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Файл:English Guide for Bio-Medical Engineers. Учебное пособие
.pdf
fracture
insulation
to be on-demand
longevity
to utilize
onset
current drain
долговечность
трещина, перелом
пользоваться спросом
начало
потребление тока
использовать
внутренняя сердечная деятельность
4.2.4 Divide the text into logical parts and entitle them.
Text C. 4.3 Lifestyle considerations
4.3.1 Read and translate text C:
A patient's lifestyle is usually not modified to any great degree after insertion of a
pacemaker. There are a few activities that are unwise such as full contact sports and
activities that involve intense magnetic fields.
The pacemaker patient may find that some types of everyday actions need to be
modified. For instance, the shoulder harness of a vehicle seatbelt may be uncomfortable if
the harness should fall across the pacemaker insertion site.
Any kind of an activity that involves intense magnetic fields should be avoided.
This includes activities such as arc welding possibly, with certain types of equipment, or
maintaining heavy equipment that may generate intense magnetic fields (such as
a magnetic resonance imaging (MRI) machine).
However, in February 2011 the FDA approved a new pacemaker device called the
Revo MRI SureScan which is the first to be proven safe for MRI use. There are several
limitations to its use including certain patients’ qualifications, body parts, and scan
settings.
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A 2008 U.S. study has found that the magnets in some headphones included with
portable music players, when placed within an inch of pacemakers, may cause
interference.
Some medical procedures may require the use of antibiotics to be administered
before the procedure. The patient should inform all medical personnel that they have a
pacemaker. Some standard medical procedures such as the use of magnetic resonance
imaging (MRI) may be ruled out by the patient having a pacemaker.
In addition, according to the American Heart Association, some home devices have
a remote potential to cause interference by occasionally inhibiting a single beat. Cellphones available in the United States (less than 3 watts) do not seem to damage pulse
generators or affect how the pacemaker works.
4.3.2 Write the transcription of following words and word-combinations, find out
the meanings:
unwise, intense magnetic fields, harness, to cause interference, to be administered,
to affect, inhibiting, magnetic resonance imaging.
4.3.3 Say whether the following statements are True or False and correct the false
ones:
1) A patient's lifestyle is usually modified to any great degree after insertion of a
pacemaker.
2) The pacemaker patient may find that some types of everyday actions need to be
modified.
3) Any kind of an activity that involves intense magnetic fields should not be
avoided.
4) However, in February 2009 the FDA approved a new pacemaker device.
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5) There are several limitations to its use including certain patients’ qualifications,
body parts, and scan settings.
6) A 2008 U.S. study has found that the magnets in some headphones included with
portable music players, when placed within an inch of pacemakers, do not cause any
interference.
7) The patient should inform all medical personnel that they have a pacemaker.
8) Some standard medical procedures such as the use of magnetic resonance
imaging (MRI) may be ruled out by the patient having an implant.
9) Cell-phones available in the United States (less than 6 watts) do not seem to
damage pulse generators or affect how the pacemaker works.
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5 Unit 5. Pacemaker maintenance
Text A. 5.1 Pacemaker maintenance
5.1.1 Read and translate text A:
Turning off the pacemaker
According to a consensus statement by the Heart Rhythm Society, it is legal and
ethical to honor requests by patients or by those with legal authority to make decisions for
patients, to deactivate implanted cardiac devices. Lawyers say that the legal situation is
similar to removing a feeding tube. A patient has a right to refuse or discontinue treatment,
including a pacemaker that keeps him or her alive. Physicians have a right to refuse to turn
it off, but they should refer the patient to a physician who will. Some patients believe that
hopeless, debilitating conditions like strokes, in combination with dementia, can cause so
much suffering to themselves and their families that they would prefer not to prolong their
lives with supportive measures, such as cardiac devices.
Security and privacy
Security and privacy concerns have been raised with pacemakers that allow wireless
communication. Unauthorized third parties may be able to read patient records contained
in the pacemaker, or reprogram the devices, as has been demonstrated by a team of
researchers. The demonstration worked at short range; they did not attempt to develop a
long range antenna. The proof of concept exploit helps demonstrate the need for better
security and patient alerting measures in remotely accessible medical implants. In response
to this threat, Purdue University and Princeton University researchers have developed a
prototype firewall device, called MedMon, which is designed to protect wireless medical
devices such as pacemakers and insulin pumps from hackers.
Complications
A possible complication of dual-chamber artificial pacemakers is pacemakermediated tachycardia (PMT), a form of reentrant tachycardia. In PMT, the artificial
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pacemaker forms the anterograde (atrium to ventricle) limb of the circuit and the
legal situation right security and privacy switch dual-chamber
firewall device treatment is tracked supportive measures
atrioventricular (AV) node forms the retrograde limb (ventricle to atrium) of the
circuit. Treatment of PMT typically involves reprogramming the pacemaker.
Another possible complication is "pacemaker-tracked tachycardia," where
a supraventricular tachycardia is tracked by the pacemaker and produces beats from a
ventricular lead. This is becoming exceedingly rare as newer devices are often
programmed to recognize supraventricular tachycardias and switch to non-tracking modes.
5.1.2 Write the transcription of following words and word-combinations, find out
the meanings:
to deactivate implanted cardiac devices, to remove a feeding tube, to refuse or discontinue
treatment, debilitating conditions, dementia, long range antenna, patient alerting measures.
5.1.3 Write the synonyms and antonyms to the following words:
to turn off, request, authority, to deactivate, device, to discontinue, to refuse, physician,
hopeless, to prolong, unauthorized, to reprogram, to exploit, remote, accessible,
researcher, to protect, artificial, possible, rare, to be tracked.
5.1.4 Complete each sentence with a word or phrase from the box:
1) Lawyers say that the ... ... is similar to removing a feeding tube.
2) A patient has a ... to refuse or discontinue treatment, including a pacemaker that
keeps him or her alive.
3) Some patients prefer not to prolong their lives with ... ..., such as cardiac devices.
4) ... ... ... concerns have been raised with pacemakers that allow wireless
communication.
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5) Purdue University and Princeton University researchers have developed a
prototype ... ... , called MedMon, which is designed to protect wireless medical devices
such as pacemakers and insulin pumps from hackers.
6) A possible complication of ... ... artificial pacemakers is pacemaker-mediated
tachycardia (PMT), a form of reentrant tachycardia.
7) ... of PMT typically involves reprogramming the pacemaker.
8) A supraventricular tachycardia ... ... by the pacemaker and produces beats from
a ventricular lead.
9) Newer devices are often programmed to recognize supraventricular tachycardias
and ... to non-tracking modes.
5.1.5 Choose the verb in the proper tense:
1) It (is/are/were) legal and ethical to honor requests by patients or by those with
legal authority to make decisions for patients, to deactivate implanted cardiac devices.
2) A patient (had/has/have) a right to refuse or discontinue treatment, including a
pacemaker that keeps him or her alive.
3) Some patients (believes/believe/had believed) that hopeless, debilitating
conditions like strokes, in combination with dementia, can cause much suffering to
themselves and their families.
4) Security and privacy concerns (has been raised/have been raised/ had been
raised) with pacemakers that allow wireless communication.
5) The demonstration (works/worked/are working) at short range; they did not
attempt to develop a long range antenna.
6) A possible complication of dual-chamber artificial pacemakers
(were/are/is) pacemaker-mediated tachycardia (PMT).
7) In PMT, the artificial pacemaker (has form/forms/form) the anterograde (atrium
to ventricle) limb of the circuit.
8) Treatment of PMT typically (involve/involves/are involving reprogramming the
pacemaker.
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9) A supraventricular tachycardia (have been tracked/ is tracked/were tracked) by
the pacemaker and produces beats from a ventricular lead.
10) This (are becoming/is becoming/were becoming) exceedingly rare as newer
devices are often programmed to recognize supraventricular tachycardias and switch to
non-tracking modes.
5.1.6 Say whether the following statements are True or False and correct the false
ones:
1) Lawyers say that the legal situation is similar to removing a feeding tube.
2) A patient doesn't have a right to refuse or discontinue treatment, including a
pacemaker that keeps him or her alive.
3) Physicians have a right to refuse to turn it off, but they should refer the patient to
a technician who will.
4) Security and privacy concerns have been raised with pacemakers that allow
wireless communication.
5) The demonstration worked at long range; they did not attempt to develop a short
range antenna.
6) The proof of concept exploit helps demonstrate the need for better security and
patient alerting measures in short-distance accessible medical implants.
7) A possible complication of dual-chamber artificial pacemakers is pacemaker-
mediated tachycardia (PMT), a form of reentrant tachycardia.
8) Treatment of PMT doesn't typically involve reprogramming the pacemaker.
9) Another possible complication is "pacemaker-tracked tachycardia," where
a supraventricular tachycardia is tracked by the pacemaker and produces beats from a
ventricular lead.
10) This complication is becoming more frequent as newer devices are often
programmed to recognize supraventricular tachycardias and switch to non-tracking modes.
37
Text B. 5.2 Pacemaker codes
5.2.1 Scan the text and express its main idea in two or three sentences.
The North American Society of Pacing and Electrophysiology and the British
Pacing and Electrophysiology Group have developed a code to describe various pacing
modes. It usually consists of three letters, but some systems use four or five:
- Letter 1: chamber that is paced (A = atria, V = ventricles, D = dual-chamber).
- Letter 2: chamber that is sensed (A = atria, V = ventricles, D = dual-chamber, 0 =
none).
- Letter 3: response to a sensed event (T = triggered, I = inhibited, D = dual - T and
I, R = reverse).
- Letter 4: rate-responsive features; an activity sensor (eg an accelerometer in the
pulse generator) in single or dual-chamber pacemakers detects bodily movement and
increases the pacing rate according to a programmable algorithm (R = rate-responsive
pacemaker).
- Letter 5: anti-tachycardia facilities.
A pacemaker in VVI mode denotes that it paces and senses the ventricle and is
inhibited by a sensed ventricular event. The DDD mode denotes that both chambers are
capable of being sensed and paced.
Indications for permanent pacing:
Persisting symptomatic bradycardia.
- Complete AV block (Stokes-Adams attacks, asymptomatic, congenital), Mobitz
type II AV block, persistent AV block post anterior myocardial infarction.
- Pacemakers may have a role in the suppression of resistant tachyarrhythmias.
- Prevention of atrial fibrillation.
- Pacemakers have a role in the management of some patients with dilated
cardiomyopathy or hypertrophic obstructive cardiomyopathy.
The National Institute for Health and Care Excellence (NICE) recommends that
dual-chamber pacemakers can be used to treat symptomatic bradycardia in people
38
with sick sinus syndrome, AV block, or both, but that there are a number of special
circumstances where dual-chamber pacemakers should not be used for symptomatic
bradycardia.
5.2.2 Write what these abbreviations stand for:
VVI, DDD, AV, NICE, MRI, NACPI, BPEG, EED, CRT, TCP, AAI, AAIR, AVB, VDD,
ICD, ECG, PMT.
5.2.3 Translate text B in written form.
Text C. 5.3 Precautions for patients
5.3.1 Read and translate text C:
Driving
The patient must inform the Driver and Vehicle Licensing Agency (DVLA) that
they have a pacemaker.
For an ordinary driving licence
The patient can start driving again after one week as long as:
- There are no symptoms such as dizziness or fainting which may affect driving.
- The patient attends regular check-ups in the pacemaker clinic.
-The patient has not recently had a heart attack or heart surgery.
For a large goods vehicle (LGV) or passenger-carrying vehicle (PCV) licence
- The patient cannot drive these vehicles for six weeks after the pacemaker is fitted.
- The patient can apply for another licence when he/she no longer has any symptoms
that would affect driving - eg, dizziness or fainting.
- The current licence is replaced with a three-year licence and the patient will have
to go to a pacemaker clinic regularly.
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Sports
- Any strenuous activity should be avoided for about three to four weeks after the
pacemaker has been fitted. After that, the patient can continue or start most activities and
sports.
- For contact sports, care should be taken to avoid collisions that may damage the
pacemaker, and a protective pad should be considered.
Hospitals and medical treatment
- A doctor or technician should be informed that the patient has a pacemaker before
any investigations or treatment.
- Always show the pacemaker registration card to any doctor or dentist providing
treatment.
- Most pacemaker generators have an X-ray code that can be seen on a
standard CXR.
- Some hospital equipment, including equipment used in surgery, may interfere with
pacemakers. The pacemaker may need to be protected during any operation and
reprogrammed afterwards.
- Radiotherapy may damage the pacemaker's circuits. The degree of damage is
unpredictable and may vary with different systems. But the risk is significant and builds
up as the radiation dose increases. The pacemaker should be shielded as much as possible
and moved if it lies directly in the radiation field.
- MRI scans can be dangerous with a pacemaker and the patient should not have an
MRI scan. If an MRI scan is absolutely necessary, the pacemaker output in some models
can be reprogrammed.
- Short-wave or microwave diathermy may bypass the pacemaker's noise protection
and interfere with or permanently damage the pulse generator.
- Transcutaneous electrical nerve stimulation (TENS) may sometimes briefly inhibit
unipolar pacing, which then requires reprogramming of the pulse generator.
Outside interference
- Most pacemakers are very resistant to outside interference and the pacemaker has
special circuits to detect and remove unwanted electrical activity.
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