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List some indications for temporary pacemaker.
- Preview of high degree conduction block
- Symptomatic Brady Cardia
- Left Bundle Branch Block
- Acetylcholine (ACH) studies
- Acute myocardial Infarction w/Tri or Bifascicular block
- Transluminal Alcohol Septal Artery Ablation for HOCM
What medication maybe used for Brady Cardia
What are some ways a temporary tranvenous pacemaker can be inserted?
- Internal Jugular vein (IJV)
- Subclavian vein
- Brachial vein
- Femoral vein (first choice)
Where is the easiest place to access a vein located?
Next to arterial access site. Never in the radial.
How is pacing acomplished in the Cath Lab?
5 or 6 French balloon tipped catheter
What is the goal of using a balloon tipped pacing catheter?
When inflated, there is a reduced risk of peforation of thin right ventricular wall or apex
What is demand mode?
The pacemaker paces when intrinsic Heart Rate drops below level set by demand rate
When is demand mode useful?
Vasovagul reaction or AV block with heart rate of 40 beats/min
What is Fixed Mode?
The pacer works continuously at a rate set on generator
What is pacemaker threshold?
The lowest milliamperage at which pacemaker will pace.
When should you determine threshold?
After the pace catheter is in place.
What is first step in determining threshold?
Set pacer mode to fix and at a higher rate than intrinsic rate.
When determing threshold, what should the milliamps be set to?
What determines the threshold?
Lower mA 1mA intervals. When pacing fails, that is the threshold.
How much more should you set the threshold in demand rate?
3 or 4 times threshold.
List the complications of setting a pacemaker catheter?
- RV perforation
- Cardiac tamponade
- Related to venous access
What patient is most commonly receives complications of setting a pacemaking?
Patients on Anticoagulant therapy
What is an alertnerantive to invasive temporary pacing.
External non-invasive cardiac stimulations (transcutaneous pacing)
What are IABPs used for?
To increase perfusion, decrease myocardial work load, and decrease oxygen demand
What is an IABP also known as?
A counter pulsation device or cardiac assist device
Atrial contractions account for additional _______ of ventricular filling.
What 2 phases is ventricular systole divided into?
Isovolumetric and Ejection phase
What happens in isovolumetric contraction?
- Ventricles contract in response to electrical stimulation
- Ventricle pressure increases and closes AV valve
What happens in the ejection phase?
- Pressure in ventricles exceeds pressure/resistance in circulation
- Semilunar valves open at arotic notch
What are the 3 phases of ejection phase?
- Intial Phase
- Rapid Ejection
- Slow Ejection
Define ventricular preload.
Blood volum in ventricles just prior to valve closure
Majority of myocardial Oxygen consumption occurs during _________.
What is afterload?
Resistance in arterial circulation against which ventricle must pump and resulatant wall tension created during systole.
Where is the IABP inserted and how?
- The arota
- It can be done either surgically or percutaneously through the Femoral artery
Where is the ideal position when performing an IABP?
Distal to the left subclavian and superior to renal arteries.
An IABP is connected to a console and filled with _________?
During IABP, when is the balloon inflated? When is it deflated?
- Diastole (inflated)
- Systole (deflated)
What is an indication to use closure devices?
Closing and reducing time to hemostatis.
For patient with Femoral anterial puncture, what size sheath should be used?
8 French or smaller
List some possible adverse events when using closure devices.
- Bleeding or Hematoma (most common)
- AV Fistula
- Pseudo Aneurysm
- Allergic reaction
- Foreign Body Reaction
List some types of closure devices
Describe an angioseal and it's components.
Creates a mechanical seal by sandwhiching the arteriotomy btwn a bio-absorbable anchor and collagen sponge
How many days before the components of an angio seal dissolve?