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I could stand for either National Association For Sport And Physical Education or North American Society Of Pacing And Electrophysiology. Still, there are others. It would help to know what area you are referring to.
I could stand for either National Association For Sport And Physical Education or North American Society Of Pacing And Electrophysiology. Still, there are others. It would help to know what area you are referring to.
I could stand for either National Association For Sport And Physical Education or North American Society Of Pacing And Electrophysiology. Still, there are others. It would help to know what area you are referring to.
I could stand for either National Association For Sport And Physical Education or North American Society Of Pacing And Electrophysiology. Still, there are others. It would help to know what area you are referring to.
I could stand for either National Association For Sport And Physical Education or North American Society Of Pacing And Electrophysiology. Still, there are others. It would help to know what area you are referring to.
I could stand for either National Association For Sport And Physical Education or North American Society Of Pacing And Electrophysiology. Still, there are others. It would help to know what area you are referring to.
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∙ 15y ago
Wiki User
∙ 15y agoI could stand for either National Association For Sport And Physical Education or North American Society Of Pacing And Electrophysiology. Still, there are others. It would help to know what area you are referring to.
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NASPE identifies the primary goal of assessment as the documentation of learning rather than the enhancement of learning?
NASPE emphasizes that assessment should focus on the documentation of students' learning process and outcomes rather than on improving or enhancing their learning. This perspective suggests that assessment should primarily serve a record-keeping function, documenting what students have learned rather than actively supporting their continued learning and growth.
Cardioversion?
DefinitionCardioversion is a method to restore an abnormal heart rhythm back to normal.InformationCardioversion can be done using an energy shock (electric cardioversion) or medications (pharmacologic cardioversion).ELECTRIC CARDIOVERSIONElectric cardioversion may use a device that can be placed inside (internal) or outside (external) the body.External electric cardioversion uses a device called a defibrillator.Electrode patches are placed on the front and back of the chest and connected to the defibrillator.When the defibrillator paddles are placed on your chest, an energy shock is delivered to your heart. This shock briefly stops all electrical activity of the heart and then allows the normal heart rhythm to return.Sometimes more than one shock is needed.Emergency external electric cardioversion is used to treat any abnormal heart rhythm (arrhythmia) that is life threatening, such as ventricular tachycardia or ventricular fibrillation. Such a shock can be life saving.External electric cardioversion may also be used when there is not an emergency.Heart rhythm problems, such as atrial fibrillation or paroxysmal supraventricular tachycardia (PSVT) that began recently or that cannot be controlled with medicines may be treated this way.First, tests such as a transesophageal echocardiogram are often done to make sure that there are no blood clots in the heart. Some people may need to take blood thinners before the cardioversion procedure.You will usually be given a sedative before the procedure starts.After the external cardioversion, you may be given medicine to prevent blood clots and to help prevent the arrhythmia from coming back.An implantable cardioverter-defibrillator (ICD) is a device that is usually placed underneath the skin of your upper chest. This is a semi-permanent implantation (devices may need to be replaced after 6 - 10 years).The ICD detects any life-threatening, rapid heartbeat. If such a heartbeat (arrhythmia) occurs, the ICD quickly sends an electrical shock to the heart to change the rhythm back to normal.An ICD is placed in people who are at high risk of sudden cardiac death from dangerous arrhythmias, such as ventricular tachycardia or ventricular fibrillation.See also: Implantable cardiac defibrillatorCARDIOVERSION USING DRUGS (PHARMACOLOGIC)Cardioversion can be done using drugs that are taken by mouth or given through an intravenous line (IV). It can take several minutes to days for a successful cardioversion. If pharmacologic cardioversion is done in a hospital, your heart rate will be regularly checked. Although rare, cardioversion using drugs can be done outside the hospital. However, this requires close follow-up with a cardiologist.As with electrical cardioversion, you may be given blood thinning medicines to prevent blood clots from forming and leaving the heart (which can cause a stroke).COMPLICATIONSPossible complications of cardioversion are uncommon, but may include:Allergic reactions from medicines used in pharmacologic cardioversionBlood clots that can cause a stroke or other organ damageBruising, burning, or pain where the electrodes were usedWorsening of the arrhythmiaPeople who perform external cardioversion may be shocked if the procedure is not done correctly. This can cause heart rhythm problems, pain, and even death.ReferencesLafuente-Lafuente C, Mahe I, Extramiana F. Management of atrial fibrillation. BMJ. 2009; 339:b5216. doi: 10.1136/bjm.b5216.Miller JM, Zipes DP. Therapy for cardiac arrhythmias. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 33.Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. 2008;117:e350-e408.
Ventricular tachycardia?
DefinitionVentricular tachycardia (VT) is a rapid heartbeat that starts in the ventricles.Alternative NamesWide-complex tachycardia; V tach; Tachycardia - ventricularCauses, incidence, and risk factorsVentricular tachycardia is a pulse rate of more than 100 beats per minute, with at least three irregular heartbeats in a row.The condition can develop as an early or late complication of a heart attack. It may also occur in patients with:CardiomyopathyHeart failureHeart surgeryMyocarditisValvular heart diseaseVentricular tachycardia can occur without heart disease.Scar tissue may form in the muscle of the ventricles days, months, or years after a heart attack. This can lead to ventricular tachycardia.Ventricular tachycardia can also be caused by:Anti-arrhythmic medicationsChanges in blood chemistry (such as a low potassium level)Changes in pH (acid-base)Lack of enough oxygen"Torsade de pointes" is a form of ventricular tachycardia that is often due to congenital heart disease or the use of certain medications.SymptomsIf the heart rate during a ventricular tachycardia episode is very fast or lasts longer than a few seconds. There may be symptoms such as:Chest discomfort (angina)Fainting(syncope)Light-headedness or dizzinessSensation of feeling the heart beat (palpitations)Shortness of breathNote: Symptoms may start and stop suddenly. In some cases, there are no symptoms.Signs and testsSigns include:Absent pulseLoss of consciousnessNormal or low blood pressureRapid pulseVentricular tachycardia may be seen on:Continuous ambulatory electrocardiogram (Holter monitor)ECGIntracardiac electrophysiology study(EPS)Loop recorderBlood chemistries and other tests may be done.TreatmentTreatment depends on the symptoms, and the type of heart disorder. Some people may not need treatment.If ventricular tachycardia becomes an emergency situation, it may require:CPRElectrical defibrillation or cardioversion (electric shock)Anti-arrhythmic medications (such as lidocaine, procainamide, sotalol, or amiodarone) given through a veinLong-term treatment of ventricular tachycardia may require the use of oral anti-arrhythmic medications (such as procainamide, amiodarone, or sotalol). However, anti-arrhythmic medications may have severe side effects. Their use is decreasing in favor of other treatments.Some ventricular tachycardias may be treated with an ablation procedure. Radiofrequency catheter ablation can cure certain tachycardias.A preferred treatment for many chronic (long-term) ventricular tachycardias consists of implanting a device called implantable cardioverter defibrillator (ICD). The ICD is usually implanted in the chest, like a pacemaker. It is connected to the heart with wires.The doctor programs the ICD to sense when ventricular tachycardia is occurring, and to administer a shock to stop it. The ICD may also be programmed to send a rapid burst of paced beats to interrupt the ventricular tachycardia. You may need to take anti-arrhythmic drugs to prevent repeated firing of the ICD.Expectations (prognosis)The outcome depends on the heart condition and symptoms.ComplicationsVentricular tachycardia may not cause symptoms in some people. However, it may be lethal in other people. It is a major cause of sudden cardiac death.Calling your health care providerGo to the emergency room or call the local emergency number (such as 911) if you have a rapid, irregular pulse, faint, or have chest pain. All of these may be signs of ventricular tachycardia.PreventionIn some cases, the disorder is not preventable. In other cases, it can be prevented by treating heart diseases and correcting blood chemistries.ReferencesOlgin JE, Zipes DP. Specific Arrhythmias: Diagnosis and Treatment. In: Libby P, Bonow RO, Mann DL, Zipes DP. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 35.Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA,HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC?AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. 117:e350-e408.
Heart pacemaker?
DefinitionA pacemaker is a small, battery-operated device that senses when your heart is beating irregularly or too slowly. It sends a signal to your heart that makes your heart beat at the correct pace.Alternative NamesCardiac pacemaker implantation; Artificial pacemaker; Permanent pacemaker; Internal pacemaker; Cardiac resynchronization therapy; CRT; Biventricular pacemakerDescriptionNewer pacemakers weigh as little as 1 ounce. A pacemaker usually has 2 parts:The generator contains the battery and the information to control the heartbeat.The leads are wires that connect the heart to the generator and carry the electrical messages to the heart.A pacemaker must be implanted under the skin. This procedure usually takes about 1 hour. You will be given a sedative to help you relax. You will be awake during the procedure.A small incision (cut) is made, usually on the left side of the chest below your collarbone. The pacemaker generator is then placed under the skin at this location.Using live x-rays to see the area, the doctor puts the leads through the incision, into a vein, and then into the heart. The leads are connected to the generator. The skin is closed with stitches. Most patients go home within 1 day of the procedure.Two kinds of pacemakers -- transcutaneous and transvenous pacemakers -- are used only in medical emergencies. They are not permanent pacemakers.Why the Procedure Is PerformedPacemakers may be used for people who have heart problems that cause their heart to beat too slowly. A slow heartbeat is called bradycardia. Two common problems that cause a slow heartbeat are sinus node disease and heart block.When your heart beats too slowly, your body and brain may not get enough oxygen. Symptoms may be lightheadedness, tiredness, fainting spells, and shortness of breath.Some, pacemakers can be used to stop a heart rate that is too fast (tachycardia) or that is irregular.Other types of pacemakers can be used in severe heart failure. These are called biventricular pacemakers. They match up the beating of both sides of the heart.All of today's biventricular pacemakers can also work as implantable cardio-defibrillators (ICD), which restore a normal heartbeat.RisksPossible complications of pacemaker surgery are:Abnormal heart rhythmsBleedingPunctured lung. This is rare.InfectionPuncture of the heart, which can lead to bleeding around the heart. This is rare.A pacemaker can usually sense if the heartbeat is above a certain rate. When it is above that rate, the pacemaker will stop sending signals to the heart. The pacemaker can also sense when the heartbeat slows down too much. It will automatically turn back on and start pacing the heartbeat again.Before the ProcedureAlways tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.The day before your surgery:Shower and shampoo well.You may be asked to wash your whole body below your neck with a special soap.On the day of the surgery:You may be asked not to drink or eat anything after midnight the night before your procedure. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.Take your drugs your doctor told you to take with a small sip of water.Your doctor or nurse will tell you when to arrive at the hospital.After the ProcedureYou will probably be able to go home after 1 day. You should be able to return to your normal activity level quickly.Talk with your doctor about how much you can use the arm on the side of your body where the pacemaker was placed. You may be advised not to lift anything heavier than 10 to 15 pounds and to avoid a lot of pushing, pulling, or twisting your arm for 2 to 3 weeks. You may also be told not to raise your arm above your shoulder for 6 weeksWhen you leave the hospital, you will be given a card to keep in your wallet. This card lists the details of your pacemaker and has contact information for emergencies. You should always carry this wallet card with you.OutlookPacemakers are often able to help keep your heart rhythm and heart rate at a level that is safe for you. The pacemaker battery lasts about 6 to 15 years. Your doctor will check the batter regularly and replace it when necessary.ReferencesEpstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. 2008;117(21): e350-408.Hayes DL, Zipes DP. Cardiac Pacemakers and Cardioverter-Defibrillators. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 34.
Implantable cardioverter-defibrillator?
DefinitionAn implantable cardioverter-defibrillator (ICD) is a device that detects any life-threatening, rapid heartbeat. If such a heartbeat, called an arrhythmia, occurs, the ICD quickly sends an electrical shock to the heart to change the rhythm back to normal. This is called defibrillation.Alternative NamesICD; DefibrillationDescriptionAn ICD is made of these parts:The pulse generator is about the size of a large cookie. It contains a battery and the electrical circuits that read the electrical activity of your heart.The electrodes are wires, also called leads, that go through your veins to your heart. They connect your heart to the rest of the device. Your ICD may have 1, 2, or 3 electrodes.All ICDs have a built-in pacemaker. Your heart may need pacing if it is beating too slowly or too fast, or if you have had a shock from the ICD.A surgeon will insert your ICD when you are awake. The area of your chest wall below your collarbone will be numbed with anesthesia, so you will not feel pain. The surgeon will make an incision (cut) through your skin and create space under your skin and muscle for the ICD generator. Usually this space is made near your left shoulder.Using special x-ray to see inside your chest, the surgeon will place the electrode into a vein, then into your heart. Then the surgeon will connect the electrodes to the pulse generator and pacemaker.The procedure usually takes 2 to 3 hours.Why the Procedure Is PerformedAn implantable cardiac defibrillator is placed in people who are at high risk of sudden cardiac death. Reasons you may be at high risk are:You have had life-threatening bouts of ventricular tachycardia(VT) or ventricular fibrillation (VF).Your heart is weakened, too large, and does not pump blood very well. This may be from earlier heart attacks, heart failure, or cardiomyopathy (a diseased heart muscle).Certain congenital (present at birth) heart problems or genetic health conditionsSee also:Heart attackHeart failureRisksRisks for any surgery are:Blood clots in the legs that may travel to the lungsBreathing problemsHeart attack or strokeAllergic reactions to medicines (anesthesia) used during surgeryInfectionPossible risks for this surgery are:Wound infectionInjury to your heart or lungsDangerous heart arrhythmiasAn ICD sometimes delivers shocks to your heart when you do not need them. Even though a shock lasts a very short time, you can usually feel it.This and other ICD problems can sometimes be prevented by changing how your ICD is programmed. It can also be set to sound an alert if there is a problem. Your electrophysiologist, the doctor who manages your ICD care, can program your device.Before the ProcedureAlways tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.The day before your surgery:Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you might have.Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap.You may also be asked to take an antibiotic, to guard against infection.On the day of the surgery:You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.Take your drugs your doctor told you to take with just a small sip of water.Your doctor or nurse will tell you when to arrive at the hospital.After the ProcedureMost people who have an ICD implanted are able to go home from the hospital in 1 day. Most quickly return to their normal activity level. Full recovery takes about 4 to 6 weeks.When you leave the hospital, you will be given a card to keep in your wallet. This card lists the details of your ICD and has contact information for emergencies. You should always carry this wallet card with you.You will need to make regular visits to the doctor so your ICD can be monitored. The doctor will check to see if the device is properly sensing your heartbeat, how many shocks have been delivered, and how much power is left in the batteries.Outlook (Prognosis)Your ICD will constantly monitor your heartbeats to make sure they are steady. It will deliver a shock to the heart when it senses a life-threatening rhythm. This device can also work as a pacemaker.ReferencesEpstein, A E, DiMarco, J P, Ellenbogen, K A, Estes, N A, 3rd, Freedman, R A, Gettes, L S, et al. (2008). "ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons." Circulation;117(21): e350-408.Hayes DL, Zipes DP. Cardiac pacemakers and cardioverter-defibrillators. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 34.
Arrhythmias?
DefinitionAn arrhythmia is a disorder of the heart rate (pulse) or heart rhythm, such as beating too fast (tachycardia), too slow (bradycardia), or irregularly.Alternative NamesDysrhythmias; Abnormal heart rhythms; Bradycardia; TachycardiaCauses, incidence, and risk factorsNormally, your heart is able to pump blood out to your body without working any harder than is needed.To help this happen, your heart has an electrical system that makes sure it contracts (squeezes) in an orderly way.The electrical impulse that signals your heart to contract begins in the sinoatrial node (also called the sinus node or SA node). This is your heart's natural pacemaker.The signal leaves the SA node and travels through the two upper chambers (atria).Then the signal passes through another node (the AV node). Finally, it passes through the lower chambers (ventricles).Different nerve messages signal your heart to beat slower or faster.Arrhythmias are caused by problems with the heart's electrical conduction system. Other areas of the electrical system may also send out signals. Other times, electrical signals are not able to move as easily or at all.When an arrhythmia is present, your heartbeat may be:Too slow (bradycardia)Too quick (tachycardia)IrregularProblems can occur anywhere along this conduction system, causing various arrhythmias. Examples include:Atrial fibrillation or flutterAtrioventricular nodal reentry tachycardia (AVNRT)Heart block or atrioventricular blockMultifocal atrial tachycardiaParoxysmal supraventricular tachycardiaSick sinus syndromeVentricular fibrillationVentricular tachycardia -- a fast heart rate that originates in the lower chambers (ventricles)Wolff-Parkinson-White syndromeThe risk of getting a tachycardia or bradycardia varies greatly, depending on:Blood chemistry imbalances, such as abnormal potassium levelsCardiomyopathy-- a weakening of the heart muscle or a change in the heart muscleHeart failureOveractive thyroid glandPast heart attackArrhythmias may also be caused by some substances or drugs, including:AmphetaminesCaffeineCocaineBeta blockersPsychotropicsSympathomimeticsSometimes anti-arrhythmic medications -- prescribed to treat one type of arrhythmia -- can actually cause another type of arrhythmia.SymptomsAn arrhythmia may be present all of the time or it may come and go. You may or may not feel symptoms when the arrhythmia is present. Or, you may only notice symptoms when you are more active.Symptoms can be very mild when present, or they may be severe or even life-threatening.Common symptoms include:Chest painFaintingFast or slow heartbeat (palpitations)Light-headedness, dizzinessPalenessShortness of breathSkipping beats - changes in the pattern of the pulseSweatingSigns and testsThe doctor will listen to your heart with a stethoscope and feel your pulse. Your blood pressure may be low or normal.The following tests may be performed to identify arrhythmias:Ambulatory cardiac monitoring with a Holter monitor (used for 24 hours), event monitor, or loop recorder (worn for 2 weeks or longer)Coronary angiographyECGEchocardiogramElectrophysiology study (EPS)If an arrhythmia is detected, various tests may be done to confirm or rule out suspected causes. EPS testing may be done to find the arrhythmia and determine the best treatment, especially if a pacemaker or catheter ablation procedure is being considered.TreatmentWhen an arrhythmia is serious, you may need urgent treatment to restore a normal rhythm. This may include:Electrical "shock" therapy (defibrillation or cardioversion)Implanting a temporary pacemaker to interrupt the arrhythmiaMedications given through a vein (intravenous)Sometimes, getting better treatment for your angina or heart failure will decrease the chance of having an arrhythmia.Medications may be used to prevent an arrhythmia from happening again, or to keep your heart rate from becoming too fast or too slow. These are called anti-arrhythmic drugs.Some of these medicines can have side effects. Not all arrhythmias respond well to medications.Cardiac ablationis a procedure used to destroy areas in your heart that may be causing your heart rhythm problems. Ablate means "to destroy."An implantable cardiac defibrillator is placed in people who are at high risk of sudden cardiac death.You may need a defibrillator if you have had life-threatening bouts of ventricular tachycardia (VT) or ventricular fibrillation (VF), or if your heart is weakened, too large, and does not pump blood very well.As soon as arrhythmia begins, the ICD sends a shock to stop it, or a burst of pacing.Pacemakers may be used for people who have heart problems that cause their heart to beat too slowly (bradycardia). Some pacemakers can be used to stop a heart rate that is too fast (tachycardia) or irregular.Expectations (prognosis)The outcome depends on several factors:The kind of arrhythmia -- whether it is supraventricular tachycardia, or a more dangerous arrhythmia such as ventricular tachycardia or ventricular fibrillationThe overall pumping ability of the heart (ejection fraction)Whether you have heart disease (coronary artery disease, heart failure, valvular heart disease) and how well it can be treatedSome types of arrhythmias may be life-threatening if not promptly and properly treated.With bradycardias treated with a permanent pacemaker, the outlook is usually good.ComplicationsAnginaHeart attackHeart failureStrokeSudden deathCalling your health care providerCall your health care provider if:You develop any of the symptoms of a possible arrhythmiaYou have been diagnosed with an arrhythmia and your symptoms worsen or do not improve with treatmentPreventionTaking steps to prevent coronary artery disease may reduce your chance of developing an arrhythmia. These steps include:Eating a well-balanced, low-fat dietExercising regularlyNot smokingReferencesEpstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. 2008;117:e350-e408.Hayes DL, Zipes DP. Cardiac pacemakers and cardioverter-defibrillators. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 34.
