MMUH reg teaching: pacemakers falls blackouts
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Pacemakers are used to treat symptomatic heart block, sinus bradycardia, and atrial fibrillation with symptomatic bradycardia. They can have early problems like infection, bleeding, or lead misplacement. Late problems include battery failure, lead fracture, skin erosion, or pacemaker syndrome where pacing is poorly coordinated. General problems include missensing heart rhythms or pacemaker mediated tachycardias. Magnet mode and lead fracture are other potential issues. Blackouts can be caused by cardiac issues like hypertrophic cardiomyopathy or long QT syndrome, or non-cardiac issues like seizures, neurocardiogenic syncope, or orthostatic hypotension. Risk of falls increases in the elderly and
![Pacemaker mediated tachy [=AVRT]
http://lifeinthefastlane.com/ecg-library/pacemaker-malfunction/](https://image.slidesharecdn.com/vuefjczsdwa3yctg0nqv-140520070057-phpapp01/85/MMUH-reg-teaching-pacemakers-falls-blackouts-14-320.jpg)
![San Fran/CHESS
The rule performed with a sensitivity of 90% (44/49 outcomes; 95%
con鍖dence interval [CI] 79% to 96%) and a speci鍖city of 33% (95% CI 32% to
34%).
Rule performance to predict serious outcomes was sensitivity 74% (95% CI
61% to 84%), speci鍖city 57% (95% CI 53% to 61%)
The rule was 98% sensitive (95% con鍖dence interval [CI] 89% to 100%) and
56% speci鍖c (95% CI 52% to 60%) to predict these events.](https://image.slidesharecdn.com/vuefjczsdwa3yctg0nqv-140520070057-phpapp01/85/MMUH-reg-teaching-pacemakers-falls-blackouts-38-320.jpg)
![Risk Assessment
Timed up and go [>20 secs abnormal]
http://www.youtube.com/watch?v=dsTfqk9ZTiw](https://image.slidesharecdn.com/vuefjczsdwa3yctg0nqv-140520070057-phpapp01/85/MMUH-reg-teaching-pacemakers-falls-blackouts-44-320.jpg)
MMUH reg teaching: pacemakers falls blackouts
- 2. Pacemakers and their problems Sept 2013
- 3. Indications Symptomatic heart block Symptomatic sinus brady AF with symptomatic brady Also: Cardiac Resynchronization Therapy De鍖bs
- 5. Normal: atria and ventricle paced
- 9. WhoCares?
- 13. Problems Early: Infection Bleeding Lead misplacement Pacemaker syndrome (poor coordination) thrombosis Late: Battery failure runaway pacemaker Lead Fracture Skin Erosion ≒Twiddlers syndrome thrombosis (usually chronic and not a problem) General: Mis-sensing Pacemaker mediated tachy
- 14. Pacemaker mediated tachy [=AVRT] http://lifeinthefastlane.com/ecg-library/pacemaker-malfunction/
- 17. Magnet Mode
- 18. Lead Fracture
- 19. Falls & Blackouts April 2012
- 20. Falls and blackouts Acknowledgements/images Life in the fast lane Sonocloud.org Andy Buck the wonders ofYouTube and Wiki Amal Mattu
- 23. Cardiac sudden palpitations chest pain witnessed ? LOC ? murmur vital signs (RR!) cognition neuro ECG ? Blood Sugar History Exam
- 24. HOCM
- 27. HOCM
- 30. Brugada Likely common cause of SCD ICD only treatment presence of symptoms is important Quoted 10% mortality a year if untreated (though recent evidence questions this...) PMID 20100972
- 34. Normal AF WPW AF
- 36. Long QT Just use the calculated QTc >500ms before badness happens Causes Syndrome - rare Low electrolytes All the drugs in the world...
- 37. CHESS
- 38. San Fran/CHESS The rule performed with a sensitivity of 90% (44/49 outcomes; 95% con鍖dence interval [CI] 79% to 96%) and a speci鍖city of 33% (95% CI 32% to 34%). Rule performance to predict serious outcomes was sensitivity 74% (95% CI 61% to 84%), speci鍖city 57% (95% CI 53% to 61%) The rule was 98% sensitive (95% con鍖dence interval [CI] 89% to 100%) and 56% speci鍖c (95% CI 52% to 60%) to predict these events.
- 40. Falls in the elderly Serious Benign Everything... Nothing...
- 41. ACS Common Usually with an associated anginal equivalent (lethargy, diaphoresis, shortness of breath) If isolated blackout with no symptoms prior or after then unlikely (quoted <1% pick up rate for trops in syncope) Dif鍖culty given baseline ECG changes and renal function
- 42. Found on the 鍖oor... Rhabdo Hypothermia Fractures
- 43. If theyre now back to baseline? PMID: 17200478
- 44. Risk Assessment Timed up and go [>20 secs abnormal] http://www.youtube.com/watch?v=dsTfqk9ZTiw
- 45. As yet... There is no good, reliable test Risk assessment Gait assessment Have they fallen in the past year Falls clinic/assessment