Bb Cardiac Pacemakers And Aicds

Front 1

What is the 5 letter code for pacers?

Back 1

position 1 chamber paced, position 2: chamber sensed; position 3: response to sensing; position IV: programmability, rate modulation; position V: antitachycardia fxn

Front 2

When would you not want to use ventricular demand pacing(VVI, VVT)?

Back 2

if AV synchrony(atrial kick) is needed to improve end diastolic filling of the LV

Front 3

When would you use a VDD setting?

Back 3

AV block with a normal atrial rate

Front 4

when would you use AAI setting

Back 4

nml AV conduction with atrial bradycardia

Front 5

When would you use DVI setting?

Back 5

AV block with atrial bradycardia

Front 6

what are rate responsive pacemakers?

Back 6

VVIR, DVIR, DDDR; sense atrial and ventricular activity as well as other stimuli; increased CO can be achieved with increased O2 consumption, increased catecholamines, increased temp

Front 7

What are programmable features on pacemakers?

Back 7

rate, stimulus output, sensitivity, refractory period, antitachycardia modes

Front 8

What are indications of preop pacemaker malfunction?

Back 8

syncope, dizziness, fatigue, chest pain,

Front 9

When should you consider placement of a pacemaker in the in the abdominal position?

Back 9

usually it is placed over the pectoralis muscle, in some patients during physical activity inhibition occurs because myopotentials are sensed

Front 10

Why should you not routinely place a magnet over a pacemaker during surgery with electrocautery?

Back 10

pacemaker can be unpredictably reprogrammed and it would not be evident until the magnet is removed

Front 11

What pacemakers can be reprogrammed by cautery or inhibited by myopotentiials or fasciculations?

Back 11

demand pacemaker

Front 12

How should you deal with rate responsive pacemakers prior to surgery?

Back 12

have the rate responsive mode deactivated prior to surgery

Front 13

How can evoked potential monitoring affect pacemakers?

Back 13

can interfere for pacer function, patients with VDD, or DDD can develop tachycardia in the presence of evoked potentials, peripheral nerve stimulators, or transcutaneous electical stimulators; these modes should be changed to VOO DOO

Front 14

How does lithotripsy affect pacer fxn?

Back 14

usually it's safe with pacers, the focal point of the lithotriptor should be kept 6 inches from the pacer

Front 15

If a MRI must be done in a patient with a pacer how should you handle the pacer?

Back 15

if patient is not pacer dependent, pulse generator should be turned off(000) or explanted

Front 16

How does radiation therapy affect pacemaker use?

Back 16

radiation therapy can damage the pacer in unpredictable ways, pacer fxn should be evaluated

Front 17

How does hypo or hyperkalemia affect pacer fxn?

Back 17

hypokalemia can lead to loss of capture; hyperkalemia can lead to ventricular irritability

Front 18

What are pacemaker indications?

Back 18

third degree heart block, type II mobitz block, severe bradycardia, symptomatic bifascicular block, any sig bradycardia with heart block

Front 19

How do you test a demand pacemaker?

Back 19

valsalva or carotid massage to decrease HR and see if pacemake kicks in

Front 20

How can you tell if there is LA hemiblock?

Back 20

LAD + slight QRS widening

Front 21

How can you tell if there is a left posterior hemiblock?

Back 21

RAD + widening of QRS

Front 22

What are indications for AICD?

Back 22

patient's who survive sudden death episodes, sustained VT, syncope due to VT, arrhythmias no amenable to ablation

Front 23

What are the meanings of the 4 letter codes for AICD?

Back 23

position 1: shock chamber
position 2: antitachycardia pacing chamber
position 3: tachycardia detection
position 4: antibradycardia pacing chamber

Front 24

Why should you be careful about using a magnet in a patient with an AICD?

Back 24

some ICDs can be deactivated in patient's with a magnet, others require programmed deactivation, ICD over a magnet can lead to unpredictably reprogramming or discharge

Front 25

If deactivation of an AICD does not occur what can happen during surgery with an electrocautery?

Back 25

ICD can interpret electrocautery as a dysrrhythmia and discharge

Front 26

If an ICD is deactivated correctly preop what pacing can remain active?

Back 26

VOO, VVI

Front 27

How is lithotripsy affected in patients that have an AICD?

Back 27

lithotripsy should be avoided unless it has been deactivated

Front 28

How does evoked potential monitors and peripheral nerve stimulators affect AICDs?

Back 28

interfere with ICDs and cause them to discharge

Front 29

In patients with AICDs what should you have available in the room?

Back 29

external defibrillating device

Front 30

If electrocautery is to be used in a patient with an AICD or pacer what should you determine?

Back 30

determine if reprogramming, conversion to asynchronous mode, and/or disabling rate responsive function is an advantage; in general suspend antiarrhythmia functions; have surgeon use bipolar cautery or harmonic scapel, have surgeon use short intermittent bursts of bipolar cautery

Front 31

How should you manage a radiofrequency ablation in a patient that has a pacer or an AICD?

Back 31

keep the radiofrequency path as far as possible from the CRMD

Front 32

In a patient that needs radiation therapy in the same location as the pulse generator of an AICD or pacer what should you do?

Back 32

have surgeon put the pulse generator somewhere else

Front 33

What should you do in a patient getting ECT that has a pacer or AICD?

Back 33

consult with a cardiologist

Front 34

Why should you worry about a patient being paced in an asynchonous mode in a patient with an intrinsic rhythm?

Back 34

pacer can fire on a T wave and can induce VT or VF

Front 35

Prior to surgery should you have a rep convert the pacemaker to an asynchronous mode or place a magnet over it?

Back 35

need to know rhythm prior to surgery and whether pacer should be reprogrammed to not pace at all or whether a magnet converting the pacer to asynchronous mode is advisable