DOCSLIB.ORG

Implanted Cardiac Pacemaker and Defibrillator Management Algorithm

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Implanted Cardiac Pacemaker and Defibrillator Management Algorithm Implanted Cardiac Pacemaker and Defibrillator Management Page 1 of 8 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. INITIAL EVALUATION ● Therapy OFF Yes ● Asynchronous Implantable ICD pacing mode ● Post-operative check cardioverter pacing prior to leaving a 5 defibrillator dependent? monitored area 4 Surgery or (ICD) No Therapy OFF ● Turn therapy ON endoscopy with ● Check pacing mode electrosurgery Asynchronous above the waist3 Yes pacing mode4 Pacemaker Pacemaker All patients need to dependent? follow-up with their No Consider post-op check4,5 physician All patients with an implantable cardiac ICD pacing device and scheduled for Place magnet6 for ICD dependent or procedure or therapeutic Surgery or temporary Therapy OFF non-dependent Postoperative check can radiation are to be seen at procedure with occur up to 30 days the Cardiopulmonary electrosurgery 6 after surgery Center1,2 below the waist3,5 Pacemaker Consider magnet for Pacemaker dependent or temporary asynchronous non-dependent pacing mode Central line placement See Page 2 Therapeutic radiation See Page 3 MRI See Page 4 Patients with Do Not Resuscitate (DNR) status See Page 5 1 3 Device check not needed if completed within the last 3 months and with documented NORMAL battery, impedances, and pacing safety Abdominal implants: If surgery between thorax and pelvis, refer to above the waist; if outside margins. Device to be rechecked when transitioning from one treatment to another (i.e., radiation, surgery). After 4:30 PM, weekends, and thorax and pelvis, refer to below the waist 4 holidays, cardiology service on-call can be contacted for emergency device checks. Follow Cardiac Device (Pacemaker/ICD) clinic recommendations note 2 5 Recommend all surgical procedures to be scheduled early in the morning Refer to Appendix A for Conditions Under Which Postoperative Interrogation is Not Necessary 6 Pacing dependent or surgery above the waist: Recommend scheduling surgery in main operating room Refer to Appendix B for Magnet Application Pacing non-dependent and surgery below the waist: Recommend scheduling surgery in either main or ACB operating room Department of Clinical Effectiveness V5 rev Approved by the Executive Committee of the Medical Staff on 06/25/2019 Implanted Cardiac Pacemaker and Defibrillator Management Page 2 of 8 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. CENTRAL LINE/PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) PLACEMENT PICC Proceed with procedure as clinically indicated1 Patient presents for CVC/PICC placement or exchange1 Note: Avoid placement of CVC/PICC Arrangements33 must be completed by direct communication between on the same side of cardiac device ICD Infusion Therapy Team and Cardiac Device (Pacemaker/ICD) clinic for intra-procedure monitoring CVC Yes Pacemaker Pacemaker dependent? No Proceed with procedure as clinically indicated CVC = central venous catheter PICC = peripherally inserted central catheter 1 Special circumstance: If ICD or pacemaker was implanted less than 3 months prior, procedure should be performed under fluoroscopy or in the Cardiac Catheterization Lab Department of Clinical Effectiveness V5 rev Approved by the Executive Committee of the Medical Staff on 06/25/2019 Implanted Cardiac Pacemaker and Defibrillator Management Page 3 of 8 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. THERAPEUTIC RADIATION PRIOR TO START OF RADIATION THERAPY Multidisciplinary conference: clinician to clinician communication) to discuss Refer to Cardiac At completion of Cardiac Yes treatment plans along with Device Management radiation treatment, Patient to be Device High risk other options plan in electronic Pacemaker Start radiation schedule patient scheduled for (Pacemaker/ device health record (EHR) or ICD treatment2 with Cardiology for radiation treatment ICD) clinic exposure? and schedule follow- final pacemaker/ consult1 Treatment plan per Radiation up as clinically No ICD assessment Oncology Team (morning indicated radiation treatment appointment recommended) 1 Radiation dose specification documented in clinic note is recommended prior to Cardiac Device (Pacemaker/ICD) clinic consult 2 Start radiation treatment in accordance with Division of Radiation Oncology Electronic Medical Device Policy Department of Clinical Effectiveness V5 rev Approved by the Executive Committee of the Medical Staff on 06/25/2019 Implanted Cardiac Pacemaker and Defibrillator Management Page 4 of 8 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. MRI PRIOR TO DURING MRI1 POST MRI1 SCHEDULING MRI Follow-up less ● Monitors applied: ● MRI protocoled than or equal to ○ Cardiac monitoring ● CIED checked for implanted 3 months or as devices by DI ○ Pulse oximetry ● Reprogram device Cardiology to Yes noted in the 2 ○ Blood pressure back to original collaborate with ● Consent patient , Cardiac Device MRI ● Program device as settings MRI-conditional Diagnostic Imaging if not previously Management approved and obtained indicated device (DI) faculty scheduled? note in the EHR regarding clinical Consult to indication of MRI No Cardiac Device (Pacemaker/ ICD) clinic noting patient Pacing non-dependent to be scheduled Yes for MRI and ● Electrophysiologist has a CIED to notify primary MRI-non- Electrophysiologist team and DI that Pacing to discuss risks and MRI patient cannot conditional No device dependent benefits of study approved? proceed with MRI 3 with patient ● DI to recommend alternative imaging study ● Cardiac Device clinic to notify primary team, DI and ● Abandoned lead electrophysiologist that patient cannot proceed with MRI ● Epicardial lead ● DI to recommend alternative imaging study CIED = cardiovascular implantable electronic device 1 There will be an appropriate, qualified and credentialed clinician to monitor patient during procedure 2 Patient needs two consents: one for MRI study and one for MRI with CIED 3 Ensure appointment is scheduled for discussion Department of Clinical Effectiveness V5 rev Approved by the Executive Committee of the Medical Staff on 06/25/2019 Implanted Cardiac Pacemaker and Defibrillator Management Page 5 of 8 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. PATIENTS WITH DO NOT RESUSCITATE (DNR) STATUS ● It is recommended to turn OFF shock therapy ● An order must be placed by the physician to turn OFF the shock therapy ICD ○ Contact Cardiac Device (Pacemaker/ICD) clinic during business hours ○ Notify manufacturer representative after 5 PM and weekends2 Advanced care planning1 has been established. Patient is DNR status Continue advanced care plan with an implanted cardiac device. Pacemaker No need for any intervention 1 The advanced care planning discussion with the patient/family member should clearly include and document whether or not shock therapy will be turned OFF. 2 Manufacturer’s information may be obtained in the following manner: ● Cardiac Device (Pacemaker/ICD) clinic progress note ● Patient/Family member has manufacturer’s card Department of Clinical Effectiveness V5 rev Approved by the Executive Committee of the Medical Staff on 06/25/2019 Implanted Cardiac Pacemaker and Defibrillator Management Page 6 of 8 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,
Load more

Recommended publications
  • 16 the Heart
    Physiology Unit 3 CARDIOVASCULAR PHYSIOLOGY: THE HEART Cardiac Muscle • Conducting system – Pacemaker cells – 1% of cells make up the conducting system – Specialized group of cells which initiate the electrical current which is then conducted throughout the heart • Myocardial cells (cardiomyocytes) • Autonomic Innervation – Heart Rate • Sympathetic and Parasympathetic regulation • �1 receptors (ADRB1), M-ACh receptors – Contractility • Sympathetic stimulus • Effects on stroke volume (SV) Electrical Synapse • Impulses travel from cell to cell • Gap junctions – Adjacent cells electrically coupled through a channel • Examples – Smooth and cardiac muscles, brain, and glial cells. Conducting System of the Heart • SA node is the pacemaker of the heart – Establishes heart rate – ANS regulation • Conduction Sequence: – SA node depolarizes – Atria depolarize – AV node depolarizes • Then a 0.1 sec delay – Bundle of His depolarizes – R/L bundle branches depolarize – Purkinje fibers depolarize Sinus Rhythm: – Ventricles depolarize Heartbeat Dance Conduction Sequence Electrical Events of the Heart • Electrocardiogram (ECG) – Measures the currents generated in the ECF by the changes in many cardiac cells • P wave – Atrial depolarization • QRS complex – Ventricular depolarization – Atrial repolarization • T wave – Ventricular repolarization • U Wave – Not always present – Repolarization of the Purkinje fibers AP in Myocardial Cells • Plateau Phase – Membrane remains depolarized – L-type Ca2+ channels – “Long opening” calcium channels – Voltage gated
    [Show full text]
  • Medicare National Coverage Determinations Manual, Part 1
    Medicare National Coverage Determinations Manual Chapter 1, Part 1 (Sections 10 – 80.12) Coverage Determinations Table of Contents (Rev. 10838, 06-08-21) Transmittals for Chapter 1, Part 1 Foreword - Purpose for National Coverage Determinations (NCD) Manual 10 - Anesthesia and Pain Management 10.1 - Use of Visual Tests Prior to and General Anesthesia During Cataract Surgery 10.2 - Transcutaneous Electrical Nerve Stimulation (TENS) for Acute Post- Operative Pain 10.3 - Inpatient Hospital Pain Rehabilitation Programs 10.4 - Outpatient Hospital Pain Rehabilitation Programs 10.5 - Autogenous Epidural Blood Graft 10.6 - Anesthesia in Cardiac Pacemaker Surgery 20 - Cardiovascular System 20.1 - Vertebral Artery Surgery 20.2 - Extracranial - Intracranial (EC-IC) Arterial Bypass Surgery 20.3 - Thoracic Duct Drainage (TDD) in Renal Transplants 20.4 – Implantable Cardioverter Defibrillators (ICDs) 20.5 - Extracorporeal Immunoadsorption (ECI) Using Protein A Columns 20.6 - Transmyocardial Revascularization (TMR) 20.7 - Percutaneous Transluminal Angioplasty (PTA) (Various Effective Dates Below) 20.8 - Cardiac Pacemakers (Various Effective Dates Below) 20.8.1 - Cardiac Pacemaker Evaluation Services 20.8.1.1 - Transtelephonic Monitoring of Cardiac Pacemakers 20.8.2 - Self-Contained Pacemaker Monitors 20.8.3 – Single Chamber and Dual Chamber Permanent Cardiac Pacemakers 20.8.4 Leadless Pacemakers 20.9 - Artificial Hearts And Related Devices – (Various Effective Dates Below) 20.9.1 - Ventricular Assist Devices (Various Effective Dates Below) 20.10 - Cardiac
    [Show full text]
  • Atrioventricular Conduction in Patients with Clinical Indications for Transvenous Cardiac Pacing1
    British Heart Journal, 1975, 37, 583-592. Atrioventricular conduction in patients with clinical indications for transvenous cardiac pacing1 Stafford I. Cohen, L. Kent Smith, Julian M. Aoresty, Panagiotis Voukydis, and Eugene Morkin From the Cardiac Unit, Department of Medicine, Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A. Eighty patients with clinical indications for cardiac pacing had atrioventricular conduction analysed by His bundle study. The indicationsfor cardiac pacing included high grade atrioventricular block, sick sinus node syndrome without tachycardia, bradycardia-tachycardia syndrome, unstable bilateral bundle-branch block, and uncontrolled ventricular irritability. Complete heart block, Wenckebach block (Mobitz I), and 2:i block were notedproximal and distal to the His bundle. Mobitz II block only occurred distal to the His bundle. Ofspecial interest were the high incidence ofdistal conduction abnormalities by His bundle analysis (40/80, 5o%), the re-establishment ofnormal atrio- ventricular conduction in acutely ill patients with recent evidence of heart block, and the high incidence of intraventricular conduction disturbances on standard electrocardiogram (48/8o, 60%). Intensive study of atrioventricular conduction by occurring electrophysiological data in this large His bundle analysis has been performed in a variety group of patients in clinical need of pacemakers of patient populations. In many instances studies constitutes the substance of this report. The data were electively undertaken in patients who had should be representative of the cardiac conduction never been threatened by a compromising cardiac abnormalities which present in a general hospital. arrhythmia. In addition, abnormalities of atrio- ventricular conduction were frequently achieved by Subjects and methods pacemaker-induced acceleration of the atrial rate.
    [Show full text]
  • The Miniaturization of Cardiac Implantable Electronic Devices: Advances in Diagnostic and Therapeutic Modalities
    micromachines Review The Miniaturization of Cardiac Implantable Electronic Devices: Advances in Diagnostic and Therapeutic Modalities Richard G. Trohman *, Henry D. Huang and Parikshit S. Sharma Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA; [email protected] (H.D.H.); [email protected] (P.S.S.) * Correspondence: [email protected]; Tel.: +1-312-942-2887 Received: 26 August 2019; Accepted: 17 September 2019; Published: 21 September 2019 Abstract: The Fourth Industrial Revolution, characterized by an unprecedented fusion of technologies that is blurring the lines between the physical, digital, and biological spheres, continues the trend to manufacture ever smaller mechanical, optical and electronic products and devices. In this manuscript, we outline the way cardiac implantable electronic devices (CIEDs) have evolved into remarkably smaller units with greatly enhanced applicability and capabilities. Keywords: implantable cardioverter defibrillators; cardiac pacing; cardiac resynchronization therapy; implantable heart failure sensor; implantable loop recorder 1. Introduction The Fourth Industrial Revolution [1], characterized by an unprecedented fusion of technologies that is blurring the lines between the physical, digital, and biological spheres, continues the trend to manufacture ever smaller mechanical, optical and electronic products and devices [2]. In this manuscript, we outline the way cardiac implantable electronic devices (CIEDs) have evolved into remarkably smaller units with greatly enhanced applicability and capabilities. 2. Prevention of Sudden Death The current annual incidence of sudden cardiac death in the United States is in the range of 180,000 to 450,000 per year [3,4]. Although the prevalence of malignant ventricular arrhythmias as the etiology has declined, they remain the most common cause of cardiac arrest [3].
    [Show full text]
  • An Interesting Case of Acute Asymptomatic Lead Perforation of a Permanent Cardiac Pacemaker
    Open Access Case Report DOI: 10.7759/cureus.13334 An Interesting Case of Acute Asymptomatic Lead Perforation of a Permanent Cardiac Pacemaker Anunay Gupta 1 , Sourabh Agstam 1 , Tushar Agarwal 1 , Sunil Verma 2 1. Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND 2. Cardiology, All India Institute of Medical Sciences, New Delhi, IND Corresponding author: Sunil Verma, [email protected] Abstract Acute complications of pacemaker implantation such as lead dislodgement, pneumothorax, and myocardial perforation are not uncommon. Management of these usually requires reintervention. We herein describe lead perforation after a single chamber pacemaker implantation, which was successfully managed conservatively. This case underscores that vigilant monitoring post lead perforation can avoid a redo procedure. Categories: Cardiac/Thoracic/Vascular Surgery, Cardiology, Radiology Keywords: impending pericardial effusion, pacemaker lead perforation, pacemaker lead displacement, pacemaker complication Introduction Acute complications such as lead dislodgement, pneumothorax, and myocardial perforation are not uncommon after pacemaker implantation. Lead perforation can be either early or late, and lead can perforate through the myocardium, into the epicardial space, pericardium, or chest wall [1]. Such perforations can sometimes be clinically occult and not accompanied by symptoms such as pain or pericardial effusion [2]. A chest X-ray in two different views is useful in demonstrating perforation but is limited by its inability to differentiate between the ventricular cavity, myocardium, and pericardium. A cardiac computed tomography (CT) is more reliable for lead tip identification. Such a case is usually managed by repositioning the leads at the desired position, at the risk of pericardial effusion, infection, and prolonged admission.
    [Show full text]
  • Cardiac Pacemaker
    Thorax: first published as 10.1136/thx.25.3.267 on 1 May 1970. Downloaded from Thorax (1970), 25, 267. Long-term evaluation of the General Electric cardiac pacemaker DONALD R. KAHN, MARVIN M. KIRSH, SATHAPORN VATHAYANON, PARK W. WILLIS, III, JOSEPH A. WALTON, KAREN McINTOSH, PAULINE W. FERGUSON, and HERBERT SLOAN Department of Surgeir and Medicine, University of Michigan Medical Center, Ann Arbor, MI 48104 A review of General Electric (G.E.) electronic cardiac pacemakers for symptomatic complete A-V heart 'block in two sequential three-year periods at the University of Michigan Medical Center indicates that there has been no increase in the useful life of these units. With G.E. epicardiall pacemakers failure occurred after an average of 12 months. In the early years the major cause of failure was wire breakage, and the later major cause was battery exhaustion or component failure. Exit block was a major complication. There was no improvement when G.E. catheter pacemakers were used instead of the epicardial type. The Medtronic catheter pace- makers lasted longer, with fewer battery and component failures and no instances of exit block. Although infection was more common with Medtronic pacemakers, secondary to erosion of the power unit or the catheter through the skin, it may be that this complication could be eliminated by locating the battery box beneath the latissimus dorsi muscle in the axilla and by careful catheter placement to avoid pressure necrosis and subsequent cutaneous perforation. http://thorax.bmj.com/ The treatment of complete atrioventricular heart pacemaker has been improved in design and con- block by the operative implantation of electronic struction enough to improve its function in the cardiac pacemakers has prolonged the life of many clinical setting.
    [Show full text]
  • Mechanisms Underlying the Cardiac Pacemaker: the Role of SK4 Calcium-Activated Potassium Channels
    npg Acta Pharmacologica Sinica (2016) 37: 82–97 © 2016 CPS and SIMM All rights reserved 1671-4083/16 www.nature.com/aps Review Mechanisms underlying the cardiac pacemaker: the role of SK4 calcium-activated potassium channels David WEISBROD, Shiraz Haron KHUN, Hanna BUENO, Asher PERETZ, Bernard ATTALI* Department of Physiology & Pharmacology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel The proper expression and function of the cardiac pacemaker is a critical feature of heart physiology. The sinoatrial node (SAN) in human right atrium generates an electrical stimulation approximately 70 times per minute, which propagates from a conductive network to the myocardium leading to chamber contractions during the systoles. Although the SAN and other nodal conductive structures were identified more than a century ago, the mechanisms involved in the generation of cardiac automaticity remain highly debated. In this short review, we survey the current data related to the development of the human cardiac conduction system and the various mechanisms that have been proposed to underlie the pacemaker activity. We also present the human embryonic stem cell- derived cardiomyocyte system, which is used as a model for studying the pacemaker. Finally, we describe our latest characterization of the previously unrecognized role of the SK4 Ca2+-activated K+ channel conductance in pacemaker cells. By exquisitely balancing the inward currents during the diastolic depolarization, the SK4 channels appear to play a crucial role in human cardiac automaticity. Keywords: cardiac pacemaker; sinoatrial node; SK4 K+ channel; Ca2+ clock model; voltage clock model Acta Pharmacologica Sinica (2016) 37: 82−97; doi: 10.1038/aps.2015.135 Introduction studying the pacemaker, and the most recent characterization Normal cardiac function depends on the adequate timing of of the previously unrecognized role of the SK4 Ca2+-activated excitation and contraction in the various regions of the heart K+ channel conductance in pacemaker cells.
    [Show full text]
  • Symbiotic Cardiac Pacemaker
    ARTICLE https://doi.org/10.1038/s41467-019-09851-1 OPEN Symbiotic cardiac pacemaker Han Ouyang 1,2,6, Zhuo Liu1,3,6, Ning Li4,6, Bojing Shi1,3,6, Yang Zou1,2, Feng Xie4,YeMa4, Zhe Li1,2,HuLi1,3, Qiang Zheng 1,2, Xuecheng Qu1,2, Yubo Fan3, Zhong Lin Wang 1,2,5, Hao Zhang1,4 & Zhou Li 1,2 Self-powered implantable medical electronic devices that harvest biomechanical energy from cardiac motion, respiratory movement and blood flow are part of a paradigm shift that is on the horizon. Here, we demonstrate a fully implanted symbiotic pacemaker based on an implantable triboelectric nanogenerator, which achieves energy harvesting and storage as 1234567890():,; well as cardiac pacing on a large-animal scale. The symbiotic pacemaker successfully corrects sinus arrhythmia and prevents deterioration. The open circuit voltage of an implantable triboelectric nanogenerator reaches up to 65.2 V. The energy harvested from each cardiac motion cycle is 0.495 μJ, which is higher than the required endocardial pacing threshold energy (0.377 μJ). Implantable triboelectric nanogenerators for implantable medical devices offer advantages of excellent output performance, high power density, and good durability, and are expected to find application in fields of treatment and diagnosis as in vivo symbiotic bioelectronics. 1 CAS Center for Excellence in Nanoscience, Beijing Key Laboratory of Micro-Nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, 100083 Beijing, China. 2 School of Nanoscience and Technology, University of Chinese Academy of Sciences, 100049 Beijing, China. 3 Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100083 Beijing, China.
    [Show full text]
  • CMS Manual System
    Department of Health & CMS Manual System Human Services (DHHS) Pub 100-03 Medicare National Coverage Centers for Medicare & Determinations Medicaid Services (CMS) Transmittal 173 Date: September 4, 2014 Change Request 8506 Transmittal 159, dated February 5, 2014, is being rescinded and replaced by Transmittal 173, dated September 4, 2014 to change the effective and implementation dates for ICD-10. All other information remains the same. SUBJECT: Pub 100-03, Chapter 1, language-only update I. SUMMARY OF CHANGES: This Change Request (CR) contains language-only changes for updating all four Parts of Pub. 100-03, Chapter 1, for conversion from ICD-9 to ICD-10, conversion from ASC X12 version 4010 to version 5010, conversion of former contractor types to Medicare Administrative Contractors (MACs), and for other miscellaneous updates. EFFECTIVE DATE: Upon Implementation of ICD-10 IMPLEMENTATION DATE: Upon Implementation of ICD 10 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row. R/N/D CHAPTER / SECTION / SUBSECTION / TITLE R 1/Table of Contents R 1/ Foreword – Purpose for National Coverage Determinations (NCD) Manual R 1/10.1/ Use of Visual Tests Prior to and
    [Show full text]
  • Thorax-Heart-Blood-Supply-Innervation.Pdf
    Right coronary artery • Originates from the right aortic sinus of the ascending aorta. Branches: • Atrial branches sinu-atrial nodal branch, • Ventricular branches • Right marginal branch arises at the inferior margin of the heart and continues along this border toward the apex of the heart; • Posterior interventricular branch- lies in the posterior interventricular sulcus. The right coronary artery supplies • right atrium and right ventricle, • sinu-atrial and atrioventricular nodes, • the interatrial septum, • a part of the left atrium, • the posteroinferior one-third of the interventricular septum, • a part of the posterior part of the left ventricle. Left coronary artery • from the left aortic sinus of the ascending aorta. The artery divides into its two terminal branches: • Anterior interventricular branch (left anterior descending artery- LAD), descends obliquely toward the apex of the heart in the anterior interventricular sulcus, one or two large diagonal branches may arise and descend diagonally across the anterior surface of the left ventricle; • Circumflex branch, which courses in the coronary sulcus and onto the diaphragmatic surface of the heart and usually ends before reaching the posterior interventricular sulcus-a large branch, the left marginal artery, usually arises from it and continues across the rounded obtuse margin of the heart. Coronary distribution Coronary anastomosis Applied Anatomy • Myocardial infarction Occlusion of a major coronary artery leads to an inadequate oxygenation of an area of myocardium and cell death. The severity depends on: size and location of the artery Complete or partial blockage (angina) • Coronary angioplasty • Coronary artery bypass grafting Cardiac veins The coronary sinus receives four major tributaries: • Great cardiac vein begins at the apex of the heart.
    [Show full text]
  • World's Smallest and Lightest Leadless Pacemaker MICRA Implanted At
    Press Release For Immediate Publication World’s smallest and lightest leadless pacemaker MICRA implanted at Fortis Malar Hospital Chennai, 22nd January 2019: Doctors at Fortis Malar Hospital successfully implanted world’s smallest and lightest leadless pacemaker MICRA on a 31-year lady here recently. The patient was suffering from complex congenital heart disease and altered cardiovascular anatomy. The challenging procedure was conducted by a team of expert doctors led by Dr E Babu, Consultant Heart Failure & Interventional Cardiologist, Fortis Malar Hospital, Chennai. Commenting on the procedure Dr E Babu, said “This procedure was particularly challenging due to the altered anatomy and septal defects. The uniqueness of this case is MICRA catheter has been manipulated via transfemoral approach and deployed successfully in RV septum in this underweight patient with complex congenital heart disease.” The patient was diagnosed with complex cyanotic congenital heart disease (complete atrioventricular canal defect with Eisenmenger syndrome), and later developed atrial tachyarrhythmiaand complete heart block with low ventricular rate. After discussion with Dr K R Balakrishnan, Director of Cardiac Sciences and Chief Cardiothoracic & Transplant Surgeon at Fortis Malar Hospital, she was deemed not suitable for corrective surgery and was advised single chamber permanent pacemaker implantation. Eventually MICRA leadless pacemaker was decided for this patient. Dr E Babu added “The function of a pacemaker is to increase the heart rate when it is low. Conventional pacemaker has to two parts namely the pulse generator (generator) and the lead. This pulse generator is implanted beneath the skin in upper chest wall through a mini surgical procedure and a long lead connects it to heart.
    [Show full text]
  • Early Detection of Perforation of the Right Ventricle by a Permanent Pacemaker Lead
    OriginalCASE Article REPORT ISSN 1738-5520 Korean Circulation J 2007;37:453-457 ⓒ 2007, The Korean Society of Circulation Early Detection of Perforation of the Right Ventricle by a Permanent Pacemaker Lead Hye Kyung Park, MD, Hyo Seung Ahn, MD, Ban Suck Lee, MD, Hye Jin Won, MD, Young Sup Byun, MD, Choong Won Goh, MD, Byung Ok Kim, MD, Kun Joo Rhee, MD and Byoung Kwon Lee, MD Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University Medical College, Seoul, Korea ABSTRACT Ventricular perforation is a rare complication of permanent cardiac pacemaker implantation. We report here on a 68-year-old woman with a dual chamber permanent pacemaker that had been implanted one month earlier, and she suffered cardiac perforation from the pacemaker lead. Frequent follow-up via12-lead surface electrocardiography and chest radiography and the proper work-up for pacemaker implantation are needed for detecting rare compli- cations after pacemaker implantation. (Korean Circulation J 2007;37:453-457) KEY WORDS：Cardiac pacemaker；Complications. Introduction p wave and the longest pause was 3.45 sec(Fig. 1A, B). Therefore, we diagnosed her with sick sinus syndrome Myocardial perforation is a rare complication follo- and she underwent implantation of a dual chamber per- wing pacemaker implantation with using contemporary manent pacemaker(Medtronic Kappa KD903, USA) for leads.1-3) Patients with myocardial perforation that’s re- treating her sick sinus syndrome. Active fixation lead lated to the pacemaker electrodes may present with va- (Medtronic 4068, USA) and passive fixation lead(Med- rious symptoms, from being asymptomatic to displaying tronic 4092, USA) were used for the atrial and ventri- cardiac tamponade.
    [Show full text]