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Z 3rd Exam Exercise Cardiology > PowerPoint Chapter 13 > Flashcards

PowerPoint Chapter 13 Flashcards

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1
Q

What is a pacemaker?

A

Any device which sends electrical impulses to the heart to stimulate cardiac contraction when its intrinsic electrical system is not functioning normally.

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2
Q

In the event of missing electrical activity the pacemaker does what?

A

Sends an appropriate pulse of energy through electrodes to heart.

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3
Q

A pacemaker is 1 or more ____ placed in heart and connected to the ____ and activity ____?

A

A pacemaker is 1 or more leads placed in heart connected to the pacemaker and activity sensor

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4
Q

What is a CIEDs?

A

Cardiac Implantable Electronic Device

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5
Q

What is the dual purpose of a CIED?

A

Delivers a shock to the heart through the electrodes
Also functions as pacemaker

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6
Q

What are the three locations leads can be placed for a pacemaker?

A

Atrial lead (right atrium)
Left ventricular lead
Right ventricular lead

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7
Q

What are nine indications for a pacemaker

A
  1. Symptomatic pronounced 1deg (or type 2 av block)
  2. Mobitz type 2 AV block
  3. Third Degree Heart Block
  4. Symptomatic Bradycardia
  5. Symptomatic Chronotropic incompetence
  6. Permanent A-Fib with symptomatic Bradycardia
  7. Heart Failure
  8. Hypertrophic Obstructive Cardiomyopathy
  9. Syncope of unknown etiology with sinus node dysfunction uncovered or proved during Electrophysiology study.
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8
Q

What type of pacemaker will be used if someone has heart failure?

A

Biventricular Pacemaker

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9
Q

What device will be used if someone has Hypertrophic Obstructive Cardiomyopathy?

A

Implantable cardioverter defibrillator

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10
Q

What is Symptomatic Chronotropic incompetence?

A

Heart rate does not increase with exercise aka Exercise intolerance

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11
Q

What are the 2 general components of a pacemaker?

A

-Pulse Generator aka “the Can”
-Electrodes

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12
Q

What are the two parts of the Pulse Generator aka “the Can”?

A

Pulse Generator aka “the Can”
-Battery (lasting about 5 years)
-Control center (Circuitry)

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13
Q

What are the two parts of the electrodes in a pacemaker?

A

Electrodes
-Wires running from pulse generator to heart
-At the end of the electrode is a screw or hook for fixation

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14
Q

What are the general four types of pacemakers?

A

-External Pacemaker (Transcutaneous)
-Temporary Epicardial
-Temporary Endocardial (Transvenous)
-Permanent Pacemaker (subcutaneous)

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15
Q

What is a External Pacemaker and when is it used (another name and when used)?

A

External Pacemaker (Transcutaneous) – wires connected to pads on skin
Mainly used during emergencies

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16
Q

What is a temporary epicardial pacemaker (wires and when used)?

A

Temporary Epicardial – used during Heart surgery, wires going to outer heart wall
Assisting heart when irritated bc of surgery

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17
Q

What is a temporary endocardial pacemaker (another name, wires, and when used)?

A

Temporary Endocardial (Transvenous) – pulse generator outside wires implanted through subclavian vein to endocardial tissue inside heart
Temp abnormality- drug induced bradycardia, recreational drugs. Chest contusion, waiting for permanent Pacemaker

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18
Q

What is a permanent pacemaker (another name and when used)?

A

Permanent Pacemaker (subcutaneous)
Heart block 3rd deg or adv 2nd degree
Symptomatic Sinus bradycardia

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19
Q

What are the four types of pacemaker administrations?

A

-Single Chamber: RA or RV
-Dual chamber: RA + RV
-Biventricular: RA + RV + LV (triple chamber)
-Implantable Cardioverter Defibrillator

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20
Q

Describe a single chamber pacemaker?

A

Single Chamber: RA or RV
Right Atrium – AV conduction is normal. SA node is not
Right Ventricle – AV conduction is abnormal. Bypassing atrium for Vent. Contraction

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21
Q

Describe a dual chamber pacemaker?

A

Dual chamber: RA + RV
Right Atrium and Right Ventricle
Synchronizing contractions

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22
Q

Describe a biventricular pacemaker?

A

Biventricular: RA + RV + LV (triple chamber)
Right atrium, Right ventricle, Left Ventricle
Severe heart Failure
Synchronizing all chambers and improve heart function

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23
Q

Describe an implantable cardioverter defibrillator?

A

Implantable Cardioverter Defibrillator
Continually monitoring rhythm and able to shock when needed

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24
Q

What general feature appears on a pacemaker ECG?

A

Note the sharp vertical line on all leads.

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25
What appears on an atrial pacemaker ECG?
Atrial Pacemaker Line before P wave
26
What appears on a ventricle pacemaker ECG?
Ventricle Pacemaker Line before QRS
27
What appears on a dual chamber ECG?
Dual chamber Line before P wave and QRS
28
What are the four positions of a pacemaker chart?
1. chamber paced 2. Chamber sensed 3. Response to sensed events 4. Rate modulation
29
Describe position 1-chamber paced?
A(Atrium), V (Ventricle), D (Dual/both)
30
Describe position 2-chamber sensed?
A, V, D, O (if sensing is temporarily disabled)
31
Describe position 3- response to sensed events?
I – inhibits pulse in response to sensed event T – triggers pulse in response to sensed event (no clinical purpose) D – Pulses can be either inhibited or triggered O – no response to sensed events
32
Describe position 4-rate modulation?
R – paced rate changes based on perceived physiological need
33
Describe VVI?
V Paced V Sensed I Response Typical indications AV block Chronic Atrial Fibrillation Not to be used with patients with normal sinus rhythm
34
Describe AAI?
A Paced A Sensed I Response Sensing and pacing P waves Typical indications Sinus Node dysfunction without AV Block This configuration doesn’t protect against AV node dysfunction worsening If Heart block develops the pacemaker cannot help.
35
VDD (typical indications)?
V Paced D Sensed D Response Typical indications AV block without sinus node dysfunction
36
Describe DDD?
D Paced D Sensed D response Both A + V leads sensed and paced Typical Indication Combination of Sinus node dysfunction and AV block in sinus rhythm
37
What are the seven different way a pacemaker can be programmed?
-Lower rate limit -Upper rate limit -AV delay -Post-Ventricular atrial refractory period -Sensitivity -Output -Mode switching
38
What is typical lower rate limit for a pacemaker?
50-60bpm
39
What is typical upper rate limit for a pacemaker?
120-130bpm
40
What is AV delay?
AV delay Period of time pacemaker waits before pacing after sensing 150-200ms
41
What is PVARP?
Post-Ventricular atrial refractory period (PVARP) Time after V depol during which an atrial impulse sensed by the atrial lead will be ignored for timing cycle purposes Safety feature 250-300ms
42
What is sensitivity in pacemaker programming (and numbers)?
Sensitivity Voltage a lead must measure in order to responds to an intrinsic depol 0.5mV Atrial lead 2mV for Ventricle lead
43
What is output for pacemaker programming?
Output Voltage the pacemaker delivers to myocardium to initiate depol 1.5-2x capture threshold
44
What is mode switching in pacemaker programming?
Mode switching Mode can automatically change with changes in heart rhythm DDD --> VVI or DDI in Afib, Aflutter, or SVT
45
What are six implanted related pacemaker complications?
Implantation - Related Pocket Hematoma Pocket infection Pneumothorax Hemothorax Lead dislodgement Cardiac perforation/ tamponade
46
What are seven delayed pacemaker complications?
Delayed -Electrode Lead Fracture -Insulation Break -Infection (pocket or lead causing Endocarditis) -Thrombosis / stenosis -Pacing induced cardiomyopathy -Pacemaker Syndrome (Palpitations, Chest pain, neck fullness) -Pacemaker – mediated tachycardia (Heart tissue recognizes paced rhythm as native causing stimulation of tissue.)
47
What are the contraindications to pacemakers (3)?
MRI (Modern Pacemakers are MRI compatible) TENS units Diathermy (surgery)
48
Pacemaker are okay with ____ and ____?
Ok with cellular phones and wearables
49
What should be done if a person with a pacemaker dies?
If Patient dies, Pacemaker should be removed prior to Cremation The Crematory will blow up!
50
What are ICD's?
Implantable Cardioverter-Defibrillators
51
What are ICD's used for (What specific condition do they terminate)?
ICD’s used to terminate VT/VF in high risk patient
52
What do ICD's contain?
Contain both pacing/sensing electrodes and 1-2 defibrillation electrodes/ coils
53
What are indications for ICD's?
Secondary prevention of cardiac arrest or sustained VT in absence of completely reversible cause Primary prevention of sudden cardiac death (SCD) -Heart Failure + Ejection Fraction < 35% -Post MI + Ejection Fraction <35% -High risk pts with congenital Long QT syndrome, Channelopathies, Hypertrophic Cardiomyopathy
54
ICD’s also have an ____-____ ____ function?
ICD’s also have an anti-tachycardia pacing (ATP) function
55
How does an ICD's prevent tachycardia?
-Attempts to stop reentrant VT -Paces ventricles at rate slightly faster than VT -ATP (anti-tachycardia pacing) is delivered in a burst of 8 paced impulses -2 attempts before shocking
56
____ ____ ____ can occur from either RV pacing and/or from an underlying cardiomyopathy?
Symptomatic ventricular desynchrony can occur from either RV pacing and/or from an underlying cardiomyopathy
57
Specific way to restore synchrony to the heart from symptomatic ventricular desynchrony?
Insertion of an additional lead into the LV can restore synchrony
58
Referral for cardiac resynchronization therapy (CRT) based on what four things?
-LV EF -QRS Width -QRS morphology (LBBB vs other) -New York Heart Association functional class (1-4)
59
What will placing a strong magnet over a pacemaker do?
Placing a strong magnet directly over a conventional pacemaker will switch its mode to asynchronous: AAI --> AOO VVI --> VOO DDD --> DOO
60
What are indications for using a magnet on a pacemaker?
Indications -Temporary use during electrocautery -Termination of pacemaker-mediated tachycardia
61
What will placing a magnet on an ICD do?
Placing a strong magnet directly over an ICD will NOT switch its mode, but will instead turn off the defibrillation and anti-tachycardia pacing function
62
What are 3 indications for using a magnet on an ICD?
Indications -Temporary use during electrocautery -Repeated inappropriate shocks -Patients on comfort care

Z 3rd Exam Exercise Cardiology (6 decks)

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