Pace Makers

Question 1

2 ways in which diseased heart tissue blocks normal impulses.

Answer 1

• Prevent impulse generation in SA node

- Inhibit impulse conduction

Question 2

2 components of pacemaker?

Answer 2

• Implantable pulse generator

- Lead wires

Question 3

Cathode is the _______ electrode and Anode is the _______ electrode.

Answer 3

• Negative

- Positive

Question 4

Describe passive lead fixation?

Answer 4

-Tines lodge in the trabeculae (fibrous meshwork) of heart

Question 5

Describe active fixation of leads?

Answer 5

-Helix (screw) extends into endocardial tissue

Question 6

What is the most common frequency associated with pacemaker interference?

Answer 6

-50-60hz

Question 7

EMI may result in what 3 things?

Answer 7

• Oversensing
• Mode changing
• Reprogramming

Question 8

When will rates accelerate as a result of EMI?

Answer 8

-If sensed as P waves in dual chamber system

Question 9

When will rates be inhibited as a result of EMI?

Answer 9

• Single chamber system

- or ventricular lead in dual chamber

Question 10

What is noise reversion?

Answer 10

• refractory sensing will cause pacing at lower rates.

- sensed “noise” will initiate new refractory period

Question 11

EMI may lead to _________ ___________ of pacing parameters and device may revert to ______ on ______ mode.

Answer 11

• Inadvertent Reprogramming

- Power on Reset

Question 12

7 Sources of EMI in hospitals.

and which is most common?

Answer 12

• Electrocautery (most common)
• Lithotripsy
• Defibrilation
• radiation
• RF ablation
• TENS unit
• MRI

Question 13

What 4 things can occur with electrocautery EMI?

Answer 13

• Oversensing
• Undersensing
• Power in reset
• Loss of output

Question 14

6 precautions for electrocautery EMI?

Answer 14

• Reprogram to VOO/DOO
• Place Magnet
• Grounding plate
• 1 sec bursts every 10 secs
• Bipolar electrocautery
• Keep positioned so that current does not intersect the PM

Question 15

How to avoid pacemaker damage with defibrillation.

Answer 15

Position paddles as far away from pacemaker as possible.

Question 16

MRI with pacemaker potential outcomes.

Answer 16

• High pacing

- asynchronous pacing

Question 17

How to avoid MRI pacemaker problems?

Answer 17

• Program output low enough for non capture

- ODO/OVO mpde

Question 18

Lithotripsy pacemaker precautions.

Answer 18

• VVI/VOO mode

- Focal point >6 inches from pacemaker

Question 19

Lithotripsy problems w/ dual chamber? adaptive?

Answer 19

• Inhibits ventricular pacing

- High pacing, piezoelectric crystal damage

Question 20

What type of radiation and for what cancers can cause pacemaker damage? RADs should be kept to what?

Answer 20

• Ionizing radiation
• Breast and lung cancer
• <500

Question 21

Describe rate response pacing.

Answer 21

-Give patients ability to vary HR when SA node cannot provide appropriate rate.

Question 22

When is rate responsive pacing indicated?

Answer 22

• Chronotropically incompetent (HR cant reach appropriate levels)
• Afib w/ slow ventricular response

Question 23

SV x HR = ?

Answer 23

Cardiac output

Question 24

_________ reserves can account for increases in CO up to 50%.

Answer 24

-Stroke volume

Question 25

What reserves can triple CO in response to metabolic demands?

Answer 25

HR

Question 26

2 types of rate responsive sensors

Answer 26

- Detect movement and increase HR according to activity | - Minute ventilation sensors detect changes in RR and tidal volume

Question 27

Class 1 (Strongest evidence that therapy is beneficial) indications for pacemaker.

Answer 27

- Sinus node dysfunction w/ brady | - Symptomatic chronotropic incomptence

Question 28

Class 2A (Evidence in favor) indications for pacemaker

Answer 28

-Symptomatic patients w/ SA node dysfunction w/o association between symptoms and brady

Question 29

Class 2B (less well established) indications for pacemaker

Answer 29

-Chronic HR <30

Question 30

Class 3 (Therapy is unnecessary) indications for pacemaker

Answer 30

-Asymptomatic sinus node dysfunction

Question 31

Describe 1st degree block

Answer 31

-Prolonged P-R interval (no drop)

Question 32

Describe 2nd degree Mobitz type 1

Answer 32

-P-R that lengthens then drops

Question 33

Describe 2nd degree Mobitz type 2

Answer 33

- Regularly dropped ventricular beats | - 2:1 block (2 P's for 1 QRS)

Question 34

Describe 3rd degree heart block

Answer 34

- Complete heart block | - Atria and ventricle contract independent of each other

Question 35

6 pacemaker indications.

Answer 35

- AV block - Sinus node dysfunction - Bi/trifasciular block - Hypersensitive carotid sinus - Vaso-vagal syncope - Cardiac transplant

Question 36

What is the 1st letter of NBG code?

Answer 36

-Chamber paced

Question 37

What is the 2nd letter of NBG code?

Answer 37

Chamber sensed

Question 38

What is the 3rd letter of NBG code?

Answer 38

Response to sensing

Question 39

What are the 5 setting for NBG code 1 and 2?

Answer 39

``` V=Ventricle A=Atrium D=Dual O=None S=Single ```

Question 40

What is NBG setting for the 3rd letter (response to sensing)

Answer 40

T=triggered I=Inhibited D=Dual O=None

Question 41

NBG code 4 settings

Answer 41

``` P=Simple programmable M=Multi programmable C=Communicating R=Rate modulating O=None ```

Question 42

NBG code 5 (antitachy) settings

Answer 42

P=Pace S=Shock D=Dual O=None

Question 43

Name 6 class 1 sinus node dysfunctions

Answer 43

- Sinus Brady - Sinus arrest - Sinus pause - Brady - tachy syndrome - Atrial flutter - Chronotropic incompentence

Question 44

indications for ICD

Answer 44

- Cardiac arrest - VT (sustained & non-sustained) - Syncope - Ejection fraction <30

Question 45

_______ and _______ pose no threat to pacemakers or ICDs

Answer 45

- Microwaves | - Ultrasound

Question 46

What will a magnet place over a pacemaker do?

Answer 46

-Convert to VVI

Question 47

What will a magnet placed over a AICD do?

Answer 47

- Suspend EMI detection | - Should be removed should VF occur