Cardiac Electrophysiology Barry
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| show | - AV heart block: 2nd degree type II and 3rd degree heart block.
-Symptomatic bradycardia.
-AV heart block =MI
-Heart block post MAZE procedure.
-Chronic bifascicular or trifascicular block.
-Sinus node dysfunction (sick sinus syndrome).
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| show | 5-8 years.
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| show | Connect power source and electronic circuitry to electrodes.
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| show | Used for cardiac sensing and stimulation.
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| Describe unipolar pacer: | show 🗑
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| Describe bipolar pacer: | show 🗑
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| show | Epicardial leads are placed directly on the heart during cardiac surgery or for biventricular pacing.
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| show | Placed transvenous for temp or perm pacing.
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| show | Epicardial and endocardial.
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| Two kinds of indirect cardiac pacing: | show 🗑
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| show | Inter-society Commission for Heart Disease.
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| Pacing 1st position: | show 🗑
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| Pacing 2nd position: | show 🗑
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| show | 3rd position designates response to sensed events. I=inhibited, T=triggered, D=double (both I and T), or O=none.
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| show | 4th and 5th positions designated programmable and special antitachycardia functions.
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| show | Asynchronous (fixed rate pacing) Pacer delivers stimuli at a programmed rate without regard to patients intrinsic rhythm. ie: AOO, VOO.
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| show | Temporary pacers.
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| show | Tachydysrhythmias.
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| show | Intrinsic atrial or ventricular myopotentials.
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| show | Inhibition of pacemaker output in one or the other chamber. ie: VVI, AAI.
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| show | A-fib. Most common pacing mode. Magnet will convert to fixed rate usually .
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| What is the most common pacing mode? | show 🗑
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| AAI: Used in... | show 🗑
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| Dual chamber pacing mode is intended to... | show 🗑
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| Dual chamber pacing mode provides AV... | show 🗑
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| show | Lowers incidence of AF.
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| show | Stroke.
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| CHF and dual chamber pacing? | show 🗑
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| show | Decreases mortality.
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| True or false. Dual chamber pacing reduces LV filling. | show 🗑
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| By how much does dual chamber pacing increase CO? | show 🗑
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| show | Reduces incidence of mitral and tricuspid regurg.
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| High tech pacing functions: Pts with prolonged QT intervals can be cont paced to... | show 🗑
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| show | Continuously pace patients with prolonged QT intervals.
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| show | A variety of pacing patterns.
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| show | Based on muscle activity and resp rate. Detects states of exercise and triggers accelerations in pacing rate to meet the needs of the patient.
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| DDD pacers will sometimes track atrial activity to a max track in paroxysmal atrial flutter. This will cause a undesirable acceleration in ventricular pacing rate. Automatic mode switching will... | show 🗑
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| Biventricular pacing is used in whom? Why? | show 🗑
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| show | 1. Right atrial lead
2. Right ventricular lead
3. Left ventricular lead
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| In biventricular pacing, how is the LV lead placed? | show 🗑
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| show | Reduces mitral regurgitation and allows for a better forward flow.
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| How does biventricular pacing reduce mitral regurg and allow for better flow? | show 🗑
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| Biventricular pacing causes synchronous contraction between left and right side of the heart. What does this do to the septal wall? | show 🗑
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| Can biventricular pacing be combined with ICD? | show 🗑
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| show | Placed transvenous under MAC.
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| Failure to output: No pacing spike is present despite an indication to pace. Troubleshoot (5 things). | show 🗑
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| How to correct failure to output (no pacing spike is present despite an indication to pace) which is being caused by cautery? | show 🗑
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| Failure to capture. Occurs when a pacing spike is not followed by either an atrial or a ventricular complex. Troubleshoot (6 things). | show 🗑
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| Oversensing. Occurs when, and is caused by what? | show 🗑
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| show | Sensitivity needs to be adjusted. Give the pacer more brain power.
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| Undersensing. Occurs when a pacer incorrectly misses intrinsic depolarization and paces despite intrinsic activity. Four causes? | show 🗑
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| Temp. transvenous or epicardial pacing: | show 🗑
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| show | Measured in mA from .1-20. Adjust according to current needed to elicit myocardial depolarization.
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| Sensitivity= Brain power. Detects pts intrinsic rhythm or lack of. The lowest number (blank) the pacer is the smartest. The highest number (blank) the pacer is brainless=asynchronous mode. | show 🗑
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| show | A, V, dual.
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| show | External Pacing pads: Ant-Post= Sandwich the heart. Ant placement= Do not place on bony area (sternum).
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| Six steps of transcutaneous pacing: | show 🗑
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| How many deaths due to VF? | show 🗑
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| AICD implanted in high risk population Successfully terminates VF in (blank) of episodes | show 🗑
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| show | Implantable cardioverter-defibrillator.
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| show | ICD.
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| What does an ICD do in the case of VT? | show 🗑
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| show | 10-30 seconds, 20-30 J, 10-30 seconds.
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| show | EMI (electromagnetic interference) from cautery can elicit a shock.
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| show | Transcutaneous pacing/defib pads need to be placed on pt.
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| How do you use a magnet on Medtronic and St. Jude? | show 🗑
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| show | Magnet over it for 30 seconds until continuous tone is heard to deactivate. Magnet back on beeping synch with R wave for reactivation.
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| show | 1.Do not use antiarrhythmics.
2.Have transcutaneous pacer/defib on patient.
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| show | Lido 1mg/kg Q 3-5 min total 3mg/kg
Pronestyl 17 mg/kg (20mg/min) new changes
Vasopressin 40 units ( May replace 1st or 2nd dose of epi)
Epi 1mg Q 3 min
Mg sulfate 1-2 gms IV for torsades
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| show | Amiodarone VT with pulse=150mg over 10 mins repeat in 10mins then infusion. Pulseless=300mg IV X1 May repeat 2nd dose at 150mg
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| Treatment for VF: | show 🗑
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| show | Dx arrhythmias by locating small area of abnormal heart tissue.
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| How does cardiac mapping diagnose arrythmias? | show 🗑
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| What is an IABP? What does it do? | show 🗑
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| show | 1. Left ventricular failure
2. Failure to wean from CPB
3. Unstable angina
4. Bridge to heart transplant
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| Four contraindications to IABP. | show 🗑
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| show | Balloon inflation occurs at the same time that the aortic valve closes (Dicrotic notch).
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| During diastole IABP benefits coronary perfusion in two ways: | show 🗑
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| show | Deflation occurs just prior to the next systole. (timing on the R wave or upstroke on arterial wave form).
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| show | For a few milliseconds after the balloon is deflated, the left ventricle has less pressure to eject against= decrease afterload.
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