Heart Block

1. heart block

2. To summariseTo summarise::
 The SA node generates an electrical signal.The SA node generates an electrical signal.
 The electrical signal spreads across the atria, causingThe electrical signal spreads across the atria, causing
them to contractthem to contract →→ P waveP wave..
 The signal is held up at the AV node while the atria finishThe signal is held up at the AV node while the atria finish
contractingcontracting →→ PR intervalPR interval..
 The signal runs down towards the base of the ventriclesThe signal runs down towards the base of the ventricles
via the bundle of Hisvia the bundle of His →→ PR intervalPR interval..
 The signal passes along the left and right bundles andThe signal passes along the left and right bundles and
then up through the ventricles, causing them to contractthen up through the ventricles, causing them to contract
→→ QRS complexQRS complex..
 The heart muscle relaxes and the cells resetThe heart muscle relaxes and the cells reset →→ T waveT wave..

3. A. Transverse blockade:
1. synus
2. atrial
3. Atrioventricular (partial,
full)
B. Longitudinal blockade:
4. Blockade of right bundle
branch block (incomplete,
complete).
5. Left bundle branch block,
(incomplete, complete).
6. Blockade anterior upper
branches LBBB - or left front
hemiblok (incomplete).
7. Blockade posterior lower
branches LBBB
(incomplete).
8. Combined longitudinal
blockade:
4 +6 = block Bailey,
СА
АV
1
2
4
5
6
6
3
heart block
7
3

4. heart block
Heart block is a delay in the conduction of electrical current as itHeart block is a delay in the conduction of electrical current as it
passes through the atrioventricular node, bundle of His, or bothpasses through the atrioventricular node, bundle of His, or both
bundle branches, all of which are located between the atria and thebundle branches, all of which are located between the atria and the
ventricles.ventricles.
 Some types of heart block cause no symptoms,Some types of heart block cause no symptoms,
but others cause fatigue, dizziness, and fainting.but others cause fatigue, dizziness, and fainting.
 Electrocardiography is used to detect heartElectrocardiography is used to detect heart
block.block.
 Some people require an artificial pacemaker.Some people require an artificial pacemaker.

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6. The SA nodal blocksThe SA nodal blocks
 The SA nodal blocks rarely give symptoms. This isThe SA nodal blocks rarely give symptoms. This is
because if an individual had complete block at this levelbecause if an individual had complete block at this level
of the conduction system (which is uncommon), theof the conduction system (which is uncommon), the
secondary pacemaker of the heart would be at the AVsecondary pacemaker of the heart would be at the AV
node, which would fire at 40 to 60 beats a minute, whichnode, which would fire at 40 to 60 beats a minute, which
is enough to retain consciousness in the resting state.is enough to retain consciousness in the resting state.
 Types of SA nodal blocks include:Types of SA nodal blocks include:
 * SA node Wenckebach (Mobitz I)* SA node Wenckebach (Mobitz I)
 * SA node Mobitz II* SA node Mobitz II
 * SA node exit block* SA node exit block

7. CLASSIFICATION
SINUS blockade
Incomplete
Full
I degree
second
degree
third
degree
Type 1 - Type Samoilov - Venkebah
type 2 - type Mobitts
ECG is not diagnosed
Sinus Arest
-

8. Differential diagnosis of CA-block and
sinus bradycardia.
 Sinus bradycardia - slow heart rate is less than 60 - 55 beats / min at the right
pace.
When CA-blockade may be blocked out of the SA node every second pulse,
and then create the same situation as with sinus bradycardia.
 For these states dyferyntiation use atropin-For these states dyferyntiation use atropin-
test.test. First fix the initial heart rate, and later iV slowly 1.5 - 2 ml ofFirst fix the initial heart rate, and later iV slowly 1.5 - 2 ml of
0.1% solution of atropine sulfate.0.1% solution of atropine sulfate.
If the heart rate is doubled, it is sinus bradycardia.If the heart rate is doubled, it is sinus bradycardia.
 If the heart rate remains preliminary, or only slightly increased (<90If the heart rate remains preliminary, or only slightly increased (<90
beats / min), this CA - blockade.beats / min), this CA - blockade.
 The same atropin-test used to diagnose the syndrome ofThe same atropin-test used to diagnose the syndrome of
weakness sinus, which also doubles heart rate afterweakness sinus, which also doubles heart rate after
administration of atropine.administration of atropine.

9. Second degree sinus block Type Samoilov –
Venkebah
передсердя
передсердя
передсердя
передсердя
S-A S-A S-A
S-A
S-A
A-V A-V A-V
A-V
RR distance gradually increases
falls complex QRS
Sinus blockage in the ratio 4:3.
P1 P2 P
3
PQRS4? P
5
P6

10. Second degree sinus block type II-Mobitts
0,94” 1,88”
0,68” 1,36” 0,68
p
P? P?
p p
0,94”
0,68” 1,36”
RR distance is the same, but falls complex QRS

11. Full sinus blockage
S I N U S A R E S T
1 2 3 4?
p p p p p p
5? 6? 7 8 9

12. Full sinus blockage

13. PP’ =0,12’’
PQ =0,26’’
Atrialna internal BLOCKADE:
P wave duration> 0.11 sec.
Bactrian R in I, II,
avl leads and negative-positive in V1-2
QRS correct form.
P P

14. Atrioventricular blockade:Atrioventricular blockade:
 Incomplete AV blockIncomplete AV block
First Degree extension RQ> 0.20 p.
Second Degree:
Mobitts I and gradual lengthening of the interval RQ
followed by deposition of QRS. These periods Samoilova-
Venkebaha
Mobitts II = normal PQ, but after oneP of the falling comple
QRS
 x 2:1, 3:2, 4:3, etc.
 difference between the frequency of ventricular and atrial
rate is two or more units, cutting bradycardia, syncope,
MES
 Full AV block
Third degree: complete AV - block = isolation atrial and
ventricular rhythms. P not is connected to the QRS
 a) proximal type: QRS is not deformed HRHR = 1/2 sinus
rhythm (40-50 beats / min);
 b) distal type: QRS deformed HR = 1/2 AB-rate, ie 20-30
beats / min, frequent MES

15. AtrioventricularAtrioventricular
blockade:blockade:

16. Atrioventricular block second degree
Mobits type-I Samoilova-Venkebaha
0,17"
0,36" 0,38"
0,17"
P
Atrioventricular block second degree
at regular intervals PR-Mobitts-2
with a ratio of 3:2
0,18"
Q
0,18"
Q
0,18"
QQ
0,18"
P P
P P P P PP P
P P P P P
0,18"

17. Atrioventricular block second degree
at regular intervals PR - Mobitts -2
Відсутній комплекс QRS
Р
0,76" 0,76" Р-Р = 0,76"
Sinus rhythm with 4:3 AV block
Sinus rhythm with atrioventricular block 4:3 and 5:4
4:3
Р Р Р Р
Р Р Р Р4:3
5:4
Р
1
32

18. atrioventricular block
with a ratio of 2:1 - Mobitts -2
Sinus rhythm with blocking every second R wave
Частота серцевих скорочень 53 за хвилину
P P P PP P P P P
- шлуночків, передсердь - 106 за хв.
Р
Р

19. Go incomplete atrioventricular block 3:2 Mobitts II atrioventricular
block in vysokostupenevu - 3: 1 with one substitution supraventricular
extrasystoles. On three successive pulses, two blocked and one is
held by the ventricles.
1 2 3 1 2 3
0,12"
0,12" 0,12"
-
P P P P
P P
Р
Do not complete high degree AV
block
P
3:2 3:1

20. 1 2 3 1* 1 2 3
0,12"
0,12" 0,12"
high degree AV block
Передсердні тони cannon tone
Strazhesko
ФКГ-t
The frequency of ventricular rate 40 per minute, the atria 80 per minute
At high degree AV blockade intervals PQ always equal, and the
complete AV blockade different
Р РР
Р
Р Р
Р
ЕX
Differential diagnosis with high degree AV block
0,08 с
0.,14 с 0,04
с
0,12 с 0,16 с

21. Full AV block
Third degree: complete AV - block =
isolation atrial and ventricular rhythms. P not is connected to the QRS

22. TreatmentTreatment
 First-degree heart block requires no treatmentFirst-degree heart block requires no treatment
even when it is caused by a heart disorder.even when it is caused by a heart disorder.
 Some people with second-degree heart blockSome people with second-degree heart block
require an artificial pacemaker.require an artificial pacemaker.
 Almost all people with third-degree heart blockAlmost all people with third-degree heart block
require an artificial pacemaker.require an artificial pacemaker.
 A temporary pacemaker may be used in anA temporary pacemaker may be used in an
emergency until a permanent one can beemergency until a permanent one can be
implanted.implanted.

23. SYNDROME Morgagni-Adams-SYNDROME Morgagni-Adams-
Stokes ( MAS)Stokes ( MAS)
Brief loss of consciousness as a result of short-term heart failure,Brief loss of consciousness as a result of short-term heart failure,
significant weakness JI development of cerebral ischemiasignificant weakness JI development of cerebral ischemia..
Clinic:
1.1. After 3-5 s: dizziness, dark circles before eyes, pale skin and sharp

2. After 15-20 s: loss of consciousness.
 3. After 21-45 s: generalized epileptiform convulsions,
involuntary urination and defecation.
 4. After 1 min: apnea, cyanosis, dilated pupils that do not
respond to light.
Missing: aura prykushuvannya tongue (epilepsy). Faces in epilepsy blue-
purple, after the attack - the pale.
 At the MAC - first pale, while the court - cyanotic, and after the attack - red

24. SYNDROME Morgagni-Adams-StokesSYNDROME Morgagni-Adams-Stokes
( MAS)( MAS)
Clinical forms:
1) bradysystolic, asystolic,
2) tahysystolic and
3) mixed - tachy-bradysystolichna.
Bradysystolic:Bradysystolic: asystolic: CA-block, sinus arrest,asystolic: CA-block, sinus arrest,
Frederic syndrom, AV-block II and III degree.Frederic syndrom, AV-block II and III degree.
Tahysystolic:Tahysystolic: VT, PVT, VF.VT, PVT, VF.

25. TREATMENT MAS
Main objective: mechanical, pharmacological and / or electrical impulses
restore the heart's contractions.
1. Prekardial kick.
External cardiac massage and breathing "mouth to mouth".
If within 3 minutes. activity of the heart is not renewed - Electric
Defibrillation.
2. When asystole - ECS with the introduction of the electrode in the
right ventricle h /subclavian or jugular vein.
3. Drug therapy:
IV - adrenaline 0.5-1.0 ml of 0.1% district in 5 ml fiz.rozchynu
Atropine 0.5-1.0 ml of 0.1% district in 5 ml fiz.r district.
IV- orciprenaline (alupent) 1-2 ml of 0.05% in 200 ml fiz.rozchynu,
Sodium bicarbonate 2 ml / kg body weight 4% district.
Artificial ventilation and cardiac massage continued 30 min.
Criteria effectiveness of resuscitation:
The emergence rate on large vessels.
SBP 70-80 mmHg
Narrowing of dilated pupils, their reaction to
light.
The disappearance of cyanosis, redness of the
skin.

26. VIOLATION intraventricular
CONDUCTIVITY
Bundle branch
block
right
left
bilateral blockade
complete
incomplete
complete
incomplete:
-Front hemiblock
(half block)
- Back hemiblock
(half block)
complete
incomplete

27. Bundle branch blockBundle branch block
 is a type of conduction block involving partial or completeis a type of conduction block involving partial or complete
interruption of the flow of electrical impulses through the right or leftinterruption of the flow of electrical impulses through the right or left
bundle branches.bundle branches.
 The bundle of His is a group of fibers that conducts electrical impulses fromThe bundle of His is a group of fibers that conducts electrical impulses from
the atrioventricular node. The bundle of His divides into two bundlethe atrioventricular node. The bundle of His divides into two bundle
branches.branches.
 The left bundle branch conducts impulses to the left ventricle, and the rightThe left bundle branch conducts impulses to the left ventricle, and the right
bundle branch conducts impulses to the right ventricle. Conduction may bebundle branch conducts impulses to the right ventricle. Conduction may be
blocked in the left or right bundle branch.blocked in the left or right bundle branch.
 Bundle branch block usually causes no symptomsBundle branch block usually causes no symptoms..
 Right bundle branch block is not serious in itself and may occur inRight bundle branch block is not serious in itself and may occur in
apparently healthy peopleapparently healthy people. However, it may also indicate significant. However, it may also indicate significant
heart damage due to, for example, a previous heart attack.heart damage due to, for example, a previous heart attack.
 Left bundle branch block tends to be more serious. In older people,Left bundle branch block tends to be more serious. In older people,
it often indicates coronary artery disease due to high blood pressureit often indicates coronary artery disease due to high blood pressure
or atherosclerosis.or atherosclerosis.

28. Methods of diagnosis of bundle branch blockMethods of diagnosis of bundle branch block
the duration of the interval internal deviation (intrinsiciodthe duration of the interval internal deviation (intrinsiciod
deflection) -from the beginning of the ventricular complex (Qdeflection) -from the beginning of the ventricular complex (Q
wave or R) wave to the top of R, or to the last notch on thewave or R) wave to the top of R, or to the last notch on the
complex QRScomplex QRS ""
0,035 – 0,06
с
>0,07 с
0,04 – 0,07 с>0,08 с
Blockade of right bundle branch
block - not full - A full - W.
А В
Left bundle branch block -
not full - A full-B.
А В
“
r

29. Methods of measuring internal deviation or time electronegativity
surface of the heart at the right blockades
and left bundle branch block

30. V1 Internal variations 0,06с
nternal deviation in V1, V2, V3R is more than 0.035 "but not more than 0,06 s
Incomplete block right bundle branch block

31. Complete block right bundle branch block
1. Distributed QRS complex width of 0.12 sec. or more.
2. Split QRS complex of the letter M.
V1
V2
V3
V4
0,12
0,12

32. Incomplete left bundle branch block
Internal variations in V5, V6 is 0.06 sec

33. Complete left bundle branch block
0,12

34. Blockade of the anterior branch of left bundle branch bloc
(left front hemiblok)
Ліва ніжка
Передня гілка
лівої ніжки- до
лівого шлуночка
Напрям
патологічного
активування
Задня гілка
лівої ніжки
Атріовентрику-
лярний вузол
Пучок Гіса
Права ніжка
Electrical axis deviation left internal deviation + V 5-6 0,04-0,07 sec
0,04 с
До правого
шлуночка

35. Blockade of the posterior branch of left bundle branch block
(left rear hemiblok)
Ліва ніжка
Передня
гілка
Напрям
патологічного
активування
Задня гілка
Атріовентрику-
лярний вузол
Пучок Гіса
Права ніжка
Electrical axis deviation Right + internal
deviation
V 5-6 0,04-0,07 sec
0,04 с

36. The blockade of the right leg and the left anterior
branch bundle branch block - type Bailey
Ліва ніжка
Передня
гілка
Напрям
патологічного
активування
Задня гілка
Атріовентрику-
лярний вузол
Пучок Гіса
Права ніжка
Напрям
патологічного
активування
1. Internal deviation V 1-2 = 0,07 sec
2. Internal deviation V 5-6 = 0,04-0,07 sec
3. Electrical axis deviation left

37. The blockade of the right leg and left rear
branch bundle branch block - type Wilson
Ліва ніжка -
передня гілка
Напрям
патологічного
активування
Задня гілка
Атріовентрикулярний
вузол
Пучок Гіса
Права ніжка
Напрямпатологічного
активування
0,09’’
1. Internal deviation V 1-2  0,07 sec
2. Internal deviation V 5-6 = 0,04-0,07 sec
3. Electrical axis deviation to the right

38. Frederick SYNDROME
I
II
III
V1
V2
Full atrioventricular block third degree, atrial flutter / fibrillation
flashing syndrome (Frederick)
F f f f f f f
f
F f f f f fF f f f f f
f
Ff f f f f f

39. Syndromes Lenegre Lev
Syndrome Lenegre
Degenerative disease characterized by damage to both bundle
branch block (tryfastsykulyarna blockade) in people young and
middle-age, requiring implantation of bipolar Pacemaker and medical
support by means of metabolic therapy.
Lev syndrome
This progressive sclerosis conduction system of the heart
especially bifurcation bundle branch block and both his legs
(tryfastsykulyarna blockade). It occurs in the elderly. Requires
bipolar implantation of artificial pacemaker and medical support by
means of metabolic therapy.
In both diseases there are no signs of
atherosclerosis scarring in contractile myocardium.
Biochemical studies exclude lipid metabolism, no
signs of inflammation of the vascular wall and

40. Sick sinus syndrome (SSSV)
Sinus node (JI) on Casey and Flack (Keith, Flack).
Is the primary pacemaker, the frequency of its 60 - 90 / min.
Reasons SSSV:
1.IHS, AMI (50% of diaphragmatic infarction);
2.Idiopatychni-sclerotic degenerative processes - Lenehre-Lev'ye
(fibrosis JI, AV-connection);
3.Rheumatic fever SLE, hemochromatosis, diphtheria, amyloidosis;
Clinical signs are caused by hypoperfusion of vital organs - brain, heart and
kidneys. More common in women elderly and elderly (60-79 years). Is the
cause of death of young athletes at the height of the load.
Presyncope and syncope is in 40-70% of patients with
SSSV.

41. Functional diagnostic Sick sinus syndrome (SSSV)
1. Atropin test. It is the heart rate to the injection of atropine. Then spray injected
intravenously with atropine calculation 0,025 mg per 1 kg of the patient. During
the administration of atropine and every 10 minutes after administration of
atropine recorded ECG to maximum heart rate. If the heart rate is less than 90
cuts for 1 min, there is a Sino-aurikulyarna block or nodal rhythm, it indicates
the presence of cer syndrome. Sensitivity test - 70%.
2. Sample with izuprel. The test is conducted as well as atropin. Izuprel
intravenously jet, the dose should not exceed 5 mg. Usually injected at a dose of
1 mg in 250 ml 5% glucose solution.

42. 3. Obzydan- atropin-test method (A.Jose, pharmacological denervation of the heart).
Originally recorded ECG, then intravenously injected jet obzidan rate of 0.2 mg per 1
kg of body weight of the patient (at 1 ampoule of 0.1% solution is 5.10 ml of the drug,
which is 5-10 mg of pure substance). Within 10 minutes after the administration of
atropine obzidan injected dose of 0.04 mg per 1 kg of body weight of the patient (at 1
ampoule of 0.1% solution is 1 ml, representing 0.1 mg of pure substance). ECG
recorded during administration of both drugs and every 10 minutes thereafter.
Maximum sinus rhythm after administration of atropine (pharmacological denervation
of the sinus node) is considered a true sinus rhythm (SRSV).
In the normal heart rate after drug "denervation"
heart is 118.1 - (0.57 x weight) 14-18.
At age 20 SRSV = 92-122
At age 60 SRSV = 69-99
4. Holter. 24-hour ECG registration during
normal human activities.
Specificity tests
Functional diagnostic SSSV

43. 5 Assessment of sinus node function by using esophageal
electrocardiography stimulation..

44. First aid in SSSN
Bradycardia
1. Atropine sulfate - 0.1% solution of 0.5-1 ml intravenous
bolus every 4-6 hours (daily dose of 4 ml). With the
ineffectiveness of atropine:
2. Isoproterenol - 5 mg sublingually every 4 hours. If
nefektyv-ness:
3. Alupent - 0.05% solution of 1-2 ml in 500 ml of isotonic
intravenous drip at a rate of 10-15 drops per minute (every
6 hours alupent repeated administration to increase heart
rate and maintain it at 60-70 for 1 minute);
4. Itrop - 8-10 drops 3-4 times a day orally (basic therapy);
5.Temporary transvenozna endocardial
elektrokardiostymulyatsiya. If no effect:
6. Pacemaker implantation.

45. First aid in SSSN
Bradycardia-tachycardia-asystolya:
In order to eliminate tachycardia drugs of choice are:
- CORDARONE: 300 mg in 300 ml of isotonic intravenous drip (up to 800 mg per
day);
- Aymalin: 2.5% 2 ml in 10 ml of isotonic intravenous bolus or infusion 2.6 ml in
300 ml of isotonic;
- Diphenine: 0.117 g, 1 tablet every 6 hours inside with ECG monitoring;
- Diuretics: hypothiazide 100 mg per day orally.
[Beta-blockers are contraindicated, novokainamid, quinidine, cardiac glycosides, finoptyn,
etmozyn, potassium preparations, as well as electric pulse therapy].
- Implantation of a permanent pacemaker. Such treatment shall be the patient
who recorded at least one attack syndrome MAC is chronic heart failure, if
attacks nadshlunkovoyi or nodal tachycardia not taken medication.

46. І ІІ
ІІІ
aVR
aVL aVF
V1
V4
V2
V5
V3
V6
Cardiac pacemakers

47. European
Society of
Cardiology
Cardiac pacemakers
Indications for implantation
Indications for implantation of CP developed in 1984 by the American College of Cardiology (ACC)
and American Heart Association (AHA), according to which they are divided into three classes
(H.V.Knyshov, Ye.M.Neyko, V.M.Krysa, 2002 ):
● Class I - indications for implantation CP absolute;
● Class II - indications implatuvannya CP relative;
● Class III - CP implantation is not shown.
 Absolute:
1. Complete permanent or intermittent AV-blockade,
there is one of the following complications:
 - Symptomatic bradycardia (syncope, dizziness, seizures
MAC, heart failure and others);
- Ectopic rhythms that require taking drugs that suppress
the automaticity of the vascular system;
- Documented periods of asystole (more than 3 seconds),
the rhythm with a frequency of 40 beats / min;
 - AV-blockade after ablation of AV-connection.
AV-block II degree, accompanied by constant or
intermittent bradycardia, regardless of the blockade.

48. Cardiac pacemakers (CP) - a new and urgent problem of practical
cardiology. Every year CP implantable 300-500 patients per 1 million population and this trend progresses.
Increasing the number of patients with CP requires family physicians and general practitioners knowledge of
strategy and tactics such patients (V.Z.Netyazhenko, 1998; V.Y.Denysyuk, 1999, Edward C. Chang, 1997).
Historical Background of the CP.
● first CP (artifical pacemeker) applied in 1927 G.Hyman patient with complete
transverse blockade and attacks syndrome Morgagni-Adams-Stokes (MAS).
This CP generate rectangular electrical pulses with a frequency of 60, 90 and
120 pulses for 1 minute. He weighed 27 kg. Interestingly, the invention
G.Hyman was not properly rated or scientists or practitioners.
● In 1952, American scientist R.M.Zoll able to resume work after his heart
stops (asystole) against myocardial infarction. In this case the driver was
extracorporeal heart and electrical impulses "filed" the heart through a special
needle electrodes. This bulky device riveted to the patient himself. Also often
tended to go septic tissue around needle electrodes.
Cardiac pacemakers

49. Historical Background of the CP.
● Portable CP first constructed a Swedish scientist R.Elmqist.
In 1958, another scientist, - P.Senning, - implantuvav device R.Elmqist patient with
complete AV block. It should be noted that the electric battery of this device should
zaryazhaty at least 1 time a week.
● The first CP had a fixed frequency stimulation, he worked in the asynchronous mode,
ie CP sent pulses with a certain constant frequency (eg 64 imp / min). Under such
conditions often interference between CP rhythm and its own rhythm, which is
dangerous for the development of ventricular fibrillation.
European
Society of
Cardiology
Cardiac
pacemakers

50. ●CP fixed-frequency stimulation of the right atrium and right ventricle is no
longer used because of the risk of ventricular fibrillation due to arrhythmia "R-
on T".
● This is why very soon got a new model CP, which included where necessary
- of demand. Gear yourself included and excluded the pulse generator. These
devices were waves amplification scheme R (Ventricle) or P (Atrium).
● Along with the improvement of single-chamber models (Ventricle, Atrium)
developed physiological (two-chamber) pacemakers that implement the
general concept elektrokardioterapiyi (multyprohramovi CP).
● The development of electronic technology has led to the creation of CP to
prevent death due to ventricular fibrillation. It was created by automatic
electric cardioverter defibrillator (AIKD), which combines the functions CP and
two-chamber defibrillator. These devices recognize the type of
tachyarrhythmia, choose for each situation treatment algorithm, are computer
protocol arrhythmia.
European
Society of
Cardiology
Cardiac pacemakers

53. Cardiac pacemakers
To ensure uniformity, depending on the features of different types of
permanent artificial pacemakers, use them in accordance with the coding
system accepted NASE / BPEG (NBG) in 1987. The main body of each
stimulator can be seen from three to five Latin code letter (depending on
features), which are characterized by the following parameters.
I the position of code - indicates which chamber of the heart
stimulates the CP:
A (Atrium) - atrium;
V (Ventricle) - ventricle;
1) (Dual - A and V) - both cameras;
S (Single) - stimulation of any one chamber of the heart.
II item code - camera heart, which receives signals
to a stimulator (detected camera):
A (Atrium) - from the atria (P perceives prong);
V (Ventricle) - from the ventricles (detected prong R);
D (Dual - A + V) - accepts signals from the two cameras;
Oh do not accept electrical signals (asynchronous mode);
S (Single) - detection of any one chamber of the heart.

54. Cardiac pacemakers
III position code - the answer mode, which runs CP:III position code - the answer mode, which runs CP:
T (Triggered) - synchronized, repetitive mode;T (Triggered) - synchronized, repetitive mode;
And (Inhibited) - prohibition regime type "of demand";And (Inhibited) - prohibition regime type "of demand";
D (Dual - T + l) - a combination of recurring atrialD (Dual - T + l) - a combination of recurring atrial
and forbidding in ventricular response modes;and forbidding in ventricular response modes;
O - asynchronous mode.O - asynchronous mode.
IV position code - programming function:IV position code - programming function:
P (Simple Programmable) - easy programmingP (Simple Programmable) - easy programming
(1-2 parameters, often frequency pulses and their(1-2 parameters, often frequency pulses and their
amplitude);amplitude);
M (Mulliprogrammable) - multiprogram (2 or moreM (Mulliprogrammable) - multiprogram (2 or more
parameters);parameters);
R (Rate modulation) - automatic correction frequencyR (Rate modulation) - automatic correction frequency
pulsespulses
including biological parameters (t ° blood O2 contentincluding biological parameters (t ° blood O2 content
or CO2 tryvalis interval QT, gestures, etc.);or CO2 tryvalis interval QT, gestures, etc.);
C (Communicating functions, telemetry) - ProgrammingC (Communicating functions, telemetry) - Programming
two-way interactive communication telemetry;two-way interactive communication telemetry;
Oh - no data functionsOh - no data functions..
V position code - protytahiarytmichna function:V position code - protytahiarytmichna function:
P (Pacing antitachyarrythmia) - volley stimulation;P (Pacing antitachyarrythmia) - volley stimulation;
S (Shock) - electrical cardioversion / defibrillation - AIKDS (Shock) - electrical cardioversion / defibrillation - AIKD
D (Dual P + S) - protytahiarytmichna dual function;D (Dual P + S) - protytahiarytmichna dual function;
Oh - no data functions.Oh - no data functions.

56. POSITION pacemaker in the chest and thePOSITION pacemaker in the chest and the
active electrode in the right ventricleactive electrode in the right ventricle

57. COMPLICATIONS Continuous electrical
stimulation of HEART
•Reducing the sensitivity of the myocardium to incentives.
The main reason for this complication - the progression of
structural changes in the myocardium. This CP is subject
to reprogramming blshim amplitude and frequency
generation of pulses.
•Reducing the frequency of stimulation in the magnetic
test less than 85 imp / min (need to replace CP). In most
CP control. Frequency pulse generator 99-100 imp / min.
(It is listed in the passport).
•Premature abandonment CP may result from defects or
generator. Low battery power (energy drain). Such
patients should direct replacement CP.