CCDS IBHRE Comprehensive Exam Prep
Latest Updated Graded A+ (Verified)
4 states of DDD pacing - ANSWER-AV, PV, AR, PR
a successful ablation of slow pathway in AVNRT is indicated by: - ANSWER-1. an
accelerated junctional rhythm with 1:1 VA conduction during the burn
2. an increase in refractoriness of the anterograde AV node
3. elimination or alteration in dual AV nodal physiology
AAD eliminates through the vascular endothelium, erythrocytes - ANSWER-adenosine
Action potential - ANSWER-5 phases, the cellular characteristics of depolarization and
repolarization
Action potential phase 0 - ANSWER-The depolarization phase
The rapid sodium channels are stimulated to open causing the resting transmembrane
from above -90mV to about 0mV
Action potential phase 1 - ANSWER-early repolarization
Action potential phase 2 - ANSWER-The plateau phase
mediated by the slow calcium channels essentially disrupts and delays the
repolarization started in phase 1 and prolonged the refractory period
Action potential phase 3 - ANSWER-the end of repolarization
Action potential phase 4 - ANSWER-the resting phase
ions leak back and forth between the membranes and cause a gradual increase in the
transmembrane potential
when the potential reaches the threshold voltage, the cell depolarizes.
This spontaneous depolarization is called automaticity
adaptive burst - ANSWER-starts as a percentage of the tachycardia cycle length
adding a subcutaneous patch to the defibrillation pathway would be expected to... -
ANSWER-lower the output impedance
the tilt would be expected to increase
adding flecainide in a chronic stable pacing system may... - ANSWER-increase capture
threshold
also other IC ADD or any type III agents including amiodarone or sotalol
,Advantages and disadvantages of ATP - ANSWER-advantage:
- minimal symptoms, immediate delivery of therapy
disadvantage:
- may need multiple burst, may accelerate the arrhythmia, prolonged high voltage
therapy
advantages of lithium/iodine cells battery - ANSWER-1. the self discharge rate is very
low, which gives the pacemaker a long shelf life
2. the voltage characteristics remain stable, allowing a clear delineation between
working voltage, recommended replacement time, and end of service
afterload - ANSWER-the tension produced by a chamber of the heart in order to
contract
pressure that heart has to generate in order to eject blood out of the chamber
Antitachycardia pacing - ANSWER-a sequence of pacing impulses faster than the
tachycardia rate in an attempt to terminate an arrhythmia
- placing the pacing lead close to reentry site may increase ATP effectiveness
AR interval - ANSWER-begins when the atrial escape interval (AEI) is allowed to "time
out" completely.
An atrial output occurs at the end of the AEI, the AV delay interval is started but is
interrupted by a sensed ventricular channel event(usually an intrinsic R wave)
Ashman's disease - ANSWER-occasional wide complex beats during atrial fibrillation
with a right bundle branch morphology are due to aberrant conduction
at what point does the threshold rise in tined leads? - ANSWER-2-3 days
atrial escape interval - ANSWER-the interval between a ventricular paced or sensed
event and the subsequent atrial output pulse
atrial septal defect - ANSWER-atrioventricular canal defect = endocardial cushion defect
= atrioventricular septal defect
one large valve allowing flow into the heart (instead of mitral and tricuspid)
commonly seen in children with down syndrome
autodecremental pacing - ANSWER-one needs to see multiple pacing episode, each of
which is occurring at a progressively faster rate
automatic interval - ANSWER-the interval between two consecutive pacing stimuli
occurring in the same chamber without an intervening sensed event in that same
chamber
, Automatic Mode Switching (AMS) - ANSWER-When an atrial rate exceeds a
predetermined value, the device switches from a tracking DDD mode to a nontracking
VVI mode
At rates between the upper tracking rate and the mode switch rate, the device will
exhibit pacemaker Wenkebach behavior until it reaches the 2:1 block point, it will then
begin 2:1 behavior
automaticity of the sinoatrial node is influenced by... - ANSWER-the autonomtic nervous
system
circulating catecholamines
central venous temperature
atrial stretch
AV delay interval - ANSWER-the period of time between the atrial output pulse and the
ventricular output pulse
maybe fixed or variable
atrial channel is refractory
AVID trial - ANSWER-largest trial but shortest, using antiarhythmics vs ICD , most
patients in AAD group receives amiodarone
patients with LVEF =35% survival was comparable, but for those with LVEF <35%
survival from all cause and arrhythmic death was superior in patients who received ICD
therapy
AVNRT - ANSWER-- AV node can be thought of as divided into two conduction
pathways
- premature impulse is blocked in the fast pathway
- impulse travels down the slow pathway
- impulse again reaches the fast pathway in retrograde fashion
- impulse then reenter the slow pathyway
battery capacity in Ah(Ampere Hours), total or usable capacity - ANSWER-Total battery
= capacity includes the unusable capacity and overestimates the usefulness of the cell
by about 10 percent
Usable capacity = takes into account the lithium cells are only usable for about 85 to
90% of their total capacity
Bipolar coaxial lead failure due to which type of insulation? - ANSWER-Pellethane 80A
insulation failure - Pacesetter 1016T and 1026T leads
compression by retention sutures over a thin anchoring sleeve
crush injury caused by lead entrapment by the scalenus muscle or costoclavicular
ligament
Bisping Coaxial lead - ANSWER-Bisping - an extendable/retractable helix type lead.
The helix or screw is active
Latest Updated Graded A+ (Verified)
4 states of DDD pacing - ANSWER-AV, PV, AR, PR
a successful ablation of slow pathway in AVNRT is indicated by: - ANSWER-1. an
accelerated junctional rhythm with 1:1 VA conduction during the burn
2. an increase in refractoriness of the anterograde AV node
3. elimination or alteration in dual AV nodal physiology
AAD eliminates through the vascular endothelium, erythrocytes - ANSWER-adenosine
Action potential - ANSWER-5 phases, the cellular characteristics of depolarization and
repolarization
Action potential phase 0 - ANSWER-The depolarization phase
The rapid sodium channels are stimulated to open causing the resting transmembrane
from above -90mV to about 0mV
Action potential phase 1 - ANSWER-early repolarization
Action potential phase 2 - ANSWER-The plateau phase
mediated by the slow calcium channels essentially disrupts and delays the
repolarization started in phase 1 and prolonged the refractory period
Action potential phase 3 - ANSWER-the end of repolarization
Action potential phase 4 - ANSWER-the resting phase
ions leak back and forth between the membranes and cause a gradual increase in the
transmembrane potential
when the potential reaches the threshold voltage, the cell depolarizes.
This spontaneous depolarization is called automaticity
adaptive burst - ANSWER-starts as a percentage of the tachycardia cycle length
adding a subcutaneous patch to the defibrillation pathway would be expected to... -
ANSWER-lower the output impedance
the tilt would be expected to increase
adding flecainide in a chronic stable pacing system may... - ANSWER-increase capture
threshold
also other IC ADD or any type III agents including amiodarone or sotalol
,Advantages and disadvantages of ATP - ANSWER-advantage:
- minimal symptoms, immediate delivery of therapy
disadvantage:
- may need multiple burst, may accelerate the arrhythmia, prolonged high voltage
therapy
advantages of lithium/iodine cells battery - ANSWER-1. the self discharge rate is very
low, which gives the pacemaker a long shelf life
2. the voltage characteristics remain stable, allowing a clear delineation between
working voltage, recommended replacement time, and end of service
afterload - ANSWER-the tension produced by a chamber of the heart in order to
contract
pressure that heart has to generate in order to eject blood out of the chamber
Antitachycardia pacing - ANSWER-a sequence of pacing impulses faster than the
tachycardia rate in an attempt to terminate an arrhythmia
- placing the pacing lead close to reentry site may increase ATP effectiveness
AR interval - ANSWER-begins when the atrial escape interval (AEI) is allowed to "time
out" completely.
An atrial output occurs at the end of the AEI, the AV delay interval is started but is
interrupted by a sensed ventricular channel event(usually an intrinsic R wave)
Ashman's disease - ANSWER-occasional wide complex beats during atrial fibrillation
with a right bundle branch morphology are due to aberrant conduction
at what point does the threshold rise in tined leads? - ANSWER-2-3 days
atrial escape interval - ANSWER-the interval between a ventricular paced or sensed
event and the subsequent atrial output pulse
atrial septal defect - ANSWER-atrioventricular canal defect = endocardial cushion defect
= atrioventricular septal defect
one large valve allowing flow into the heart (instead of mitral and tricuspid)
commonly seen in children with down syndrome
autodecremental pacing - ANSWER-one needs to see multiple pacing episode, each of
which is occurring at a progressively faster rate
automatic interval - ANSWER-the interval between two consecutive pacing stimuli
occurring in the same chamber without an intervening sensed event in that same
chamber
, Automatic Mode Switching (AMS) - ANSWER-When an atrial rate exceeds a
predetermined value, the device switches from a tracking DDD mode to a nontracking
VVI mode
At rates between the upper tracking rate and the mode switch rate, the device will
exhibit pacemaker Wenkebach behavior until it reaches the 2:1 block point, it will then
begin 2:1 behavior
automaticity of the sinoatrial node is influenced by... - ANSWER-the autonomtic nervous
system
circulating catecholamines
central venous temperature
atrial stretch
AV delay interval - ANSWER-the period of time between the atrial output pulse and the
ventricular output pulse
maybe fixed or variable
atrial channel is refractory
AVID trial - ANSWER-largest trial but shortest, using antiarhythmics vs ICD , most
patients in AAD group receives amiodarone
patients with LVEF =35% survival was comparable, but for those with LVEF <35%
survival from all cause and arrhythmic death was superior in patients who received ICD
therapy
AVNRT - ANSWER-- AV node can be thought of as divided into two conduction
pathways
- premature impulse is blocked in the fast pathway
- impulse travels down the slow pathway
- impulse again reaches the fast pathway in retrograde fashion
- impulse then reenter the slow pathyway
battery capacity in Ah(Ampere Hours), total or usable capacity - ANSWER-Total battery
= capacity includes the unusable capacity and overestimates the usefulness of the cell
by about 10 percent
Usable capacity = takes into account the lithium cells are only usable for about 85 to
90% of their total capacity
Bipolar coaxial lead failure due to which type of insulation? - ANSWER-Pellethane 80A
insulation failure - Pacesetter 1016T and 1026T leads
compression by retention sutures over a thin anchoring sleeve
crush injury caused by lead entrapment by the scalenus muscle or costoclavicular
ligament
Bisping Coaxial lead - ANSWER-Bisping - an extendable/retractable helix type lead.
The helix or screw is active
