the case.
a 66 year old male is referred to your ED with recurrent bouts of dizziness over the past 2-3 weeks. [Read more…]
pulling apart cases from the ED...
the case.
a 66 year old male is referred to your ED with recurrent bouts of dizziness over the past 2-3 weeks. [Read more…]
the case.
An 80 year old male is bought to your ED via ambulance following a syncopal episode. He reports sitting on a church pew, when he apparently collapsed without prior warning. According to bystanders he was unresponsive on the ground looking pale then ‘blue’. He was making some respiratory effort and eventually recovered without intervention.
By the time you examine him, he is alert and oriented (though, amnestic to the actual event). His pulse is 60, he is warm and perfused (with a BP of 138/66). There is no evidence of cardiac failure and his neurological exam is unremarkable. You do note a pacemaker box in his upper left chest and his CXR shows that this is a ‘dual-lead’ variety….
ECG.
Impression.
?Syncope secondary to complete heart block (whilst atrially paced)
– why didn’t his ventricular pacing kick in ??
– is there a pacemaker malfunction ??
??tachydysrhythmia
He is admitted to Coronary Care for telemetry whilst he awaits a pace-maker interrogation…..
In short, this case prompted some further reading on PPMs & AICDs, particularly the codings, the variety of settings available & how each functions to assist native cardiac activity (or lack thereof…..).
What’s in one … ??
What does it do … ??
Who gets it … ??
What do those codes mean … ??
Examples:
What about the magnet … ??
Magnet application (placed externally over the pulse generator in the chest wall) causes closure of a reed-switch within the pace-maker circuitry, converting the pacemaker to an asynchronous or fixed-rate pacing mode (set by the manufacturer), and the pacemaker is no longer inhibited by the patient’s intrinsic electrical activity.
the conclusion.
Well our fella’s pacemaker was interrogated a few hours later in the CCU.
MVP mode (a Medtronic program) is designed to reduce the risk of AF in patients with permanent pacemakers.