MMUH reg teaching: pacemakers falls blackouts
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slideset from this talk http://emergencymedicineireland.com/2012/08/blackouts-and-syncope/
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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 •Defibs
- 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 •‘Twiddler’s 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% confidence interval [CI] 79% to 96%) and a specificity of 33% (95% CI 32% to 34%). Rule performance to predict serious outcomes was sensitivity 74% (95% CI 61% to 84%), specificity 57% (95% CI 53% to 61%) The rule was 98% sensitive (95% confidence interval [CI] 89% to 100%) and 56% specific (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) •Difficulty given baseline ECG changes and renal function
- 42. Found on the floor... •Rhabdo •Hypothermia •Fractures
- 43. If they’re 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