RESUMO
Concise and complete guidelines of indications for permanent pacemakers are critical for the clinician involved in permanent pacing. A critical appraisal of the American College of Cardiology/American Heart Association 1998 guidelines on indications for permanent pacing clarifies inconsistencies and expands on information within the current guidelines.
Assuntos
Estimulação Cardíaca Artificial/normas , Guias de Prática Clínica como Assunto , Bloqueio Cardíaco/terapia , Humanos , Infarto do Miocárdio/terapia , Sociedades Médicas , Síncope/terapia , Estados UnidosAssuntos
Cardiomiopatia Hipertrófica/terapia , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Estimulação Cardíaca Artificial/métodos , Feminino , Ventrículos do Coração/cirurgia , Humanos , Marca-Passo Artificial , Propranolol/administração & dosagem , Propranolol/uso terapêuticoAssuntos
Doenças Cardiovasculares/terapia , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , Encaminhamento e Consulta , Cardiologia , Certificação , Medicina de Família e Comunidade , Guias como Assunto , Humanos , Imperícia/legislação & jurisprudência , Avaliação de Resultados em Cuidados de Saúde , Papel do Médico , Estados UnidosAssuntos
Arritmias Cardíacas/diagnóstico , Estimulação Cardíaca Artificial , Cardiologia/educação , Educação Médica , Eletrofisiologia/educação , Especialização , Adulto , Arritmias Cardíacas/terapia , Currículo , Desfibriladores Implantáveis , Avaliação Educacional , Humanos , Marca-Passo Artificial , Estados UnidosRESUMO
These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Drs Homer A. Boushey, Professor of Medicine, and David G. Warnock, Associate Professor of Medicine, under the direction of Dr Lloyd H. Smith, Jr, Professor of Medicine and Associate Dean in the School of Medicine. Requests for reprints should be sent to the Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA 94143.
Assuntos
Infarto do Miocárdio/fisiopatologia , Testes de Função Cardíaca , Humanos , Infarto do Miocárdio/terapia , Prognóstico , RiscoRESUMO
Many factors affect the threshold for myocardial stimulation in patients with cardiac pacemakers. The acute local tissue reaction at the electrode-myocardium interface accounts for early threshold rises and may be minimized by choice of specific electrodes (steroid-eluting or carbon-tip). Physiologic variations due to changes in autonomic tone (including eating, sleeping, and exercise) account for day-to-day fluctuations in pacing threshold. Electrolyte and metabolic abnormalities, especially hyperkalemia, alkalosis, acidosis, and hyperglycemia, increase the pacing threshold. Commonly used antiarrhythmic drugs (quinidine and procainamide) also increase pacing threshold. Patients with pacemakers who require antiarrhythmic agents or who have coincident metabolic or electrolyte disturbances should be observed closely for failure to capture. Management of failure to capture is directed at removing the inciting cause and attempting to lower the pacing threshold with isoproterenol, if the situation is urgent. Acute increases in pacing threshold immediately following pacing system implantation can be treated with corticosteroids. Increasing the energy output of programmable pacemakers, in specific circumstances, or insertion of a temporary pacemaker capable of delivering higher energy output than the implanted generator may also be successful.
