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Biomedical subjects

Liza A Prudente

Publications and source records attributed to Liza A Prudente.

5 recordsLinked to original sources
PubMed2006

Psychological indices and phantom shocks in patients with ICD.

INTRODUCTION: Some patients with ICDs experience the sensation of a shock in the absence of true therapy (phantom shock). We hypothesize that phantom shocks may be a manifestation of anxiety, depression or PTSD. METHODS AND RESULTS: All patients over 18 years old with an ICD were eligible to enroll in the study. The first 75 subjects who agreed to participate were enrolled and divided into three groups: ICD patients with phantom shocks (n = 19); ICD patients who had actual shocks (n = 28) and ICD patients who had no shocks (n = 28). During a clinic visit a demographic questionnaire and three psychological rating scales were administered: the Spielberger State-Trait Anxiety Inventory (STAI); the Center for Epidemiologic Studies Depression Scale (CES-D) and the Posttraumatic Stress Checklist (PCL-C). No significant differences between groups were found in gender, race, age, history of MI or cardiac surgery status. Data analysis of the psychological indices using one-way ANOVA showed that the group with phantom shocks had more depression (CES-D p = 0.011) and more anxiety (STAI p = 0.010) than the other groups. Multiple comparisons of group means showed a greater percentage of clinically depressed patients in the phantom shock group than in the other groups. CONCLUSION: Patients with phantom shocks are more likely to be clinically depressed and have higher levels of anxiety than other ICD patients, regardless of history of actual shocks.

Aged↗
PubMed2005

Placement of transvenous pacemaker and ICD leads across total chronic occlusions.

OBJECTIVE: To establish a method of implantation for device leads across total venous occlusions. BACKGROUND: Indications for pacemaker and implantable cardiac defibrillator implantation continue to expand. Chronic venous occlusions are increasingly encountered with lead placement. Some degree of obstruction can be as high as 13% before device implantation and 50% after transvenous device implantation. We report an approach of venoplasty/dilatation of chronic total occlusions to allow lead placement. METHODS: From January 1, 2002 through December 16, 2004, 1,356 systems (initial and upgrade) were implanted at the University of Virginia. At the time of device implant, seven patients were noted to have chronic venous occlusions and alternative access was precluded. Four of the seven patients had an existing system; the other three received initial implantations. Subsequently, these seven patients had a 5 Fr catheter placed in the basilic/axillary/subclavian vein and a venogram was obtained to demonstrate the area of chronic occlusion. A guide wire was advanced across the lesion for initial recanalization. Dilatation or venoplasty was performed at the occluded site. A guide wire was retained across the lesion and the patient underwent lead implantation. RESULTS: In all seven patients, recanalization was achieved and leads were successfully placed. There were no complications or damage to the vessels or existing leads. CONCLUSIONS: Venoplasty or dilatation of chronic total venous occlusion is a safe and effective technique, which allows for placement of transvenous leads.

Adult↗
PubMedDate not supplied

Update on implantable pacemakers.

There are currently more than 3 million patients worldwide with implanted pacemakers, and indications for implants are expanding. Pacemakers today are smaller (23-30 g) and fashioned in a more physiologic shape so as to be less obtrusive. They are replete with sophisticated diagnostic and programming features that make troubleshooting of complicated arrhythmias easier. Advanced nurse clinicians need to have a basic understanding of pacemaker function, indications for implantation, an awareness of potential complications, and facility with basic troubleshooting. The purpose of this article is to describe the features of the pacemakers available today and approaches to troubleshooting these devices.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Psychological disturbances, adjustment, and the development of phantom shocks in patients with an implantable cardioverter defibrillator.

The implantable cardioverter defibrillator (ICD), approved for use in 1985, is used to treat potentially lethal ventricular arrhythmias by delivering an electrical impulse to the heart to convert the rhythm back to normal. Since that time, newer studies, such as MADIT II and SCD-HeFT, demonstrated the expanding utility of the ICD, which increases the likelihood of every clinician encountering a patient with an ICD. Patients with an ICD face psychological, physical, and social adjustments. Patients with an ICD, in general, have been shown to have high levels of anxiety, depression, and a sense of helplessness. A subset experiences a phenomenon of phantom shock, which may represent a manifestation of anxiety, depression, or other emotional disturbance. It is important to be aware of this phenomenon, as a phantom shock may either represent or contribute to the patient's maladjustment to the ICD. In lieu of specific screening and treatment options for phantom shock at present, we must use a general approach for recognizing patients experiencing this phenomenon.

Adjustment Disorders↗