CICM SAQ 2010.2 Q15

Questions

The following questions refer to implantable cardiac pacemakers and implantable cardiac defibrillators.

  • a) What is the effect of applying a magnet to these devices?
  • b) What information can you gain from a chest X-Ray in a patient with an implantable cardiac device?
  • c) What are the advantages of DDD pacing compared to VVI pacing?
  • d) List 4 benefits of cardiac resynchronisation therapy.

Answers

Answer and interpretation

a) What is the effect of applying a magnet to these devices?

  • CD: it turns off antiarrhythmic programme but has no affect on backup pacemaker
  • Pacemaker: It defaults to asynchronous mode or a fixed rate. Rate depends on battery life.

b) What information can you gain from a chest X-Ray in a patient with an implantable cardiac device?

  • Single v dual chamber
  • Biventricular or left ventricular (cardiac resynchronisation) Lead displacement or injury
  • Number of devices present

c) What are the advantages of DDD pacing compared to VVI pacing?

  • AV synchronisation maintained
  • Avoids pacemaker syndrome
  • Reduced incidence of AF
  • Possible decreased thrombotic events

d) List 4 benefits of cardiac resynchronisation therapy.

  • improved LVEF, CO and haemodynamics improved exercise tolerance
  • decreased NYHA class
  • decreased hospitilisation
  • improved quality of life
Exams LITFL ACEM 700

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

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