...Pacemaker Behavior’s Behavior s Prof Glikson, Sandra Schor-Wider Nadav Hayman Patient Case Description • This is a patient with SSS + PAF with a DDDR pacemaker . He did not tolerate MVP in the past so we turned it off. • He recently complains of palpitations of two types : • Sudden events of rate around115 • Rate about 80 , general weakness that reminds him of the sense of temporary VVI pacing during clinic visits • He was able to record both episodes • We programmed the AHR diagnostics to detect relatively slow tachycardias which were indeed recorded . Pacemaker setup •RAAVD – OFF •SEARCH AV – OFF •MS- OFF •ACM & VCM – ON •SINUS PEREFERENCE –ON SINUS ON Patient Holter strip – Baseline Rhythm Tachycardia (the faster type ) in Holter strip Sudden termination of the tachycardia Episodes of AHR From the Pacemaker Memory Continued Episodes of AHR From the Pacemaker Memory – the “faster “ type Another AHR Episode From The Pacemaker – the “slower” type Questions • What do you think of the strips ? • Is there any “strange behavior” of the pacemaker ? strange behavior • What are the two Different diagnosis for the two strips ? • Th h ld , sensing and i Thresholds i d impedances are all within normal d ll ithi l ranges Think and …. Answer to The first rhythm – is it PMT? 1 2 3 4 5 6 7 8 VA conduction test performed in clinic by pacing V VA during testing is indeed very similar to VA in tachycardia: PMT most likely explanation ...
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...Personalizing Medicine By: Daniel Ostroff 12-09-2009 I believe it is absolutely essential to take steps to further personalize medicine. There are too many generalized treatments that may work for most patients, but still a great many patients with slight irregularities are not eligible because of these slight differences. For example, research is being done at the BIO5 Institute at the University of Arizona by Dr. Jonathan VandeGeest and his laboratory to switch the commonly used generalized metallic stents to treat an aortic aneurysm to custom manufactured Functional (due to the use of dendrimers for drug delivery) Polymeric Endoluminal Paving prototypes. The development of these customized prototypes for aneurysm patients is a massive step forward in personalized medicine. The traditional procedure to correct this condition involved complex open-chest surgery. Depending on the size and growth rate of the aneurysm, surgery can take many hours and may require multiple return visits. During surgery, the two traditional treatments are aortic grafts or metallic stents. The grafts are a wire mesh that is sewn into place to prevent further growth and leaking, which involves an extremely dangerous and invasive procedure. Otherwise, a generalized metallic stent is used, but because this device is pre-formed, it will only fit a select group of patients whose aorta is in a straight and vertical orientation. Any other shape and the treatment...
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...ELECTROCARDIO-graphy (E.C.g.) Uses: - To detect arrhythmias To diagnose chamber hypertrophy To diagnose myocardial infarction Electrocardiogram is the graphic representation of electrical changes occurring in the cardiac muscle. It is recorded by using surface electrodes. These are of two types: Bipolar leads Unipolar leads Bipolar leads Lead I-Right wrist and left wrist Lead II –Right wrist and left ankle Lead III- Left wrist and left ankle Unipolar leads - Limb leads and chest leads a. Limb leads- aVR – right wrist aVL –left wrist aVF – left ankle b. Chest leads- V1-4th right intercostal space at the sternal border V2-4th left intercostal space at the sternal border V3- between V2 & V4 V4- at the midclavicular line in the left 5th intercostal space V5- at the anterior axillary line in the same horizontal plane V6- at the mid-axillary line in the same horizontal plane V3R - on the right side – position same as that of V3 V4R - on the right side – position same as that of V4 E.C.g. - - paper speed-25mm/sec horizontally 1mm(one small square)=0.04sec (one large square=0.04x5=0.2sec vertically 1mm=0.1mv P-wave- atrial depolarisation –upright width – 2.5mm=0.1sec QRS - ventricular de-polarisation width – 1-2.5mm=0.04-0.1sec average 0.08sec height – variable PR- interval-from...
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