PM/ICDs

Question 1

Two most common indications for PM insertion?

Answer 1

SA node dysfunction and AV block

Question 2

Indications for PM insertion?

Answer 2

correlation of at least one symptom and an arrythmia

Question 3

What is HTN Carotid Sinus Syndrome?

Answer 3

recurrent syncopal episodes associated with carotid stimulation

Question 4

What is chronotropic competence/incompetence?

Answer 4

instead of a fast rise in hr when they start exercising, followed by stable hr during exercise, and slow drop off when they’re done exercising, these people have a very slow increase in hr, not stable during exercise, when finished exercising is quick drop off. main symptom is exercise intolerance

Question 5

Which type of heart block warrants a PM even if the patient doesnt have symptoms?

Answer 5

2nd degree AV block Type II

Question 6

What are 3 lifestyle assessment tests for patient needing a PM?

Answer 6

graded treadmill test, holter monitor, or EP studies in cath lab

Question 7

Does every PM have a reed switch?

Answer 7

yes

Question 8

What are the components of a PM?

Answer 8

battery, connection outlet, electrical circuit, lead (insulated wire), electrode tip

Question 9

What does putting a magnet on a PM do to the reed switch?

Answer 9

closes reed switch and pm switches to diff mode and paces at fixed rate.

Question 10

What is a reed switch?

Answer 10

an electrical switch operated by an applied magnetic field

Question 11

PMs use a 5 letter system for PM coding. What does each of the 5 letters represent?

Answer 11

1- chambers paced II- chambers sensed III- response to sensed event IV- programmability features V- antitachyarrhythmic functions

Question 12

PM codes: t stands for?

Answer 12

trigger pacing

Question 13

PM codes: i stands for

Answer 13

inhibit pacing

Question 14

PM codes: p stands for

Answer 14

programmability of rate and/or output

Question 15

PM codes: c stands for

Answer 15

communicating

Question 16

PM codes: o stands for

Answer 16

none

Question 17

This part of the PM includes the energy source and electrical circuit for pacing and sensing functions?

Answer 17

pulse generator

Question 18

This part of the PM is the insulated wires that come from the pulse generator to the electrode?

Answer 18

leads

Question 19

This part of the PM is the exposed metal end of the lead that comes in contact with the epicardium or endocardium?

Answer 19

electrode

Question 20

Disadvantage to using unipolar lead over bipolar lead?

Answer 20

unipolar lead is more likely to pick up extra noise

Question 21

How does unipolar lead pacing work?

Answer 21

there is a negative lead, or cathode, from which current flows to the heart and stimulates the heart and then returns to the + pole on the casing of the generator via the myocardium and adjacent tissue to complete the circuit

Question 22

How does bipolar lead pacing work?

Answer 22

2 separate electrodes: + and _ (anode and cathode) and both located in chamber being paced. electrodes placed very close so signal is crisp and they are much less likely to pick up extra noise

Question 23

This type of pacing is also known as transvenous pacing. The lead system is placed thru vein in to RA or RV. Typically use right SC vein

Answer 23

endocardial pacing

Question 24

Minimum amt of energy needed to consistently cause depol/contraction on heart?

Answer 24

pacing threshold

Question 25

What happens to the PM threshold in the first month after PM implantation?

Answer 25

the pacing threshold increases

Question 26

Measure of minimum voltage of intrinsic r wave necessary to activate sensing circuit of pulse generator and thus inhibit pacing circuit?

Answer 26

r wave sensitivity

Question 27

If PM resistance suddenly changes, what does it usually indicate?

Answer 27

usually indicates a problem in the lead system

Question 28

What does very high resistance usually indicate?

Answer 28

conductor fracture or lousy connect to PM

Question 29

What does very low resistance usually indicate?

Answer 29

broken wire and insulation failure

Question 30

This is the diff between intrinsic hr at which pacing begins and pacing?

Answer 30

hysteresis

Question 31

What happens in a runaway PM?

Answer 31

acceleration in paced rates due to aging of PM and or damage produced by leakage of tissue fluids in to PM

Question 32

How do you treat a runaway pacemaker?

Answer 32

NOT with drugs or cardioversion; change PM to asynchronous mode or reprogram to lower outputs. if pt is HD unstable, use a temporary PM until the pulse generator can be changed

Question 33

Sx associated with needing a PM?

Answer 33

syncope, dizziness, CHF, confusion, seizures, chest pain, palpitations, fatigue, SOB, chest tightness, exercise intolerance

Question 34

Examples of sinoatrial dysfunction?

Answer 34

sinus brady, sinus arrest, sinus pause, tachy/brady syndrome, atrial flutter, atrial fibrillation, chronotropic incompetence

Question 35

Is a PM indicated for first degree AVB?

Answer 35

rarely

Question 36

Is a PM indicated for 2nd degree Type I AVB?

Answer 36

only when symptoms are present

Question 37

Is a PM indicated for 3rd degree block?

Answer 37

yes, usually

Question 38

Patient assessment for PM?

Answer 38

H&P, EKG, lifestyle assessment: holter monitor, EP studies, graded treadmill

Question 39

Types of pacemakers?

Answer 39

unipolar vs bipolar and fixed rate vs responsive

Question 40

In the PM system, what is resistance?

Answer 40

sum of resistance in lead and resistance thru pt’s tissue and polarization that takes place when voltage and current delivered in to tissues