HF
Frank starling law
greater the stretch the greater the contraction UNTIL AN OPTIMAL POINT
Class 1A recommendation for CRT
Class 2A recommendation for CRT
QRS > 150 ms and LBBB (and female)
QRS= 120-150ms (LBBB or non-LBBB)
What is the most common lead used today for CRT PTs
IS-4 quadripolar
3 things that are placed in the delivery cath to aid in getting into the CS
inner lumen
guidewire 0.035 in
EP deflectable cath
Ischemic DCM vs non ischemic DCM
Ischemic DCM is a consequence of MI and infarctio. related to atherosclerosis
non Ischemic DCM occurs without an MI (could be from infection, valve disease, immune system issues, sarcoidosis etc)
MUSTIC trial goal and results
goal- find benefit of CRT for PT with AF vs meds
results- CRT beneficial for AF PTs and improved their QOL
What is the purpose of the adapter
attaches to the proximal end of the lead to provide a secure connection while testing threshold at implant
which valve makes it harder to gain access into the CS as it may cover the CS os
thebesian
HCM is a common cause of ___ and is the most common genetic cardiac disease.
HOCM is a form of HCM. What does it stand for and what does it do to the heart?
SCA
Hypertrophic obstructive cardiomyopathy is when the LV walls thicken to such an extent that they block the blood from exiting the heart (LVOT occlusion)
what study looked at both CRT-P and CRT-D compared to OPT
companion
What is multipoint pacing and what are the benefits
pace from multiple sites on LV lead (ie: LV 1-2 and LV 3-4 simultaneously)
helps PT become more of a responder by capturing more of left lateral wall creating more of a synchronous, whole depol of LV (rather than in segments)
also helps improve hemodynamics, narrow the QRS, and reduce complications.
This is a good reason we should always be ready to __
Ventricular standstill (no V depol)
Must be ready to pace
Restrictive cardiomyopathy
stenosis of LV (not thinner or thicker), diastolic problem, least common type of cm, caused by sarcoidosis
WHat study looked at CRT for AF PTs
MUSTIC
CRT-P vs CRT-D headers
CRT-P will have small capacitor and only ports for IS-1/ IS-4 pacing leads
CRT-D will have larger capacitor and will have a port for a DF-4 lead
What will PVC's on a monitor indicate
that we have crossed the tricuspid and are in the RV.
Once the CS has been cannulated the PVC's should terminate (can use the LAO view to ensure guide cath is in CS and not RVOT)
As disease progresses in PTs with DCM we may need to change device to a ___
BIV ICD
ALL of the following are required for cl I indication for CRT except
NSR
LBBB w QRS <140 ms
Class II, III, IV amb
On GDMT
LBBB w QRS <140
(must be 150 or more)
LV pacing challenges
higher thresholds
extra cardiac stimulation (PNS, diaphragmatic stim)
anodal stimulation