Pacemakers Review Pt. 1

    NextPrevious

    Pacemakers Review Pt. 1

    The pursuit of mastery over cardiovascular emergencies demands a rough familiarity with implanted devices which includes why they get implanted in the first place (indications), how they work, how they malfunction, and how they affect the EKG., among other features. Today we’ll we’ll start with the basics of implanted pacemakers including indications, anatomy, and radiography.

    Generally speaking, patients are suitable for pacemaker implantation when they exhibit 1) symptomatic bradycardia or symptomatic chronotropic incompetence (i.e. inability to generate an age appropriate heart rate during exertion) 2) third degree AV block 3) Mobitz Type II second degree AV block 4) carotid sinus mediated recurrent syncope 5) sustained PAUSE-DEPENDENT ventricular tachycardia and 6) severe CHF i.e. with electromechanical ventricular dyssynchrony.

    Complications include infection, upper extremity venous thrombosis, hemothorax, pneumothorax, and pocket hematoma.

    pacemaker anatomy

    source: healthjade.com

    An external file that holds a picture, illustration, etc.
Object name is JCIS-4-74-g003.jpg

     

     

    A pacemaker consists of a pulse generator usually implanted subcutaneously usually in the left infraclavicular fossa with leads traversing the ipsilateral subclavian vein.  The typical “dual chamber” pacemaker will have one lead tip implanted in the right atrial appendage and a second tip in the right ventricular apex.  The above picture has a third lead traversing the coronary sinus for placement in the left ventricular wall (i.e. biventricular pacing).

    Note the white arrow pointing to the right atrial lead and the black arrowhead pointing to the right ventricular lead. Appropriate positioning of the generator in the left infraclavicular fossa can be compared with prior chest XR.

     

    That’s it for part 1.  In the next post we’ll cover pacemaker function and how to interpret their unique electrocardiographic morphologies.

     

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • ED Postpartum Hemorrhage

      So you’re in the ED and a G9P8 patient at 40w2d rolls in with contractions every 3 minutes. Before sending the patient upstairs you do a brief examination and you see this…   You deliverRead more

    • Lewis Leads & Invisible P’s

      You ever have a tough time visualizing P waves on EKGs? Have no fear, a Lewis Lead EKG might just be the thing you need! The Lewis Lead (aka S5) is a modified EKG obtained in a mannerRead more

    • Head Scratcher of a Head CT?

      Hey there guys and gals and welcome back to my channel! If you’re like me and TERRIBLE at reading your own imaging studies, settle in for a quick 20 minute run down for all thoseRead more

    • Central Line Troubleshooting. Beyond the Basics.

      Needle, wire, nick, dilate, catheter. Sounds simple right? However, simple doesn’t always mean easy. Placing a central line on a mannequin can be much easier than the 250lb ESRD patient with peripheral vascular disease andRead more

    • Narcan Overdose. Too Much of a Good Thing?

      What do smack, dragon, horse, salt, brown sugar, china white, and black pearl have in common? That’s right… they are all nicknames for heroin. We all know that Naloxone (Narcan) is a useful antidote inRead more

    • Health Information Exchange: Quest for the Omni-Chart.

      Have you ever opened a chart of a very sick or obtunded patient, only to find it completely blank? Of course you have…probably at some point today. The minor panic that having to find vitalRead more

    • Clinical Decision Support…your daily helper.

      Continuing with the theme of clinical informatics, today we will touch on the topic of Clinical Decision Support Systems (CDSS), or sometimes just called Clinical Decision Support (CDS). The basic premise of clinical decision supportRead more

    • What Is Clinical Informatics?

      If you loved the super sexy topic of cerumen impaction yesterday…Well, hold on to your socks, because today we will continue our rousing educational foray by tackling the riveting question: What is Clinical Informatics? ShallRead more

    NextPrevious