Добавил:
ivanov666
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:English Guide for Bio-Medical Engineers. Учебное пособие
.pdf
3.1.3 Write out key words and word combinations from the text A 3.1.
3.1.4 Say whether the following statements are True or False and correct the false
ones:
1) Transcutaneous pacing (TCP), also called internal pacing, is recommended for the
initial stabilization of hemodynamically significant bradycardias of all types.
2) External pacing should not be relied upon for an extended period of time.
3) Pacing artifact on the ECG and severe muscle twitching may make this
determination easy.
4) The epicardial pacemaker leads were placed after the patient collapsed
before aortic valve surgery.
5) At the beginning of the tracing, distortion results from muscle contractions due to a
(short) hypoxic seizure.
6) Temporary epicardial pacing is used during open heart surgery should the surgical
procedure create atrio-ventricular block.
7) A pacemaker wire is placed into an aorta, under sterile conditions, and then passed
into either the right atrium or right ventricle.
8) Transvenous pacing is often used as a bridge to permanent pacemaker placement.
9) Most commonly, the generator is placed below the subcutaneous fat of the chest
wall, above the heart.
10) Modern pacemakers usually have the only function.
11) The most basic form monitors the heart's native electrical rhythm.
12) These modes AAIR and VDD are unusual in the US and very rarely used in Latin
America and Europe.
13) The coronary sinus lead wraps around the inside of the left ventricle, enabling
pacing of the right ventricle.
14) CRT devices have been shown to reduce mortality and improve quality of life in
patients with heart failure symptoms.
21
3.1.5 Fill in the gaps in the sentences below with the suitable words:
1) This ... an old procedure used only as a life saving means until an electrical
pacemaker is brought to the patient.
2) The procedure is performed ... placing two pacing pads on the patient's chest,
either in the anterior/lateral position or the anterior/posterior position.
3) External pacing should not be relied upon for an extended period ... time.
4) It is an emergency procedure that acts as a bridge until transvenous pacing or other
therapies can ... applied.
5) Progressively weaker pacing stimuli are administered, ... results in asystole in the
second half of the tracing.
6) Transvenous pacing, when used ... temporary pacing, is an alternative to
transcutaneous pacing.
7) It can ... kept in place until a permanent pacemaker ... implanted or until there is no
longer a need for a pacemaker and then it is removed.
8) Permanent pacing with an implantable pacemaker involves transvenous placement
of one or ... pacing electrodes within a chamber, or chambers, of the heart.
9) The procedure is performed ... incision of a suitable vein into which the electrode
lead is inserted and passed along the vein.
10) ... are three basic types of permanent pacemakers, classified according to the
number of chambers involved and their basic operating mechanism.
11) This pacemaker ... sensors that detect changes in the patient's physical activity and
automatically adjust the pacing rate ... fulfill the body's metabolic needs.
12) The outer casing of pacemakers is so designed that it will rarely ... rejected by the
body's immune system.
13) Modern pacemakers usually ... multiple functions.
14) The ... basic form monitors the heart's native electrical rhythm.
15) The DDDR mode is ... commonly used as it covers all the options.
22
Text B. 3.2 Advancements in function
3.2.1 Read and translate text B:
Figure 7 – X-ray image of installed pacemaker showing wire routing
A major step forward in pacemaker function has been to attempt to mimic nature by
utilizing various inputs to produce a rate-responsive pacemaker using parameters such as
the QT interval, pO2 - pCO2 (dissolved oxygen or carbon dioxide levels) in the arterialvenous system, physical activity as determined by an accelerometer, body
temperature, ATP levels, adrenaline, etc. Instead of producing a static, predetermined heart
rate, or intermittent control, such a pacemaker, a 'Dynamic Pacemaker', could compensate
for both actual respiratory loading and potentially anticipated respiratory loading. The first
dynamic pacemaker was invented by Dr. Anthony Rickards of the National Heart
Hospital, London, UK, in 1982.
Dynamic pacemaking technology could also be applied to future artificial hearts.
Advances in transitional tissue welding would support this and other artificial
organ/joint/tissue replacement efforts. Stem cells may or may not be of interest to
transitional tissue welding.
Many advancements have been made to improve the control of the pacemaker once
implanted. Many of these have been made possible by the transition
to microprocessor controlled pacemakers. Pacemakers that control not only the ventricles
but the atria as well have become common. Pacemakers that control both the atria and
23
ventricles are called dual-chamber pacemakers. Although these dual-chamber models are
anticipate
stem cell
ventricle
atrium
dual-chamber
pumping efficiency
congestive heart failure
rate-responsive pacemaker
exacerbate
transitional
предвидеть
двухкамерный
эффективность подачи
предсердие
стволовая клетка
желудочек
кардиостимулятор частоты
сердцебиения
застойная сердечная недостаточность
переходный
обострять
usually more expensive, timing the contractions of the atria to precede that of the
ventricles improves the pumping efficiency of the heart and can be useful in congestive
heart failure.
Rate responsive pacing allows the device to sense the physical activity of the patient
and respond appropriately by increasing or decreasing the base pacing rate via rate
response algorithms.
The DAVID trials have shown that unnecessary pacing of the right ventricle can
exacerbate heart failure and increases the incidence of atrial fibrillation. The newer dual
chamber devices can keep the amount of right ventricle pacing to a minimum and thus
prevent worsening of the heart disease.
3.2.2 Match the words and word-combinations in the right hand column with the
words and word-combinations in the left hand column:
24
3.2.3 Complete each sentence with a word or phrase from the box:
a rate-responsive pacemaker heart rate was invented pacemaking
improve as well pumping efficiency incidence
1) A major step forward in pacemaker function has been to attempt to mimic nature
by utilizing various inputs to produce ... ... ... using parameters.
2) Instead of producing a static, predetermined ... ... , or intermittent control, such a
pacemaker, a 'Dynamic Pacemaker', could compensate for both actual respiratory loading
and potentially anticipated respiratory loading.
3) The first dynamic pacemaker ... ... by Dr. Anthony Rickards of the National Heart
Hospital, London, UK, in 1982.
4) Dynamic ... technology could also be applied to future artificial hearts.
5) Many advancements have been made to ... the control of the pacemaker once
implanted.
6) Pacemakers that control not only the ventricles but the atria ... ... have become
common.
7) The ventricles improves the ... ... of the heart and can be useful in congestive
heart failure.
8) The DAVID trials have shown that unnecessary pacing of the right ventricle can
exacerbate heart failure and increases the ... of atrial fibrillation.
3.2.4 Put the words in the right order to make sentences:
1) A, major, forward, in, step, nature, has, been, function, to attempt, to, pacemaker,
mimic.
2) Rickards, first, Dr., pacemaker, dynamic, by, The, was, Anthony, invented.
3) technology, artificial, Dynamic, could, also, future, pacemaking, be, applied, to,
hearts.
25
4) may, cells, or, may, to, tissue, not, be, Stem, of, transitional, interest, welding.
5) dual-chamber, that, control, atria, Pacemakers, both, the, and, are, called,
ventricles, pacemakers.
6) these, more, usually, dual-chamber, models, Although, expensive, are.
7) responsive, Rate, activity, allows, the, device, pacing, to, sense, the, of, the,
physical, patient.
26
4 Unit 4. Pacemaker usage considerations
Text A. 4.1 Insertion of a pacemaker
4.1.1 Read and translate text A:
A pacemaker is typically inserted into the patient through a simple surgery using
either local anesthetic or a general anesthetic. The patient may be given a drug for
relaxation before the surgery as well. An antibiotic is typically administered to prevent
infection. In most cases the pacemaker is inserted in the left shoulder area where an
incision is made below the collar bone creating a small pocket where the pacemaker is
actually housed in the patient's body. The lead or leads (the number of leads varies
depending on the type of pacemaker) are fed into the heart through a large vein using
a fluoroscope to monitor the progress of lead insertion. The Right Ventricular lead would
be positioned away from the apex (tip) of the right ventricle and up on the interventricular
septum, below the outflow tract, to prevent deterioration of the strength of the heart. The
actual surgery may take about 30 to 90 minutes.
Following surgery the patient should exercise reasonable care about the wound as it
heals. There is a follow-up session during which the pacemaker is checked using a
"programmer" that can communicate with the device and allows a health care professional
to evaluate the system's integrity and determine the settings such as pacing voltage output.
The patient should have the strength of their heart analyzed frequently with
echocardiography, every 1 or 2 years, to make sure the that placement of the right
ventricular lead has not led to weakening of the left ventricle.
The patient may want to consider some basic preparation before the surgery. The
most basic preparation is that people who have body hair on the chest may want to remove
the hair by clipping just prior to surgery or using a depilatory agent (preoperative shaving
has been on the decline as it can cause skin breakage and increase infection risk of any
27
surgical procedure) as the surgery will involve bandages and monitoring equipment to be
simple surgery
general anesthetic
drug
to administer
prevent infection
left shoulder
collar bone
apex
deterioration
to heal
evaluate
to make sure
right ventricular lead
to be afixed
incision
monitoring equipment
предотвращать инфекцию
простая хирургическая операция
общий наркоз
лекарство
левое плечо
применять
верхушка
ключица
лечить
ухудшение, повреждение
убедиться
оценивать
оборудование для мониторинга
рассечение, разрез
быть прикрепленным
правожелудочковый электрод
afixed to the body.
Since a pacemaker uses batteries, the device itself will need replacement as the
batteries lose power. Device replacement is usually a simpler procedure than the original
insertion as it does not normally require leads to be implanted. The typical replacement
requires a surgery in which an incision is made to remove the existing device, the leads are
removed from the existing device, the leads are attached to the new device, and the new
device is inserted into the patient's body replacing the previous device.
4.1.2 Write out fifteen bio-medical terms from text A, translate and learn them.
4.1.3 Match the words and word-combinations in the right hand column with the
words and word-combinations in the left hand column:
28
4.1.4 Write the plan to the text A 4.1 and retell it according to the plan.
Text B. 4.2 Living with a pacemaker and periodical pacemaker checkups
4.2.1 Read and translate text B:
International pacemaker patient identification cards carry information such as
patient data (among others, symptom primary, ECG, aetiology), pacemaker center (doctor,
hospital), IPG (rate, mode, date of implantation, manufacturer, type) and lead.
Figure 8 – Two types of remote monitoring devices used by pacemaker patients
Once the pacemaker is implanted, it is periodically checked to ensure the device is
operational and performing appropriately. Depending on the frequency set by the
following physician, the device can be checked as often as is necessary. Routine
pacemaker checks are typically done in-office every six (6) months, though will vary
depending upon patient/device status and remote monitoring availability.
At the time of in-office follow-up, the device will be interrogated to perform
diagnostic testing. These tests include:
Sensing: the ability of the device to "see" intrinsic cardiac activity (atrial and
ventricular depolarization).
Impedance: A test to measure lead integrity. Large and/or sudden increases in
impedance can be indicative of a lead fracture while large and/or sudden decreases in
impedance can signify a breach in lead insulation.
29
Threshold: this test confirms the minimum amount of energy (both volts and
patient data
physician
can be checked
remote monitoring
availability
intrinsic cardiac activity
impedance
данные пациента
наличие
могут быть проверены
удаленный мониторинг
врач-терапевт
полное сопротивление
изоляция
pulse width) required to reliably depolarize (capture) the chamber being tested.
As modern pacemakers are "on-demand", meaning that they only pace when
necessary, device longevity is affected by how much it is utilized. Other factors affecting
device longevity include programmed output and algorithms (features) causing a higher
level of current drain from the battery.
An additional aspect of the in-office check is to examine any events that were stored
since the last follow-up. These are typically stored based on specific criteria set by the
physician and specific to the patient. Some devices have the availability to display
intracardiac electrograms of the onset of the event as well as the event itself. This is
especially helpful in diagnosing the cause or origin of the event and making any necessary
programming changes.
4.2.2 Write the transcription of following words and word-combinations, find out
the meanings:
identification card, remote monitoring device, frequency set, remote monitoring,
availability, impedance, breach, threshold, current drain.
4.2.3 Match the words and word-combinations in the right hand column with the
words and word-combinations in the left hand column:
30
Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]