RCES EXAM REVIEW QUESTIONS Flashcards
(226 cards)
1
Q
What exits the patient during fluoroscopy to create a radiographic image?
A
Remnant beam
2
Q
Which medication is commonly administered to facilitate AVNRT?
A
Isoproterenol
3
Q
A properly RV pacing lead should produce what Morphology on the surface lead?
A
LBBB
4
Q
A properly LV pacing lead should produce what morphology on the surface lead?
A
RBBB
5
Q
What pacemaker adjustment would change the unit from the demand mode to the asynchronous mode?
A
Decreased sensitivity
5
Q
What is the name of the ridge of tissue in front of the inferior vena cava?
A
Eustachian Ridge
6
Q
Which of the following is the most important consideration when selecting the site for a peripheral IV in a patient undergoing a device implant?
A
the planned side of implant
7
Q
Immediately following transeptal puncture, which medication should be given to a patient who is heparin- induced platelet aggregation (HIPA) positive?
A
Integrellin
8
Q
What is the high/low pass filter for intracardia electrograms in Hertz?
A
30/500
9
Q
What is the high/low pass filter for surface electrograms in Hertz?
A
.5/100
10
Q
While assisting with a pacemaker generator change on a pacemaker dependent patient, the doctor attaches the new generator but nothing happens until it is placed back into the pocket why is this?
A
Its a unipolar generator
11
Q
What functions are programmable in Both VVI and DDD pacemakers?
A
Sensitivity, Voltage output, rate smoothing
12
Q
Prior to placing a left ventricular pacing lead, what should be preformed?
A
a coronary sinus venogram
13
Q
The following prerequisites describe which type of tachycardia mechanism?
Two pathways (A&B) must be connected
One pathway must be conduct more slowly
The slower pathway must have a shorter effective refractory period
A
Re entry
14
Q
The AV node is located at the base of the?
A
RA, at the apex of the triangle of Koch
15
Q
Most coronary sinus pacemaker leads can accept a wire with a maximum diameter of?
A
0.035”
16
Q
After correctly positioning the transeptal sheath for a transeptal puncture into the LA, which fluoroscopic position is ideal for viewing the intraatrial septum?
A
RAO
17
Q
Which ventricular tachycardias are often provoked with exercise?
A
RVOT, idiopathic left posterior fascicular VT, VT associated with ARVC
18
Q
What is the most common catheter position for preforming an initial VT Study?
A
HRA, HIS, RVOT, RVA
19
Q
What filter adjustment minimizes signal overlap without adjusting voltage amplitude?
A
Clipping
20
Q
Which cardiac structure is present during fetal development that may remain patent in adults?
A
Foramen Ovale
21
Q
When removing a venous sheath, manual pressure should be held where?
A
on the puncture site
22
Q
What are the benefits of a subcutaneous ICD?
A
Decreased risk of Pneumothorax, Decreased vascular complication, decreased post procedural patient discomfort
23
Q
What is most likely to perforate the coronary venous vasculature?
A
Guide wires
24
Which blood test would be ordered prior to pulling a sheath?
ACT
24
What is the most important consideration when selecting a site for an IV in a patient undergoing a device implant? and why?
You want to take into consideration the side the device is going on. Usually the opposite of their dominant hand. This is due to wanting the IV to be on the same side to put contrast in to reduce risk of pneumothorax
25
What should the ACT level be before pulling a sheath?
<160
26
During a pacemaker implant, the sterile gloved hands of the scrub staff must be kept ______ at all times and not drop below_______.
In front of chest and, below the scrub staff waist
26
SVT has just been induced at a cycle length of 278. What is the heart rate and how do you get it?
HR= 216 bpm you take 60,000 and divide it bt 278
26
During an atrial fibrillation procedure, a physician preforms a transeptal puncture and proceeds to advance long wire into the left atrium. What would you expect to see on the screen?
The wire should enter the pulmonary veins
27
The patient begins to complain of shortness of breath after a venography, The patient is exhibiting signs of what?
They could be having an allergic reaction to the contrast
28
The corrected QT interval for a patient with an RR interval of 857 ms and a QT of 395 ms is what? How do you get that?
.43 You convert ms to s 857=.857 395=.395 you then do the QT in s divided by the square root of the RR in seconds
29
Peaked T waves on a 12 lead ECG is associated with what?
Hyperkalemia
30
The name of the ridge of tissue in front of the inferior vena cava
The eustachian ridge
31
Class IIa recommendation indicates that effective prevention and therapy are supported by what classification of recommendations?
IT is reasonable to preform (moderate)
32
Class 1 recommendations indicate that the procedure is what?
Useful and beneficial and effective (strong)
33
Class IIb recommendations indicate that the procedure is what?
Less favorable
34
Class III
The procedure is not useful or is harmful ( No benefit)
35
According to ACLS protocol for an adult patient, what would an acceptable respiration rate during a cardiac implant device procedure?
12-18
36
Focal arrhythmia are typically characterized by presystolic activation timing of a minimum of how many msec
200
37
The BCL is 850 and the SNRT is 1095 msec. What is the CSNRT and how do you get that
The CSNRT is SNRT-BCL(Cycle Length)
245 msec
38
Relative to the coronary sinus the IVC lies where?
Inferior and laterally
39
While advancing the RV catheter, the patient suddenly goes into complete heart block. What would be the most likely explanation for this?
The patient has an underlying LBBB
40
When handling sterile items, it is important to do what?
Keep them within the sterile field
41
Prior to scheduled idiopathic VT ablation, an acceptable pre procedural potassium (K) value is what?
3.5-5.4
42
The most common cause of non- cardiac syncope is what?
vasovagal
43
During ventricular entrainment pacing of an SVT, a post-pacing response of A-A-V is noted. This response is consistent with?
Atrial Tachycardia
44
While ablating near the osmium of coronary sinus, a sudden 60ohm increase in impedance is observed . What does this finding mean?
The catheter has fallen into the CS
45
According to the Joint Commission standards, the critical aspects for patient identification are what?
Verbal confirmation of two identifiers with patient
46
Prior to starting the case, and after explaining the procedure to the patients well as identifying risks and potential complications, permission is given to proceed with the study. This is known as what?
Informed Consent
47
One of the complications specific to PVI is
atrioesophageal fistula
48
For IV conscious sedation, a typical initial dose of fentanyl would be what?
25-50 mcg
49
What are the electrical properties of the cardiac cell?
Excitability, automaticity, conductivity
50
A patient is taken off Coumadin (warfarin) for one week prior to an RF ablation procedure. The INR yields a value of 4. What is the next logical step?
Send the patient home and repeat the INR at a later date
51
What is the normal range for INR for individuals on Coumadin?
2.0-3.0
52
What is the normal range for INR for individuals not on Coumadin?
0.9-1.2
53
Which technology, in addition to fluoroscopy, is most frequently used to identify anatomical landmarks prior to transeptal puncture?
TEE
54
What nerve lies over the right atrial appendage and affects diaphragmatic motion?
Phrenic Nerve
55
When preparing a patient for NIPS, what is the most important thing to have?
Back up defibrillator just incase the patient ICD doesn't shock them out of the arrhythmia
56
What is the file format that allows healthcare systems to receive and transmit clinic images?
DICOM
57
During LAA Closure device insertion, it is recommended that the ACT is maintained at what?
250-350 / 300-400
58
The activation sequence of the Left Lateral pathway is characterized by what?
Distal CS Activating first
59
DFT may be preformed in what circumstances
failed therapy delivery, Congestive HF, Appropriate therapy delivery
60
At the time of device implant, the atrial sensing threshold should be at least?
1.5 mV
61
Lead conductor fracture usually leads to what
High impedance
62
A properly functioning RV catheter pacing should produce what kind of morphology?
LBBB
63
Give an example of when a pacemaker would be needed?
A symptomatic 1st degree AV block with the His Purkinje Disease
63
A properly functioning LV catheter pacing should produce what kind of morphology?
RBBB
64
What is likely to happen with lead maturation?
Electrode encapsulation
65
Which temporary pacemaker adjustment would change the unit of demand mode to asynchronous mode?
Decrease the sensitivity
66
The primary source of airborne bacteria is what?
The healthcare team
67
The physician orders ibutilide 1 mg IV. What aspect of the patients rhythm should be monitored?
The QT interval
68
Give an example of a class 1a antiarrythmic
Procainanmide
69
Give an example of a class IB AAD
Lidocaine
70
Give an example of a class Ic AAD
Flecainide and propafenone
71
Give an example of a Class II AAD
BB Metoprolol
72
Give an example Class III AAD
Amiodarone
73
Give an example Class IV AAD
Verapamil or Diltiazem
74
Give an example Class V AAD
Adenosine
75
During an open irrigated ablation, the pump alarms. What should you do?
Stop ablation and notify physician
76
Burst pacing protocol consists of what?
a fixed pacing sequence
77
Repetitive delivery of 8 atrial beats at the same cycle length followed by a 9th at a shorter cycle length describes what?
Decremental atrial pacing
78
Tachycardia has just been induced in a patient who did not have an VA block with adenosine. The tachycardia has a V-A of 180 ms. Suddenly, the patient develops a LBBB and the V-A increases to 220 ms. The patient most likely has what?
A left sided AP
79
What is retrograde conduction?
Backward conduction, example Ventricles to atria
80
What is the result of moving the ground patch closer to the site of RF energy?
Decreased impedance
81
During RF ablation, a high impedance reading continually shuts off the RF generator. The first trouble shooting attempt should be what?
check if the patient ground id secure
82
Prior to using the laser sheath for lead extraction a _____ should be used as first attempt.
Locking stylet
83
During monitoring of an RF ablation, you observe the catheter temp reach 80 degrees Celsius. What is the next action?
Alert the physician and stop the ablation delivery because of potential coagulum
84
What is the most common site for idiopathic VT?
RVOT
85
What is the normal range for pacemaker lead impedance?
300-1200 ohms
86
Following an EP/ ablation procedure, what instruction should be included on the post EP discharge education?
No heavy lifting
87
What four structures outline the triangle go Koch?
Tendon of Todaro, Bundle of His, Septal leaflet of tricuspid annulus , CS os
88
Hypoventilation causes what?
PCO2 to increase and pH to decrease
89
Hyperventilation cause what?
PCO2 to decease and pH to increase
90
resistance in measured in what unit?
Ohms
91
What is the HR in beats for a tachycardia rate of 320 ms? how do you figure that out?
60,000/320= 188 bpm
92
How would you measure a capture threshold testing for permanent pacemaker implant?
Starts at 5 mV, decrement voltage until capture is lost, the increase voltage until capture comes back and document that value
93
A patient presents with an infected ICD pocket, to prepare for a laser lead extraction, the best source to find lead sizing information for a laser sheath would be where?
The SLS reference
94
Hysteresis is used to do what?
Promote inartistic conduction
95
What should be done prior to using a temporary pacemaker for pacing?
Check date of the last battery change
96
The mA of the stimulator is conventionally set at what?
2x the diastolic threshold
97
While providing patient education post-pacer implant, signs of pacemaker malfunction would include what?
Dizziness, dyspnea, angina, peripheral edema, return of previous symptoms
98
What medication prolongs the action potential and hence refractoriness?
Amiodarone
99
What should be done after a venous subclavian puncture and why?
Chest X-ray, due to the risk of a pneumothorax and to confirm correct placement of the catheter
100
A delta wave is cause by what?
antegrade AP conduction pre-exciting the ventricular tissue
101
Notification by the EP team to recovery room RN, post accessory pathway ablation, summarizing procedural activities is known as what?
Hand-off-report
102
His bundle disease, or damage, is indicated by the prolongation of what?
The H-V interval
103
During a cardiac resynchronizing therapy device implant, real-time pacing support, and device programming is achieved by which of the following?
Pacing system analyzer (PSA)
104
Repetitive delivery of 8 atrial beats at the same cycle length followed by the 9th beat which is delivered with a progressively shorter cycle length?
Decremental atrial pacing
104
What are two examples of pure class III AAD?
Dofetilide and ibutilide
104
What is most appropriate action to take when you are unable to discern a pedal pulse on a palpitation?
You assess the pulse using a doppler and then make sure it it noted that you used a doppler
105
ICD conductor fracture should be suspected when there is an impedance increase from the baseline of what value?
1500 Ohms
106
The on face view of the tricuspid and mitral valve
LAO
107
Differentiates atria from ventricles
RAO
108
Differentiates Left and Right side of the heart
LAO
109
What view helps locate the CS?
RAO
110
To reduce radiation exposure the fluoroscopic frame rate should be set at how many frames per second?
15 on average, some can get down to 10
111
What 12 lead ECG findings are commonly associated with Arrhythmogenic right ventricular cardiomyopathy/ dysplasia?
Epsilon Waves, and T wave inversion
112
What is the most appropriate drug to treat WPW?
amiodarone
113
Circulation distal to the femoral artery is best assessed by what pulse?
Dorsalis pedis pulse
114
Cardiac signals that display a low and wide signal are described as what?
Far field
115
Cardiac signals that display a sharp and narrow signal are described as what?
Near field
116
A 12 lead ECG shows an atrial rate of 200ms with a negative saw tooth pattern in leads II,III, and aVF. What is the arrythmia?
Typical Counterclockwise flutter
117
A 12 lead ECG shows an atrial rate of 200ms with a positive saw tooth pattern in leads II,III, and aVF. What is the arrythmia?
Typical clockwise flutter
118
What is the best way to describe the threshold for a single chamber implantable pacemaker?
The minimum about of mA required to elicit a response from the chamber paced
119
How is the left atrium activated simultaneously with the right atrium?
Via the Bachman's bundle
120
The imaging directional term meaning anatomically "Superior"
Cranial
121
How is Wilson central terminal average calculated?
limb leads RA, LA, and LL
122
A potential complication of VVI pacing is what?
Pacemaker syndrome
123
Explain crosstalk when it comes to pacemakers
Cross talk is when a lead from one chamber is sensed by the lead in the other chamber. It can only happen in dual pacing
124
Explain Pacemaker syndrome
since there is no atrial sensing lead to guide the ventricle, the ventricle contracts at the programmed rate regardless of the timing of atrial contraction. This leads to loss of AV synchrony
125
Prior to the patient being put on the table for an implant, the procedure staff must do what
126
What are the indications for a BI-V device insertion?
EF less than or equal to 30 and a QRS greater than 150
127
What is the normal value for sodium?
135-145
128
What is the normal value for calcium?
8.5-10
129
What is the normal value for magnesium?
1.5-2
130
What is the normal value for Chloride?
95-105
131
What is normal glucose levels?
65-110
132
What is normal Cholesterol levels
130-200
133
What is the normal value for Aterial blood saturation (SaO2)
95-100%
134
What is normal blood pressure?
120/80
135
What is normal temperature?
97.8-99.1
136
What is normal oxygen saturation?
greater than 95%
137
What is normal PaCO2?
35-45
138
What is normal PaO2
80-100
139
What is normal bicarbonate (HCO3)
22-26
140
What are normal troponin levels?
0.0-0.4
141
Normal creatine kinase?
25-200
142
GFR below 15 means? What do you want your GFR to be?
Kidney Failure, Above 90
143
What is normal pH of the blood?
7.35-7.45
144
What should be done with used needles?
They should be put in the sharps, no need to cap them
145
If a patient is left handed what site would you prepare?
Normally you place a pace maker on the left side however, if someone is left handed you would prep the right side
146
Prior to transferring a patient from the table to the bed what must you do?
Secure the femoral lines to avoid them being removed
147
What must be done before the surgery?
A time out session where the staff verifies the patient, what procedure they are doing, and marking the correct site.
148
When pacing from the CS measuring laterally, what activation time would likely indicate successful ablation of typical flutter?
200
149
During open-irrigated ablation, the pump alarms. What should be done?
Stop ablation and notify physician
150
During the monitoring of a radiofrequency ablation procedure, you observe the catheter temperature reach 80 degrees. What should you do next?
Alert the physician and stop the ablation delivery because of potential coagulum
151
During RF ablation, a high impedance reading continually shuts off the RF generator. What should be your first line of trouble shooting?
Check if the patient ground is secure
152
What should be placed in a biohazard bag?
All items saturated with blood or bodily fluid
153
What does a low impedance mean during a follow up post pacemaker implant?
it means there's is a possible lead insulation break
154
What does it mean when impedance changes by more than 200 ohms
failure in the pacing system or an insulation break.
155
What does it mean when impedance changes by more than 700 ohms?
Lead wire fracture
156
If the impedance is greater than 1500 what does that mean?
Lead wire fracture
157
What does it mean if impedance is less than 300?
Insulation break
158
During an RF ablation of AVNRT, there is a loss of retrograde atrial conduction. What do you do next?
Stop RF application as the ablation is complete once there is not dual pathway present
159
Tachycardia initiated by an impulse that blocks in the fast pathway and conducts through the slow pathway is described as what?
AVNRT
160
Where is the tricuspid valve?
On the right side of the heart
161
Where is the mitral valve?
On the left side of the heart
162
When looking at the tricuspid and mitral valve from the superior portion where is the aortic valve and pulmonary valve?
The aortic valve in medial and slightly superior and then the pulmonary valve sits right above the aortic valve
163
When draping a patient for a pacemaker implant what area do you drape?
You drape the area closest to you to continue to keep a sterile environment and avoid any on sterile items coming in contact with you.
164
ICD conductor fracture should be suspected when there is an impedance from the baseline of what?
1500 Ohms (300-1200 is normal)
165
alpha particles, beta particles, gamma rays, and X-rays (Fluoroscopy). These are all examples of what?
Ionizing radiation
166
Ultra-Violet light, visible light, infrared, radio-frequency (EP ablation) and microwaves. These are examples of what?
Non- ionizing radiation
167
With exception of the local stimulus of above normal strength, which of the following refractory periods describe the timing during depolarization in which the longest coupling interval of input into a tissue fails to produce capture?
Effective
168
the time elapsed between the end of ERP to the beginning of phase 4 of the action potential.
relative
169
is the shortest coupling interval between two successive conducted impulses, measuring both refractoriness and conduction velocity of the tissue of interest.
Functional
170
Depolarization of the cell occurs at what phase and why?
Phase 0.This occurs because the sodium channels open allowing positively charge sodium ions to to rush into the cell
171
Repolarization of the cell occurs at what phase and why?
Phase 0-3. this occurs because the sodium channels close ending the influx of sodium ions into the cell. Potassium ions begin to flow out of the cell starting the repolarization process. Next calcium channels will open allowing calcium ions to move into the cell. Finally calcium channels close but potassium keeps coming out of the cell. the sodium potassium pump pushes sodium out of the cell and pulls potassium back in. 3 sodium to 1 potassium
172
Explain phase 0 action potential
Sodium channels open allowing sodium ions to rush into the cell
173
Explain phase 2 action potential
calcium channels open allowing calcium ions into the cell known as the absolute refractory period where the cell cannot be depolarized.
174
Explain phase 3 action potential
calcium channels close but potassium ions keep coming out of the cell. a sodium potassium pump pulls sodium ions out of the cell and pulls potassium ions back into the cell completing depolarization repolarization. This is the relative refractory period of a cardiac cell – during this time the cell will depolarize if given a strong enough stimulus.
175
Explain phase 4 action potential
The distribution of sodium and potassium ions is restored, and the cell is available for depolarization.
176
Explain phase 1 action potential
sodium channels close stopping sodium ions to come into the cell. Potassium ions begin flowing out of the cell
177
178
What are indications for single or dual chamber ICD implants?
Primary and secondary preventions, incessant VT
179
After connecting the ablation catheter to the ablation cable, it is observed on the recording system that one of the bipolar is not displaying any information. What is the FIRST step to take?
Disconnect and reconnect the ablation cable
180
During an ablation for atrial tachycardia near the bundle of His, a patient goes into complete heart block. The next logical step would be to?
Stop ablation and prepare for a pacemaker
181
Defibrillation threshold testing (DFT) may be preformed in which circumstances?
Congestive Heart Failure, Post MI, failed therapy delivery
182
During an electro-anatomical mapping procedure the system gives a patient movement warning. What is the next recommended step?
No action required
183
During an RF ablation, the baseline impedance is 180 ohms as measure through the ablation catheter this can be corrected by what?
Adding a second grounding patch or moving the patch closer to the heart. The closest to the heart the lower the impedance, the further away from the heart the higher the impedance
184
What is normal impedance for ablations?
90-120 ohms
185
High impedance in ablations can cause what?
Char, or thrombus
186
How do you know based on impedance if you have achieved a successful lesson formation?
There will be a 5-10 ohms drop
187
What is normal temperature for ablation catheters?
50-70 degrees c
188
Catheter temps above 70 can cause what?
Char and thrombus
189
Catheter temps above 100 can cause what?
Steam pops
190
What is the normal power for an ablation
20-60 watts
191
Low power will do what?
ineffective lesion
192
High power can cause what?
Promotes char, thrombus, steam pops
193
What is the relationship between power and temperature
The higher the power the higher the temperature. The lower the power the lower the temperature
194
A 300 pound patient is prepped for an RF ablation. Baseline impedance is 200 ohms. The next step would be to do what?
195
Dextrocardia is what?
When the heart is on the right side of the body instead of the left
196
What is transportation of the great vessels?
the aorta starts from the right ventricle and the pulmonary artery from the left ventricle. instead of normal position where the aorta starts from the Left ventricle and the pulmonary artery starts from the right ventricle
197
What is persistent Left Superior vena cava?
A defect where the PLSVC runs between the left pulmonary veins and the left atrial appendage enlarging the coronary sinus as it enters the atrium.
198
When preparing to transport a patient for a cardiac device implant, what documents must be updated and reviewed?
H&P, signed patient consent
199
When ablating the osmium of the coronary sinus, a sudden 60 ohm drop occurs. What does this finding indicate?
Ablation catheter has fallen into the CS
200
How can you tell the difference on an EGM of PVI entrance block vs exit block
Entrance block will occur in the proximal leads and fade as they get to the distal leads, an exit block will start at the distal leads and fade as it moves more proximal
201
What is PMT in a pacemaker?
Pacemaker mediated tachycardia is a type of arrhythmia that happens in patients with dual-chamber pacemakers
202
what is mode switching in a pacemaker?
the ability of a pacemaker to reprogram itself from tracking to non-tracking mode in response to atrial tachyarrhythmias, and to regain tracking mode as soon as the tachyarrhythmia terminates.
203
What meds should be given to a patient with WPW who comes in with wide complex VT?
Amiodarone
204
What pacing protocol are most likely to induce typical atrial flutter?
PES from the proximal cs and from the lateral RA
205
carotid massage would be preformed on a patient with syncope and?
a negative EP study
206
If a QRS is wide during AVRT what does that mean?
It means the AVRT is antidromic, or in a retrograde fashion
207
If a QRS is narrow during AVRT what does that mean?
it means its orthodromic, in a normal fashion
208
how do you decide if a AVRT is right or left sided?
If its right sided it then the ventricular deflection of the RVA proceeds the “V” deflection of the His EGM. If it is left sided. If ventricular deflection of the proximal CS precedes the “V” deflection of the His EGM
209
(-) delta wave on V1 =
right sided
210
(+) delta wave on V1=
left sided
211
AVNRT is what kind of mechanism of activation?
Macro- reentry
212
What is a normal AH interval?
50-120
213
What is a normal HV interval?
35-55
214
What is a normal QRS?
less an 120
215
During tachycardia, if “A” and “V” signals are fused on the distal CS (1-2), the AP resides on
Left side
216
f the “A” and “V” signals are fused on the proximal CS (9-10), the AP resides on the
right side
217
Increase in V-A interval if RBBB develops
Right side
218
Increase in V-A interval if LBBB develops
Left sided
219
WPW is a form of what tachycardia?
Orthodromic AVRT
