Deck 16: Pacemakers and Implanted Cardioverter-Defibrillators

Question 1

Artificial pacemakers are:

A) medical devices that deliver electrical impulses to the heart to stimulate a normal heartbeat.
B) used to maintain an adequate heart rate when the heart's own pacemaker cannot.
C) used when there is a block in the heart's electrical conduction system that slows the heart rate.
D) All of these.

Answer 1

All of these.

Question 2

An implantable defibrillator is a device that:

A) delivers electrical shocks to the heart in the presence of life-threatening ventricular tachycardia or ventricular fibrillation.
B) is external to the body and used to provide temporary treatment.
C) Is employed during open heart surgery when the surgical procedure causes bradycardia.
D) Is used to synchronize the heartbeat of the right and left ventricles.

Answer 2

delivers electrical shocks to the heart in the presence of life-threatening ventricular tachycardia or ventricular fibrillation.

Question 3

A permanent pacemaker is a medical device:

A) in which electrode pads are applied to the surface of the patient's chest.
B) in which an electrode is placed in contact with the ventricular epicardium.
C) that is external to the body and an electrode is fed through a vein into the right atrium or right ventricle.
D) Implanted in a surgically created pocket beneath the skin in the patient's chest just below the clavicle.

Answer 3

Implanted in a surgically created pocket beneath the skin in the patient's chest just below the clavicle.

Question 4

Pacemakers can be of tremendous clinical benefit in:

A) symptomatic bradycardia.
B) sick sinus syndrome.
C) atrial fibrillation with bradycardia.
D) All of these

Question 5

The pacemaker consists of:

A) a generator that consists of a power source, sensing amplifier, computer logic and output circuitry.
B) four lead wires that connect the device to the heart and carry the impulse to the myocardium.
C) a rechargeable battery.
D) a durable plastic casing.

Question 6

Match the following pacemaker components with the function they each perform:

-Output circuitry

A)Processes the electrical activity of the heart detected by the pacemaker electrodes
B)Brain of the pacemaker
C)Provides energy needed to operate pacemaker
D)Delivers the pacing impulse to the lead wire

Question 7

Match the following pacemaker components with the function they each perform:

-Sensing amplifier

A)Processes the electrical activity of the heart detected by the pacemaker electrodes
B)Brain of the pacemaker
C)Provides energy needed to operate pacemaker
D)Delivers the pacing impulse to the lead wire

Question 8

Match the following pacemaker components with the function they each perform:

-Computer logic

A)Processes the electrical activity of the heart detected by the pacemaker electrodes
B)Brain of the pacemaker
C)Provides energy needed to operate pacemaker
D)Delivers the pacing impulse to the lead wire

Question 9

Match the following pacemaker components with the function they each perform:

-Power source

A)Processes the electrical activity of the heart detected by the pacemaker electrodes
B)Brain of the pacemaker
C)Provides energy needed to operate pacemaker
D)Delivers the pacing impulse to the lead wire

Question 10

Pacemakers can be adjusted according to:

A) pacing mode.
B) output.
C) refractory period.
D) All of these

Question 11

The most widely used pacemaker mode is the:

A) fixed rate.
B) demand.
C) rate-responsive.
D) single chamber.

Question 12

In this mode the ventricle is paced and sensed. If spontaneous cardiac output is detected, then the device is inhibited.

A) DVI
B) VVI
C) VDD
D) DDD

Question 13

In this mode, the pacemaker paces and senses in the atrium, the ventricle, or both. On sensing activity in either chamber, the pacemaker inhibits pacing in that chamber. Or, on sensing atrial activity, the pacemaker may trigger ventricular pacing.

A) DVI
B) VVI
C) VDD
D) DDD

Question 14

Another type of pacemaker is the biventricular pacemaker. This pacemaker:

A) delivers cardiac resynchronization therapy.
B) paces both the right and left atria.
C) is used to defibrillate a heart that does not beat in synchrony, a common problem in patients with heart failure.
D) a and b

Question 15

A lead wire that is positioned in the atria produces a pacing spike and a:

A) wide QRS complex
B) wide P wave
C) normal looking P wave
D) a and b

Question 16

A lead wire that is positioned in the ventricle produces a pacing spike and a:

A) broad QRS complex
B) wide P wave
C) normal looking P wave
D) a and b

Question 17

With a dual-chamber pacemaker there will be a/an:

A) initial pacing spike followed by a P wave and second pacing spike followed by a broad QRS complex.
B) wide P wave and a broad QRS but not pacing spikes
C) initial pacing spike followed by a broad P wave and second pacing spike followed by a narrow QRS complex.
D) initial pacing spike followed by an inverted P wave and second pacing spike followed by a narrow QRS complex.

Question 18

Failure to sense can be recognized by

A) the presence of pacemaker spikes that are not followed by P waves or by broad QRS complexes.
B) an absence of pacemaker spikes in the presence of a heart rate that is slower than the rate set for the pacemaker.
C) ECG pacemaker spikes that fall where they shouldn't.
D) a tachycardia with a pacemaker spike preceding each QRS complex on the EGG.

Question 19

Oversensing can be recognized by

A) the presence of pacemaker spikes that are not followed by P waves or by broad QRS complexes.
B) an absence of pacemaker spikes in the presence of a heart rate that is slower than the rate set for the pacemaker.
C) ECG pacemaker spikes that fall where they shouldn't.
D) a tachycardia with a pacemaker spike preceding each QRS complex on the EGG.

Question 20

Pacemaker-mediated tachycardia can be recognized by

A) the presence of pacemaker spikes that are not followed by P waves or by broad QRS complexes.
B) an absence of pacemaker spikes in the presence of a heart rate that is slower than the rate set for the pacemaker.
C) ECG pacemaker spikes that fall where they shouldn't.
D) a fast heart rate with a pacemaker spike preceding each QRS complex on the EGG.

Question 21

An implantable cardioverter-defibrillator can be used to treat:

A) bradycardia.
B) complete AV heart block.
C) ventricular tachycardia and fibrillation.
D) All of these

Question 22

Some modern implantable devices have both a pacemaker and defibrillator combined into one unit.

Question 23

The basic function of pacemakers is to sense for normal heart activity, and if it does not occur, induce action potentials by passing depolarizing currents into a heart chamber, triggering a self-propagating wave of electrical depolarization.

Question 24

The more complex permanent pacemakers have the ability to sense and/or stimulate both the atrial and ventricular chambers.

Question 25

Pacemakers must be internally programmed via a surgical procedure.

Question 26

The ECG can be used to identify if a patient's pacemaker is properly working.

Question 27

The biventricular pacemaker employs three leads: one is placed in the right atrium, one is located in the right ventricle, and the last one is inserted through the coronary sinus to pace the free wall of the left ventricle.

Question 28

On the ECG, the firing of a permanent pacemaker and its movement down the lead wire appears as a narrow vertical line referred to as a pacing spike or pacing artifact.

Question 29

Pacemaker spikes appear in all 12 leads.

Question 30

The implantable cardioverter-defibrillator is capable of rate discrimination, rhythm discrimination, and morphology discrimination.