

Triggers a contraction (not often used)

Dual- either triggers or inhibited

Question 5

Describe I in 3rd letter

Answer 5

Inhibited by activity

* if electrical signal is sensed, PM will not fire

Question 6

Fourth and fifth letter?

Answer 6

Fourth- programmability

Fifth- anti-tachycardia features

Question 7

DDD description

Answer 7

Both chambers sensed

Sensed atrial signal causes PM to inhibit the atrial output

If QRS occurs naturally, the PM will inhibit the ventricular output

Question 8

4th code?

Answer 8

Rate modulation

Question 9

Fourth code letters

Answer 9

P
M
C
R

Simple programmability
Multi programmable- HR, sensing, output, etc
Communicating by telemetry
Rate response- can respond to physical activity

Question 10

What is the fourth code based on physiologically

Answer 10

Minute ventilation

Question 11

Pros and cons of rate modulation

For activity based

Answer 11

Activity based-

HR response slow with movements that are smooth (biking)

Question 12

Pros and cons of rate modulation

For physiologic based

Answer 12

Physiologic- requires longer warmup

Aka slight delay to activity

Question 13

What shows up in failure to capture

Answer 13

Spikes of firing are not followed by depolarization complexes

Question 14

What shows up in failure to sense

Answer 14

Fires in complete disregard to pt’s own rhythm
May compete with heart for control

1. Under sensing
2. Oversensing

Question 15

What is Rx for failure to one

Answer 15

New battery

Question 16

6 Symptoms of PM when it isn’t meeting demands?

Answer 16

1. SOB
2. fatigue
3. Syncope or near syncope
4. Vertigo***
5. Chest pain
6. Confusion**
7. CHF symptoms**
8. Dizziness***

Question 17

2 simple PT consideration for pacemaker

Answer 17

Take BP often

Note change in PM firing rate with activity

Question 18

difficult PT implications for PM

In Tachy dysrhythmia

Answer 18

If PM for Tachy dysrhythmia

Note cut off rate

10 beats below cut off rate = max HR for activity

Question 19

difficult PT implications for PM

In Brady dysrhythmia

Answer 19

Note if induces symptoms

Question 20

If atrial rate is fixed, what may show up? *****

Answer 20

pt. may have blunted HR response to exercise

Indicates longer warm up and cool downs

Question 21

If ventricles are paced what may happen on ECG?

Answer 21

ECG may not pick up ischemia

Question 22

PT consideration exercise

Answer 22

No lifting x 6 weeks

No over head exercise until Md clears

Avoid contact sport

Question 23

ICD monitors what

Answer 23

Heart RHYTHM

Question 24

What dangerous rhythms does ICD detect and amend?

Answer 24

1. V tach
2. V fib
3. Previous cardiac arrest
4. Uncontrolled dysrhythmia with medication
5. Cardiomyopathy with dysrhythmia
6. CAD, low LVEF and an episode of V Tach

Question 25

What does ICD do?

Answer 25

Prevent sudden cardiac death

Question 26

Battery lifespan of ICD

Answer 26

7 years

Question 27

ICD can reset what kind of V yacht problem?

Answer 27

Cardio version Aka V tach Shocks QRS to reset rhythm

Question 28

When does ICD defibrillate?

Answer 28

V fib When ICD fails to correct the V tach

Question 29

What's stronger shock from ICD? V fib or V tach?

Answer 29

V fib, because ICD fails to correct the V tach

Question 30

Other functions of ICD?

Answer 30

Anti tachycardia pacing Gently shocks to decrease heart pace Anti bradycardia pacing

Question 31

Mild strong thump of ICD indicates what?

Answer 31

Cardio version or defibrillation

Question 32

Define ICD Storm

Answer 32

Two or more shocks in 24 hrs

Question 33

When can pt do low to moderate intensity competitive sports?

Answer 33

If no dysrhythmia in 6 months

Question 34

How long should pt avoid over head activity?

Answer 34

1 month

Question 35

What position of exercises increase RPP via higher HR response?

Answer 35

Supine exercises

Question 36

How long no driving after implantation or shock?

Answer 36

6 months no driving

Question 37

If at airport how long avoid mania scanner?

Answer 37

No more than 30 seconds

Question 38

2 Psychosocial issue with ICD

Answer 38

Anxiety Depression

Question 39

What is associated with Pm increase anxiety?

Answer 39

Younger than 50 years old High number of discharge Poor understanding of ICD Poor social support Poor overall health

Question 40

3 | Classification

Answer 40

Chambers paced Chambers sensed Response to sensed impulse