Pacemaker Therapy
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- 1.A 63-year-old man presents to your office for a check-up. On cardiac examination, you notice an irregular rhythm. The patient walks two miles every day and has no significant dyspnea. A 12-lead electrocardiogram shows a Mobtiz type II second degree atrioventricular (AV) block, as well as a left bundle-branch block. The patient asks what, if anything, needs to be done, since he has no symptoms. Which of the following statements concerning the patient's AV conduction abnormality is most accurate?
- A.
A pacemaker is not indicated because he is asymptomatic
- B.
A pacemaker is not indicated because this is a stable rhythm
- C.
A pacemaker is indicated in a type II AV block when a wide QRS is present
- D.
A pacemaker is indicated in all type II AV blocks
- 2.A 53-year-old woman is admitted to the hospital after having an acute inferior myocardial infarction. Within hours of admission, she develops third-degree AV block but remains hemodynamically stable. For this patient, which of the following statements is true?
- A.
Conduction abnormalities are uncommon in the setting of an acute myocardial infarction
- B.
Temporary pacing does not necessarily imply a need for permanent pacing because conduction abnormalities are often transient in the acute setting
- C.
In an inferior infarction, conduction abnormalities often persist and so necessitate a permanent pacemaker
- D.
Patients with inferior infarction are more likely to require permanent pacing than those with anterior infarction
- 3.A 53-year-old male patient with ischemic cardiomyopathy returns for a follow-up visit. Despite receiving all recommended heart failure medications, he continues to experience shortness of breath when at rest. He asks if there are any further interventions which may improve his symptoms. Which of the following statements concerning cardiac resynchronization therapy (CRT) is true?
- A.
CRT utilizes one atrial and one ventricular lead to overcome atrioventricular dyssynchrony
- B.
CRT is proven to be beneficial in any patient with a left ventricular ejection fraction less than 35%
- C.
CRT has been shown to improve functional status, but it has no effect on mortality
- D.
CRT requires three pacing leads to overcome atrioventricular, interventricular, and intraventricular dyssynchrony
- 4.A 57-year-old male patient returns for a regular follow-up visit. He recently had a dual chamber pacemaker implanted to treat symptomatic sinus node dysfunction. He asks why a dual-chamber pacemaker was needed Which of the following statements regarding single- and dual-chamber pacing is true?
- A.
Dual-chamber pacing is associated with a decreased incidence of heart failure admissions and of atrial fibrillation, as compared with single-chamber pacing
- B.
Excessive pacing of the right ventricle by dual-chamber pacemakers decreases hospitalizations for heart failure
- C.
Pacemaker syndrome is not commonly associated with single-chamber ventricular pacemakers
- D.
Single-chamber atrial pacemakers are recommended to treat atrioventricular dysfunction
- 5.Yesterday, a 68-year-old female patient of yours was implanted with a dual-chamber pacemaker as therapy for symptomatic second-degree atrioventricular block. Today the patient has several questions related to the ongoing care of her pacemaker. For this patient, which of the following instructions regarding pacemakers is true?
- A.
She can now resume normal activity
- B.
Because pacemaker batteries last for several years, regular follow-up visits are not needed during the first year after implantation
- C.
Household appliances such as microwaves and television remote controls may affect pacemaker function
- D.
MRI scanners can lead to unwanted programming changes and can even induce arrhythmias
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