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IBHRE Guaranteed to Pass - PacerICD.com

1 Not really. Motivation, intellect and a willingness to spend only 1 minute answering each question are also to Pass1 ExAM Tidbits in easy to digest, bite sized morsalsVolume 1: Number 1AV Node Reentry TachycardiaIn the past, questions concerning AVNRT have figured prominately in the NASPExAM. Although one can never becertain, I would expect a few questions centered around this accounts for about 60% of arrhythmias presenting as Supraventricular or Paroxsymal Atrial Tachycardia(PAT). It affects all age groups and sexes equally. There is no evidence that patients presenting with AVNRT have ahigher percentage of heart disease than the normal AVNRT, the AV node can be thought of as divided into two conduction pathways, a fast pathway and a slowpathway.

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1 1 Not really. Motivation, intellect and a willingness to spend only 1 minute answering each question are also to Pass1 ExAM Tidbits in easy to digest, bite sized morsalsVolume 1: Number 1AV Node Reentry TachycardiaIn the past, questions concerning AVNRT have figured prominately in the NASPExAM. Although one can never becertain, I would expect a few questions centered around this accounts for about 60% of arrhythmias presenting as Supraventricular or Paroxsymal Atrial Tachycardia(PAT). It affects all age groups and sexes equally. There is no evidence that patients presenting with AVNRT have ahigher percentage of heart disease than the normal AVNRT, the AV node can be thought of as divided into two conduction pathways, a fast pathway and a slowpathway.

2 The fast pathway has a longer refractory period than the slow pathway. Tachycardias generally result whena premature impulse is blocked in the fast pathway but continues to travel down the slow pathway. By the time theimpulse again reaches the fast pathway in a retrograde fashion, the fast pathway has repolarized allowing theimpulse to circuitously reenter the slow pathway. AVNRT is born. Because of the way the tachycardia begins, onewill see a prolonged PR interval in the beat that starts the reentry. This is caused by "jumping" from the fast to theslow AVNRT1. The reentrant circuit is located within the AV Node2. In most cases, both the atria and the ventricles are stimulated by impulses exiting from the circuit during Neither the atria or the ventricles are necessary for the maintenance of that reentrant It is possible to have block in the His bundle, preventing the ventricles from being stimulated, without affectingthe reentrant circuit It is possible to have retrograde block, preventing the atrial from being stimulated, but without affecting above is paraphrased from "Electrophysiologic Testing" by Richard N.

3 Fogoros. Second Edition. BlackwellScience Clinical Features1. AVNRT is the most common form of supraventriculartachycardia; it results from conduction through areentrant circuit comprising fast and slowatrioventricular nodal pathways2. Heart rate, 150 250 beats/min3. Neck pounding4. Palpitations, light-headedness, near-syncope5. Narrow QRS complexes on ECG6. The P wave is either buried within the QRS complexor inscribed just after the QRS complex7. The P wave inscribed by retroconduction over the AVnode is negative in the inferior leads and positive inlead V1; PSVT may manifest as small negativedeflections in the inferior leads and a small positivedeflection in V1 (pseudo r pattern)8.

4 Abrupt onset and termination of episodes9. More common in women than in men10. Frequently presents after 20 yr of ageIn AVNRT the anatomic substrate or abnormality is the presence of dualAV node pathways (designated a and b or slow and fast, respectively) eachwith slightly differing conduction and refractory periods. An extrasystoleexposes the differing properties of the two pathways and often initiatestachycardia. During AVNRT, the atria are depolarized retrogradely at atime simultaneous with anterograde ventricular depolarization so that theretrograde P waves are buried in the QRS complex. Sometimes, they arejust visible as part of the terminal QRS complex (the r ). Blocking AV nodeconduction by changing autonomic tone or using pharmacologic agents willterminate the really.

5 Motivation, intellect and a willingness to spend only 1 minute answering each question are also to Pass1 ExAM Tidbits in easy to digest, bite sized morsalsVolume 1: Number 2 Rheobase and Chronaxie TimeRheobase is the lowest point on a strength duration curve at an infinitely long pulse duration. For cardiac pacing,rheobase is usually reached between 1 and 2 milliseconds; at shorter durations, threshold Time is the pulse width at twice the rheobase value. The Chronaxie Time approximates the most efficientstimulation pulse Duration Curve - the quantity of charge, current, voltage, or energy required to stimulate the heart at aseries of pulse this section of the exam, you may be asked to determine certain electrical parameters using calculate "charge" in microcoulombs: multiply mean current times pulse duration (time).

6 This is shown by theformula C (charge) = I x T (I is the symbol for current).To calculate "energy" in microjoules: multiply mean current by mean voltage by pulse duration. The formula maybe thus: E = I x V x to remember these points:1. The strength duration curve (SDC) is the quantity ofcharge, current, voltage, or energy required to stimulatethe heart at a series of pulse These values vary significantly as a function of Only charge is approximately In order to set a voltage or pulse duration for parameteroutput programming, the position that a specific voltageor pulse duration occupies on the curve must be "A Practice of Cardiac Pacing, Third Edition" by Furman, et. al.

7 Published by following steps are followed in order to determine rheobase and chronaxieStep 1 determine the rheobase, which is the minimum Stimulus Strength that will produce a response. This is thevoltage to which the Strength-Duration curve asymptotes. In the example above, this value is 2 calculate 2 rheobase ( = V in the above example).Step 3 determine chronaxie, which is the Stimulus Duration that yields a response when the Stimulus Strength isset to exactly 2 rheobase. In the example above, the chronaxie is are a couple mnemonic hints to help you remember which term is which:1. The root word rheo means current and base means foundation: thus the rheobase is the foundation, orminimum, current (stimulus strength) that will produce a The root word chron means time and axie means axis: chronaxie, then, is measured along the time axisand, thus, is a Duration that gives a response when the nerve is stimulated at twice the rheobase really.

8 Motivation, intellect and a willingness to spend only 1 minute answering each question are also to Pass1 ExAM Tidbits in easy to digest, bite sized morselsVolume 1: Number 3 Some EP Terms to Remember1. Functional Refractory Period (FRP)- the coupling interval which first results in a measurable degree of delay inimpulse Effective Refractory Period (ERP)- the longest coupling interval to be associated with Resting (transmembrane) potential: the voltage difference between the inside and outside of the cell Action Potential - the cellular characteristics of depolarization and repolarization. The action potential consistsof five 0: The depolarization phase. During this phase, the rapid sodium channels are stimulated to open,causing the resting transmembrane potential to spike from about -90 mv to about 0 1: Early 2: The "Plateau Phase.

9 " This phase, mediated by the slow calcium channels, essentially disrupts anddelays the repolarization started in phase 1 and prolongs the refractory 3: The end of repolarization. Note: the period beginning at the end of phase 0 through the end of phase3 is the refractory period of cardiac 4: The resting phase. It is during this phase that, in some cardiac cells, ions leak back and forthbetween membranes and cause a gradual increase in the transmembrane (resting) potential. Whenthe potential (voltage) reaches the threshold voltage, the cell depolarizes. This spontaneousdepolarization is called really. Motivation, intellect and a willingness to spend only 1 minute answering each question are also required.

10 The realpurpose of these newsletters is to STIMULATE thought and self-help research. Your comments and suggestions are to Pass1 ExAM Tidbits in easy to digest, bite sized morsels Volume 1: Number 4 Test taking helpIt is not unusual to be presented with a pacemaker rhythm strip without any accompanying information. How doesone begin to analyze the rhythm?First of all, make sure you have a good familiarity with the NBG Code (there will be questions). Next take asystematic approach to interpreting the presenting Is pacing present? : is the pacing appropriate for the rhythm? For instance, are pacer spikes present along with R waves? If so,are the intervals correct? Is the pacing rate the expected rate?


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