Core IM | Internal Medicine Podcast
#140 Bonus Pacemaker & ICDs: 5 Pearls Segment
Nov 29, 2023
This podcast discusses topics such as approaching syncope history in patients with implantable devices, distinguishing between benign vagal episodes and life-threatening arrhythmias, avoiding heparin products for patients with pacemakers or ICDs, new technologies and devices for contractility and heart failure, and anticoagulation and technology update.
24:46
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Quick takeaways
- When evaluating syncope in patients with pacemakers and ICDs, it is crucial to consider different categories like reflex syncope, orthostatic syncope, and cardiogenic syncope, to rule out mimics and determine the underlying cause.
- In patients with pacemakers or ICDs requiring surgery, the location of the surgery (above or below the iliac crest) determines the need for involvement from cardiology and specific measures like placing a magnet for asynchronous pacing or reprogramming ICD therapy to ensure uninterrupted pacing.
Deep dives
Approaching syncope in patients with pacemakers and ICDs
When evaluating syncope in patients with pacemakers and ICDs, it is important to consider three main categories: reflex syncope, orthostatic syncope, and cardiogenic syncope. These categories help in ruling out common mimics and determining the underlying cause. Reflex syncope is usually vasovagal, orthostatic syncope can be due to autonomic nervous system dysfunction, hypovolemia, or medications, and cardiogenic syncope may be caused by abnormal heart rhythms or valvular disease. Additionally, it is crucial to assess prodromal symptoms and ask about post-episode feelings to distinguish between vasovagal episodes and life-threatening arrhythmias.
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