Question 1

POSITION category of pacemaker code:

Accepted Answer

1 = chamber paced
2 = chamber sensed
3 = response to sensing
4 = programability, rate modulation
5 = antitachycardia fxn.

Question 2

position V OF PACemakers are antitachycardia functions such as ?

Accepted Answer

O NONE
P PACING
S SHOCK
D DUAL PACE AND SHOCK

Question 3

the first trhee code in pacemaker mode describes? the last two describes?

Accepted Answer

first three = antibradycardia fxn.
last two = programmability and antitachycardia fxn.

Question 4

VOO, AOO, DOO describes what modes? what is the problem with this type of modes?

Accepted Answer

fixed rate or asynchronious mode. may cause afib, aflutter and firing on T wave

Question 5

AAI, AAT describes what modes in pacemakers? what is necessary? what side effect? what are indications?

Accepted Answer

atrial demand or synchronious modes. it requires intact AV condution. can cause afib, aflutter. indications include sick sinus, sinys block/arrest.

Question 6

VVI, VVT, describes what modes in pacemakers? when is it indicated?

Accepted Answer

ventricular demand synchronious mode. indicated in av dysfunction such as in SVT.

Question 7

when is ventricular pacing not optimal ?

Accepted Answer

when in need of atrial kick.

Question 8

VAT, VDD, DVI, DDD DEScribes what modes? this ensures what? patient must have what intact. in what type of patient is it used for?

Accepted Answer

dual pacemaker deman or synchronious mode. ensures coordinated av conduction. patient need  sa node intact.

Question 9

which type of patient is the VAT and VDD cant be used?

Accepted Answer

in the setting of retrograde ventriculoatrial conduction they can cause ventricular mediatied tachycardia

Question 10

WHICH mode result in AV sequential pacing? when is it indicated?

Accepted Answer

DVI. indicated in setting of av block with atrial bradycardia

Question 11

when is the AAI indicated?

Accepted Answer

normal av conduction with atrial bradycardia

Question 12

when is VDD indicated?

Accepted Answer

av block with normal atrial rate.

Question 13

what helps to achieve the rate responsive pacemakers to sense stimuli such as exercise, emotion/catecholamines, temperature?

Accepted Answer

the piezoelectric sensors.

Question 14

rate responsive pacemakers are designated by?

Accepted Answer

R. I.E. VVIR, DVIR, DDDR.

Question 15

WHAT are the programmable features of pacemakers?

Accepted Answer

1. rate upper and lower limit
2. stimulus output volts, ma
3. sensitivity mv
4. refractory periods
5. antitachycardia modes either on or off.

Question 16

in patients with pacemakers, which preop electrolytes are particularly important?

Accepted Answer

potassium

Question 17

a patient with syncope, dizzines, fatigue, chest pain with pacemaker. what do you suspect?

Accepted Answer

pacemaker malfunction

Question 18

the pacemaker is usually placed over the pectoralis muscle often have what problems? what can be utilized instead?

Accepted Answer

myopotentials are sensed and may cause inhibition to pacemaker. the abdominal  position is utilized instead.

Question 19

during surgery, pacemakers should be assumed as what?

Accepted Answer

demand programmable rather then fixed nonprogrammable as the pulse generator can be reprogrammed by electromagnetic interference during electrocautery.

Question 20

how should you use magnets for pacemakers during surgery?

Accepted Answer

magnets should not be routinely use especially in the presence of cautery for risk of reprogramming of the pulse generator, but always available.

Question 21

what should be avoided during surgery as they can inhibit demand pacemakers?

Accepted Answer

myopotentials, fasciculation, and shivering. treat shivering with nondepolarizing blockers.

Question 22

what are best uses of electrocautery during surgery with pacemakers?

Accepted Answer

short bursts, long pauses.  bipolar instead of unipolar. bovie as far from the pulse generator and closer to incision site and return pad.

Question 23

prior to surgery patients with rate responsive pacemakers needs what changes?

Accepted Answer

rate responsive to be turned off prior to surgery.

Question 24

patients with VDD and DDD SHould have what done prior to surgery?

Accepted Answer

modes changed to VVI or VOO prior to surgery because may cause tachycardia in the presence of evoked potentials, peripheral nerve stimulators, or transcuataneous electrical stimulators.

Question 25

patients with pacemakers about to be defribilated, what should not be done?

Accepted Answer

defribilators should not be passed directly over the pulse generator.

Question 26

patients with pacemakers about to have lithrotipsy, what should be ensured?

Accepted Answer

that the focal point of lithrotripsy be 6 inches away from the pacemaker.

Question 27

how can a patient with pacemaker undergo MRI?

Accepted Answer

MRI is contraindicated with pacemaker. if MRI is necessary, only patients that are not dependent to pacemaker and it turned of to OOO may undergo MRI, or pacemaker be explanted prior to MRI.

Question 28

A PATient with pacemaker underwent radiotherapy. what should be ensured?

Accepted Answer

pacemaker function needs to be checked after the radiotherapy as it can damage pacemaker circuitry

Question 29

what electrolyte abnormality can affect pacemakers and how?

Accepted Answer

hypokalemia can lead to loss of capture and hyperkalemia can lead to ventricular irritab9ility.

Question 30

what are the indications of pacemakers?

Accepted Answer

1. any bradycardia with heart block
2. third degree block
3. symptomatic bradycardia
4. symptomatic bifascicular block
5. acute MI with second degree Mobitz type 2 block.

Question 31

how many spikes are there with AV sequential pacemaker?

Accepted Answer

two spikes.

Question 32

when a magnet is applied to a demand pacemaker what usually happens?

Accepted Answer

the demand pacemaker is converted to a synchronious mode.

Question 33

when checking if demand pacemaker is working and vasalva and carotid message does not lower heart rate, what can you do next?

Accepted Answer

apply magnet.

Question 34

what are the causes of heart block?

Accepted Answer

drugs: quinidine, digitalis, procainamide, propanolol.
conduction diseases - lenegre's 
congenital heart block
cardiac tissue diseases - CAD with ischemia, myocarditis, cardiomyopathy, increased vagal tone.

Question 35

what causes a tacy-brady sydrome?

Accepted Answer

sick sinus syndrome. - failure to activate the rest of the atrium leading to severe persistent bradycardia.

Question 36

what is made up of unifascicular block?

Accepted Answer

block of one of two fascicle of the left ventricle. types are LA hemiblock and Left posterior hemiblock.

Question 37

the ekg signs for left atrial hemiblock and left posterior hemiblock?

Accepted Answer

LA hemiblock - left axis deviation and slight qrs widening. 
left posterior hemiblock - right axis deviation and widened qrs.

Question 38

when is diagnosis of MI difficult?

Accepted Answer

in the presence of LBBB.

Question 39

LBBB implies what? RBBB implies what/

Accepted Answer

LBBB - severe cad, htn, lvh
rbbb - does not imply CAD.

Question 40

ekg sign of bifascicular block?

Accepted Answer

RBBB plus one of the two fascicles of the lbbb.

Question 41

indication of ICDs?

Accepted Answer

1. survived from sudden death
2. sustaine VTACH
3. SYncope due to V TACH
4. arrythmia not amendable with ablation.

Question 42

the functions of ICDs?

Accepted Answer

monitor and treat for 
VT (antitachycardia and countershock) and afib (countershock)

Question 43

anesthetic management of patients with ICD?

Accepted Answer

1. IF ICD is deactivated, then the VVI AND VOO pacing can remain active
2. angina and chf must be recognized and optimized.

Question 44

magnet placed over ICDs can cause what?

Accepted Answer

like pacemakers can lead to unpredictable reprogramming and discharge.

Question 45

what are the ways to deactivate an icd?

Accepted Answer

1. with magnet
2. or requires reprogramming.

Question 46

if ICDs failed shielding from magnet, what may happen?

Accepted Answer

icd can interpret electrocautery as dysrythmia and discharge.

Question 47

what should be available intraoperatively with a patient with ICD?

Accepted Answer

1. external defribrillator.

Question 48

what should be avoided with icd?

Accepted Answer

1. lithotripsy, unless they are deactivated
2. MRI
3. evoked potentials, peripheral nerve stimulators can interfer with icds and cause them to discharge inappropriately.

Question 49

a patient with CRMD (cardiac rhythm management device) requires a pacemaker, what needs to be doen?

Accepted Answer

consult cardiologist preoperatively.

Question 50

what are the preoperative evaluation of a patient with a CRMD?

Accepted Answer

1. FOCUS HISTORY
2. determine the type of CRMD - get card from patient, online database, cxray
3. identify function of crmd - cardiologist, pacemaker service providers.
4. ask if patient had symptoms from arrythmias.

Question 51

what are the preoperative preparation of a patient with crmd?

Accepted Answer

1. availability of external pacer/defibrilator
2. if EMI to be used, determine if reprogramming, conversion to asynchronous mode, and or disabling rate responsive function is an advantage. 
3. in general suspend antiarrythmia function
4. use bipolar.

Question 52

how do you manage crmd dysfunction due to EMI FROM radiofrequency ablation?

Accepted Answer

avoid direct contact with pulse generator and leads. keep the radiofrequency current path as far as possible from the the crmd.

Question 53

how do you manage crmd dysfunction due to EMI FROM lithotripsy? ?

Accepted Answer

1. if the lithotripsy triggers on the r wave, atrial pacing should be disabled 
2. consult cardiologist
3. avoid the beam on or near the pulse generator.

Question 54

how do you manage crmd dysfunction due to EMI FROM radiation therapy? ?

Accepted Answer

is generally safe, if the radiation field is in the generator field, the generator should be removed and placed elsewhere.

Question 55

putting a magnet over a demand pacemaker will do what to it?

Accepted Answer

with convert the pacemaker from demand to asynchronious mode.

Question 56

with regard to magnet use on medtronic AICD?

Accepted Answer

magnet should be avoided since pacing function  for bradycardia is unaffected and defibrillation may be necessary.

Question 57

with regard to magnet use on medtronic pacemakers?

Accepted Answer

will convert medtronic pacemakers to asynchronious mode but depends upon patient's intrinsic, underlying rate and rhythm probably requiring a cardiologist.

Question 58

with regard to boston scientific pacemakers, placing a magnet will allow?

Accepted Answer

when magnet is used, the boston scientific is programmed to switch to 1. asynchroneous mode, do nothing mode, e-gram mode.

Question 59

the chief advantage for the asynchroneous mode is to ?

Accepted Answer

check for battery life over the telephone by provider.

Question 60

the presence of electromagnetic interference is an indication to do what to pacemakers?

Accepted Answer

asynchroneous mode.

Question 61

what is the use of the 'do nothing mode' of boston scientific pacers?

Accepted Answer

setting of strong magnetic fields such as in industrial settings where large magnets are used.

Question 62

what is the use of the boston scientific of store e-gram mode/

Accepted Answer

when wanting to rule out if the paceer is malfunctioning such as when patient feels palpitations or when pacer is felt not to function properly, patient can change it by themselves to this mode.

Question 63

bottom line for boston scientific pacers?

Accepted Answer

a cardiologist should make recommendations, and not advisable to routinely convert pacers to asynchroneous mode with a magnet.

Question 64

what recommendations are made to electrocautery when patients are with pacers?

Accepted Answer

1. short bursts, long pauses
2. low current
3. return pad and bovie as far away from generator pulse.

Question	Answer
POSITION category of pacemaker code:	1 = chamber paced 2 = chamber sensed 3 = response to sensing 4 = programability, rate modulation 5 = antitachycardia fxn.
position V OF PACemakers are antitachycardia functions such as ?	O NONE P PACING S SHOCK D DUAL PACE AND SHOCK
the first trhee code in pacemaker mode describes? the last two describes?	first three = antibradycardia fxn. last two = programmability and antitachycardia fxn.
VOO, AOO, DOO describes what modes? what is the problem with this type of modes?	fixed rate or asynchronious mode. may cause afib, aflutter and firing on T wave
AAI, AAT describes what modes in pacemakers? what is necessary? what side effect? what are indications?	atrial demand or synchronious modes. it requires intact AV condution. can cause afib, aflutter. indications include sick sinus, sinys block/arrest.
VVI, VVT, describes what modes in pacemakers? when is it indicated?	ventricular demand synchronious mode. indicated in av dysfunction such as in SVT.
when is ventricular pacing not optimal ?	when in need of atrial kick.
VAT, VDD, DVI, DDD DEScribes what modes? this ensures what? patient must have what intact. in what type of patient is it used for?	dual pacemaker deman or synchronious mode. ensures coordinated av conduction. patient need sa node intact.
which type of patient is the VAT and VDD cant be used?	in the setting of retrograde ventriculoatrial conduction they can cause ventricular mediatied tachycardia
WHICH mode result in AV sequential pacing? when is it indicated?	DVI. indicated in setting of av block with atrial bradycardia
when is the AAI indicated?	normal av conduction with atrial bradycardia
when is VDD indicated?	av block with normal atrial rate.
what helps to achieve the rate responsive pacemakers to sense stimuli such as exercise, emotion/catecholamines, temperature?	the piezoelectric sensors.
rate responsive pacemakers are designated by?	R. I.E. VVIR, DVIR, DDDR.
WHAT are the programmable features of pacemakers?	1. rate upper and lower limit 2. stimulus output volts, ma 3. sensitivity mv 4. refractory periods 5. antitachycardia modes either on or off.
in patients with pacemakers, which preop electrolytes are particularly important?	potassium
a patient with syncope, dizzines, fatigue, chest pain with pacemaker. what do you suspect?	pacemaker malfunction
the pacemaker is usually placed over the pectoralis muscle often have what problems? what can be utilized instead?	myopotentials are sensed and may cause inhibition to pacemaker. the abdominal position is utilized instead.
during surgery, pacemakers should be assumed as what?	demand programmable rather then fixed nonprogrammable as the pulse generator can be reprogrammed by electromagnetic interference during electrocautery.
how should you use magnets for pacemakers during surgery?	magnets should not be routinely use especially in the presence of cautery for risk of reprogramming of the pulse generator, but always available.
what should be avoided during surgery as they can inhibit demand pacemakers?	myopotentials, fasciculation, and shivering. treat shivering with nondepolarizing blockers.
what are best uses of electrocautery during surgery with pacemakers?	short bursts, long pauses. bipolar instead of unipolar. bovie as far from the pulse generator and closer to incision site and return pad.
prior to surgery patients with rate responsive pacemakers needs what changes?	rate responsive to be turned off prior to surgery.
patients with VDD and DDD SHould have what done prior to surgery?	modes changed to VVI or VOO prior to surgery because may cause tachycardia in the presence of evoked potentials, peripheral nerve stimulators, or transcuataneous electrical stimulators.
patients with pacemakers about to be defribilated, what should not be done?	defribilators should not be passed directly over the pulse generator.
patients with pacemakers about to have lithrotipsy, what should be ensured?	that the focal point of lithrotripsy be 6 inches away from the pacemaker.
how can a patient with pacemaker undergo MRI?	MRI is contraindicated with pacemaker. if MRI is necessary, only patients that are not dependent to pacemaker and it turned of to OOO may undergo MRI, or pacemaker be explanted prior to MRI.
A PATient with pacemaker underwent radiotherapy. what should be ensured?	pacemaker function needs to be checked after the radiotherapy as it can damage pacemaker circuitry
what electrolyte abnormality can affect pacemakers and how?	hypokalemia can lead to loss of capture and hyperkalemia can lead to ventricular irritab9ility.
what are the indications of pacemakers?	1. any bradycardia with heart block 2. third degree block 3. symptomatic bradycardia 4. symptomatic bifascicular block 5. acute MI with second degree Mobitz type 2 block.
how many spikes are there with AV sequential pacemaker?	two spikes.
when a magnet is applied to a demand pacemaker what usually happens?	the demand pacemaker is converted to a synchronious mode.
when checking if demand pacemaker is working and vasalva and carotid message does not lower heart rate, what can you do next?	apply magnet.
what are the causes of heart block?	drugs: quinidine, digitalis, procainamide, propanolol. conduction diseases - lenegre's congenital heart block cardiac tissue diseases - CAD with ischemia, myocarditis, cardiomyopathy, increased vagal tone.
what causes a tacy-brady sydrome?	sick sinus syndrome. - failure to activate the rest of the atrium leading to severe persistent bradycardia.
what is made up of unifascicular block?	block of one of two fascicle of the left ventricle. types are LA hemiblock and Left posterior hemiblock.
the ekg signs for left atrial hemiblock and left posterior hemiblock?	LA hemiblock - left axis deviation and slight qrs widening. left posterior hemiblock - right axis deviation and widened qrs.
when is diagnosis of MI difficult?	in the presence of LBBB.
LBBB implies what? RBBB implies what/	LBBB - severe cad, htn, lvh rbbb - does not imply CAD.
ekg sign of bifascicular block?	RBBB plus one of the two fascicles of the lbbb.
indication of ICDs?	1. survived from sudden death 2. sustaine VTACH 3. SYncope due to V TACH 4. arrythmia not amendable with ablation.
the functions of ICDs?	monitor and treat for VT (antitachycardia and countershock) and afib (countershock)
anesthetic management of patients with ICD?	1. IF ICD is deactivated, then the VVI AND VOO pacing can remain active 2. angina and chf must be recognized and optimized.
magnet placed over ICDs can cause what?	like pacemakers can lead to unpredictable reprogramming and discharge.
what are the ways to deactivate an icd?	1. with magnet 2. or requires reprogramming.
if ICDs failed shielding from magnet, what may happen?	icd can interpret electrocautery as dysrythmia and discharge.
what should be available intraoperatively with a patient with ICD?	1. external defribrillator.
what should be avoided with icd?	1. lithotripsy, unless they are deactivated 2. MRI 3. evoked potentials, peripheral nerve stimulators can interfer with icds and cause them to discharge inappropriately.
a patient with CRMD (cardiac rhythm management device) requires a pacemaker, what needs to be doen?	consult cardiologist preoperatively.
what are the preoperative evaluation of a patient with a CRMD?	1. FOCUS HISTORY 2. determine the type of CRMD - get card from patient, online database, cxray 3. identify function of crmd - cardiologist, pacemaker service providers. 4. ask if patient had symptoms from arrythmias.
what are the preoperative preparation of a patient with crmd?	1. availability of external pacer/defibrilator 2. if EMI to be used, determine if reprogramming, conversion to asynchronous mode, and or disabling rate responsive function is an advantage. 3. in general suspend antiarrythmia function 4. use bipolar.
how do you manage crmd dysfunction due to EMI FROM radiofrequency ablation?	avoid direct contact with pulse generator and leads. keep the radiofrequency current path as far as possible from the the crmd.
how do you manage crmd dysfunction due to EMI FROM lithotripsy? ?	1. if the lithotripsy triggers on the r wave, atrial pacing should be disabled 2. consult cardiologist 3. avoid the beam on or near the pulse generator.
how do you manage crmd dysfunction due to EMI FROM radiation therapy? ?	is generally safe, if the radiation field is in the generator field, the generator should be removed and placed elsewhere.
putting a magnet over a demand pacemaker will do what to it?	with convert the pacemaker from demand to asynchronious mode.
with regard to magnet use on medtronic AICD?	magnet should be avoided since pacing function for bradycardia is unaffected and defibrillation may be necessary.
with regard to magnet use on medtronic pacemakers?	will convert medtronic pacemakers to asynchronious mode but depends upon patient's intrinsic, underlying rate and rhythm probably requiring a cardiologist.
with regard to boston scientific pacemakers, placing a magnet will allow?	when magnet is used, the boston scientific is programmed to switch to 1. asynchroneous mode, do nothing mode, e-gram mode.
the chief advantage for the asynchroneous mode is to ?	check for battery life over the telephone by provider.
the presence of electromagnetic interference is an indication to do what to pacemakers?	asynchroneous mode.
what is the use of the 'do nothing mode' of boston scientific pacers?	setting of strong magnetic fields such as in industrial settings where large magnets are used.
what is the use of the boston scientific of store e-gram mode/	when wanting to rule out if the paceer is malfunctioning such as when patient feels palpitations or when pacer is felt not to function properly, patient can change it by themselves to this mode.
bottom line for boston scientific pacers?	a cardiologist should make recommendations, and not advisable to routinely convert pacers to asynchroneous mode with a magnet.
what recommendations are made to electrocautery when patients are with pacers?	1. short bursts, long pauses 2. low current 3. return pad and bovie as far away from generator pulse.
patient in preop area has pacemaker. the heart rate is currently instrinsic and over the pacer rate, how do you check if the pacer still is functioning?	do vasalva that will lower patients heart rate and determine if the pacer will capture.
how do you inhibit myopotentials from triggering pacers?	use muscle relaxants, avoid fasciculation from succs, avoid shivering.
what disease/pathologic process may cause a generator pulse pacer failure to reach treshold? what can you do?	MI, hypoxia, acidosis and scar tissues. may increase output from the generator to re-establish capture
pacemaker electrodes when placed in atrium, ventricle will create what on ekg?	if electrodes in atrium will create p waves. if electrodes in ventricle will create LBBB if in right ventricle, and RBBB if in left ventricle.

"Know" box contains:
Time elapsed:
Retries:

Question

Question

Question

pacemakers and AICD