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Pacemakers Flashcards

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1
Q

Where is a pacemaker typically located?

A

clavicle area, but could be placed anywhere

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2
Q

Where would a pacemaker be placed in a baby?

A

near stomach

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3
Q

Where is the lead of the pacemaker usually placed?

A

right heart

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4
Q

How is it determined which side the pacemaker is placed?

A

may just be based on if the patient is right or left handed

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5
Q

What is the goal of pacemaking?

A

To mimic the natural conduction system

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6
Q

Why is a temporary pacemaker put in?

A

To see if it solves the problem so that a permanent one can be put in

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7
Q

What is another name for Sick Sinus Syndrome?

A

tachy brady syndrome

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8
Q

What happens when the SA node fires too fast sometimes and too slow sometimes?

A

Sick Sinus Syndrome

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9
Q

What is the concern when the SA node fires too slowly?

A

the patient becomes symptomatic

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10
Q

what are symptoms of SA node firing too slowly?

A
  1. dizzy
  2. impaired memory
  3. ectopic beats – heart rate is so slow that some other area is trying to take over
  4. atrial fib
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11
Q

What are conditions that are indications for pacemaker?

A 
Sick Sinus syndrome
Heart blocks
drug-refractory dysrhythmias
cardiovascular surgery
diagnostic uses
acute infarct with ischemia to SA or AV nodes
Severe electrolyte imbalance
Severe dig toxicity
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12
Q

What is required to be placed whenever there is a failure of the normal conduction system to transmit signals from the SA node to the ventricles OR when there is failure to generate an impulse spontaneously OR whenever you need to maintain primary control the electrical functions / pacing functions of the heart ( we need to control the heart)

A

pacemaker

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13
Q

What does a two lead pacemaker pace?

A

Both atrium and ventricle

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14
Q

What does a single lead pacemaker typically pace?

A

ventricle

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15
Q

What makes direct contact with the myocardial tissue and is what also actually conducts the electrical energy from the pacemaker to the myocardium?

A

electrode

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16
Q

What carries the info from the pulse generator to the heart and vice versa?

A

lead wire

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17
Q

Which pacemakers have both positive and negative electrodes within the cardiac tissue?

A

bipolar

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18
Q

Where are the positive electrodes placed with unipolar pacemakers?

A

positive in pacemaker and negative in heart

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19
Q

What do ou see on EKG with a unipolar pacemaker when it fires?

A

large spike

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20
Q

Why are there larger spikes on EKG with unipolar pacemakers?

A

because a stronger electrical impulse is required to depolarize due to the setup (one electrode in the heart, the other is in the pacemaker)

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21
Q

What happens if there is a spike then nothing on the strip?

A

the signal failed to capture a beat

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22
Q

What type of spikes are seen with bipolar pacemakers on EKG?

A

smaller

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23
Q

Why are bipolar spikes smaller?

A

it takes less energy to depolarize since both electrodes are within the heart

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24
Q

What is the potential (force) capable of doing work?

A

voltage

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25
What is a function of the amounts of charged material placed inside the battery cell by the manufacturer?
battery voltage
26
What pushes electrons out of the battery?
voltage
27
If the voltage is higher, what does it do to the push?
makes it stronger
28
What does a pacemaker need to function?
a battery
29
What is an opposition to current (tries to stop flow)
resistance
30
If there is low resistance, what is the current?
high
31
If there is high resistance, what happens to the current?
low
32
What is resistance primarily a function of?
cardiac tissue and electrode position
33
What type of resistance does a lead have?
negligible
34
What is an example of something in a heart that can cause resistance?
scar tissue
35
What is resistance imposed by?
the body
36
What is the flow of electrons leaving the battery (pacemaker)?
current
37
What is current a result of?
voltage
38
If there is a greater push from voltage, what does that produce with current?
greater flow
39
What is the minimum output voltage that consistently achieves capture outside the heart’s refractory period?
Stimulation Threshold
40
What is depolarization of cardiac muscle following an electrical stimulus (ventricular and atrial paced rhythm)?
capture
41
What is the degree that the pacing system “sees” or senses signals?
Sensitivity
42
What is sensitivity controlled by?
sensitivity setting
43
What is the importance of good sensitivity?
so that the pacemaker senses correctly and fires when it should
44
What are the 3 types of pacing?
asynchronous demand dual chamber
45
what are 2 other names for asynchronous pacing?
fixed fate / non-demand
46
Which pacing happens when pacemaker will fire regardless of heart’s ability to produce a spontaneous impulse?
asynchronous
47
What is an example of asynchronous pacing?
if the pacemaker is set at 80, and the patient’s heart is beating at 90, the pacemaker is still going to try to produce beats at a rate of 80, so it’s hardly ever appropriate (why would we want to compete with a functioning heart)
48
What is the danger with asynchronous pacing?
it could fire on T wave and cause patient's rhythm to deteriorate
49
Which pacing senses natural electrical activity?
demand
50
Which pacing can sense that if there is not a beat within a certain number of milliseconds, it needs to fire?
demand
51
If there is a meet, does demand fire?
no
52
When does demand pacing initiate?
only when needed
53
Which pacing can pace atria and ventricles and have combinations of those functions?
dual chamber
54
Which pacing can set the atrium as “asynchronous” and set the ventricle “on demand” when a patient is in a fib?
dual chamber
55
What are the 3 methods of implantation?
transthoracic epicardial transvenous
56
Which implantation is external and delivers pacing to heart though thoracic musculature via surface electrodes?
transthoracic
57
Do electrodes have direct contact with heart in transthoracic implantation?
no
58
Which implantation takes a larger amount of energy to stimulate depolarization if you go though muscle?
transthoracic
59
When is transthoracic implantation used?
When transvenous can not be immediately performed
60
Is the pacemaker implanted with transthoracic?
no
61
Where is transthoracic pacing sometimes done and with what?
ER with paddles
62
Which is a temporary pacemaker?
transthoracic
63
Which implantation is done where wires placed on the epicardial surface of the heart and the wires are run through the thorax to the outside of the body to the battery pack?
epicardial
64
What is the most common use for epicardial pacing?
heart surgery
65
After heart surgery and the epicardial pacing is no longer needed, what is done?
it is removed
66
What is a use for epicardial pacing other than heart surgery?
a patient has a very large, scarred heart and they can’t get a lead to stick internally
67
When an epicardial implantation is used because of scarring, where is the battery pack placed?
wherever on the inside of the body
68
Why is epicardial pacing for scarring not done much?
because it is an open chest procedure and it is pretty aggressive for pacing
69
What is another name for transvenous implantation?
endocardial
70
Is transvenous permanent or temporary?
either
71
Which impantation runs a lead wire through large subclavian vein or jugular vein into the right atrium or the right ventricle?
transvenous
72
What is the universal code for all pacemakers?
The NASPE/BPEG generic code
73
What does the pacemaker code consist of?
5 (I-V) positional letters, we need to know the first three
74
Which code position indicates which chamber is being paced?
position I
75
Which code position indicates the chamber that is sensed?
position II
76
What does 0 indicate in position II?
none
77
What does A indicate in position II?
Atrium
78
What does V indicate in position II?
Ventricles
79
What does D indicate in position II?
Dual (both atrium and ventricle)
80
Which code position indicates the pacemaker's response to sensing?
position III
81
What does 0 indicate with position III?
nothing
82
What does T indicate with position III?
triggers pacing
83
What does I indicate with position III?
inhibits pacing
84
What does D indicate with position III?
dual
85
If the pacemaker code is VVI, what does it mean?
Ventricular Demand | Paces and senses in the ventricles
86
If the code is AAI, what does it mean?
1. Atrial Demand | 2. paces and senses in the atrium
87
If the code is DVI, what does it mean?
1. A-V Sequential 2. Paces the atrium, paces and senses the ventricle a. An extra P wave won’t hurt you
88
If the code is DDD, what does it stand for?
1. Fully automatic 2. paces and senses both the atrium and the ventricle 3. Fairly common code
89
Which pacemaker switches modes to accommodate the patient so if they are running, they pace the heart faster and if you normally go to bed at 8:00, it will begin to slow the pace at that time?
Mode Switching pacemakers
90
When are mode switching pacemakers only used?
younger, active patients
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