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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
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What medication maybe used for Brady Cardia
Atropine
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What are some ways a temporary tranvenous pacemaker can be inserted?
- Internal Jugular vein (IJV)
- Subclavian vein
- Brachial vein
- Femoral vein (first choice)
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Where is the easiest place to access a vein located?
Next to arterial access site. Never in the radial.
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How is pacing acomplished in the Cath Lab?
5 or 6 French balloon tipped catheter
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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
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What is demand mode?
The pacemaker paces when intrinsic Heart Rate drops below level set by demand rate
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When is demand mode useful?
Vasovagul reaction or AV block with heart rate of 40 beats/min
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What is Fixed Mode?
The pacer works continuously at a rate set on generator
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What is pacemaker threshold?
The lowest milliamperage at which pacemaker will pace.
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When should you determine threshold?
After the pace catheter is in place.
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What is first step in determining threshold?
Set pacer mode to fix and at a higher rate than intrinsic rate.
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When determing threshold, what should the milliamps be set to?
5mA
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What determines the threshold?
Lower mA 1mA intervals. When pacing fails, that is the threshold.
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How much more should you set the threshold in demand rate?
3 or 4 times threshold.
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List the complications of setting a pacemaker catheter?
- RV perforation
- Cardiac tamponade
- Related to venous access
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What patient is most commonly receives complications of setting a pacemaking?
Patients on Anticoagulant therapy
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What is an alertnerantive to invasive temporary pacing.
External non-invasive cardiac stimulations (transcutaneous pacing)
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What are IABPs used for?
To increase perfusion, decrease myocardial work load, and decrease oxygen demand
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What is an IABP also known as?
A counter pulsation device or cardiac assist device
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Atrial contractions account for additional _______ of ventricular filling.
20-30%
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What 2 phases is ventricular systole divided into?
Isovolumetric and Ejection phase
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What happens in isovolumetric contraction?
- Ventricles contract in response to electrical stimulation
- Ventricle pressure increases and closes AV valve
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What happens in the ejection phase?
- Pressure in ventricles exceeds pressure/resistance in circulation
- Semilunar valves open at arotic notch
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What are the 3 phases of ejection phase?
- Intial Phase
- Rapid Ejection
- Slow Ejection
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Define ventricular preload.
Blood volum in ventricles just prior to valve closure
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Majority of myocardial Oxygen consumption occurs during _________.
Isovolumetric contraction
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What is afterload?
Resistance in arterial circulation against which ventricle must pump and resulatant wall tension created during systole.
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Where is the IABP inserted and how?
- The arota
- It can be done either surgically or percutaneously through the Femoral artery
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Where is the ideal position when performing an IABP?
Distal to the left subclavian and superior to renal arteries.
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An IABP is connected to a console and filled with _________?
Helium
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During IABP, when is the balloon inflated? When is it deflated?
- Diastole (inflated)
- Systole (deflated)
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What is an indication to use closure devices?
Closing and reducing time to hemostatis.
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For patient with Femoral anterial puncture, what size sheath should be used?
8 French or smaller
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List some possible adverse events when using closure devices.
- Bleeding or Hematoma (most common)
- AV Fistula
- Pseudo Aneurysm
- Infection
- Allergic reaction
- Foreign Body Reaction
- Inflammation
- Edema
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List some types of closure devices
- Angioseal
- Perclose
- Starclose
- Mynx
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Describe an angioseal and it's components.
Creates a mechanical seal by sandwhiching the arteriotomy btwn a bio-absorbable anchor and collagen sponge
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How many days before the components of an angio seal dissolve?
60-90 Days
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