Guide 9-PACEMAKER AND DESFIBRILLATOR

In this blog, we describe how the pacemaker and defibrillator were performed, according to the established parameters, such as having a patient simulator where four pathologies could be selected, seeing both the pathology wave form and the team that corrects it.

GLOSSARY

1. PACEMAKER

The pacemaker electrical biomedical device is placed inside helping to correct the slow, rapid or deformed heart rate, because it sends electrical impulses to the heart stimulating the contractions and correcting the normal rhythm of a heart. The primary objetive of a pacemaker is to maintain an adequate heart rate, either because the heart's natural pacemaker is not fast enough, or because there is a block in the heart's electrical conductive system.

The pacemaker when placed on the body, has different parts such as the head which has the connection of leads, which are cables covered with soft and flexible material; after this is the generator which is responsible for sending electrical impulses to the heart; and finally the anchors that connect to the cardiac muscle.

a. Bradycardia:

When a heart rate of less than 60 beats per minute (BPM) is present, it is called bradycardia. When this pathology occurs, the heart rate can fail below 60 BPM during deep sleep.

Causes:

• Problems with the sinoatrial (SA) node, sometimes called the heart's natural pacemaker

• Problems in the conduction pathways of the heart (electrical impulses are not conducted from the atria to the ventricles)

• Metabolic problems such as hypothyroidism (people with low thyroid hormone)

• Damage to the heart from heart attack or heart disease (myocardial infarction or MI)

b. Tachycardia:

When the heart beats at a heart rate of more than 100 beats per minute (BPM) it is called tachycardia. This rapid frequency often occurs in the upper chambers of the heart, triggering abnormally, interfering with the electrical signals that are sent from the sinoatrial node. The accelerated heart rate does not allow enough time for the heart to fill before compromising blood flow to the rest of the body.

2. DESFIBRILLATOR

The biomedical defibrillator is a device that gives an electric shock to the heart when the patient presents different pathologies such as ventricular estrasistoles, polymorphic ventricular tachycardia and inclusivae when cardiac arrest occurs.

The mode of use is as follows:

a. Make sure the patient is not wet.

b. Turn it on.

c. Prepare the chest area.

d. Place the included patches.

e. Electrodes are placed on the chest to provide an electrical shock to the heart.

a. Extrasistoles ventriculares:

Ventricular extrasystoles are ectopic stimuli produced in the ventricles which produce a premature ventricular depolarization and occur in patients with structural heart disease.

In the ECG: Premature QRS complex in relation to the expected stimulus of the basal rhythm. Wide QRS complex with abnormal morphology. Alterations in the ST and in the T wave. The Ventricular Extrasystole is not preceded by Onda P. Complete compensatory pause: After the Ventricular Extrasystole there is a delay until the appearance of the basal rhythm.

b. Tachycardia ventricular

Ventricular tachycardias (VT) are a group of arrhythmias encompassed within ventricular arrhythmias. It is characterized by the presence of three or more consecutive ventricular beats with a high cardiac frequency. The appearance of Ventricular Tachycardia, especially in patients with Ischemic Heart Disease, continues to be an important problem in clinical practice and, together with Ventricular Fibrillation, is one of the main causes of sudden cardiac death, especially in patients with structural heart disease.

DISEÑO

DEVELOPMENT

Simulator.

For the realization of the patient simulator, it was done through pic18f4550 and code in MPLAB; where you pass through an R2R circuit the signal is printed by the D port.

In the first place for the realization of the code of the simulator of patient, the libraries that are going to be used must be included, in this case math libraries, of writing, of exits of port; as well as how to configure Port D as output and the occluding frequency for signals

For the signals, the vector is created in the Matlab software, creating an ECG with normal heart rate of 100, for the case of the pathologies Bradycardia and Tachycardia is controlled by means of delay; On the other hand, for the polymorphic ventricular tachycardia section, a new vector without QRS complex is created, as well as a new vector for the arrest.

Normal ECG, Bradycarida, Tachicardia-Tachicardia ventricular

%%%%ECG normal, taticardia, bradicardia%%%%

% x=[8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 9, 9, 9, 9, 10, 10, 10, 10, 11, 11, 11, 12, 12, 12, 12, 12, 13, 13, 13, 13, 13, 13, 13, 13, 14, 14, 14, 14, 14, 14, 14, 14, 14, 13,13, 13, 13, 13, 13, 13, 13, 12, 12, 12, 11, 11, 10, 10, 9, 9, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 7, 7, 6, 6, 5, 5, 5, 4, 4, 4, 4, 6, 9, 13, 16, 20, 24, 29, 33, 38, 42, 46, 49, 52, 54, 55, 54, 53, 51, 48,45, 41, 37, 32, 28, 23, 19, 15, 10, 5, 1, 0, 0, 0, 1, 1, 2, 3, 3, 4, 5, 6, 6, 7, 7, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8,8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 9, 10, 11, 12, 12, 12, 12, 13, 13, 13, 13, 14, 14, 14, 14, 14, 14, 14, 14, 15, 15, 15, 15,15, 15, 15, 15, 15, 15, 15, 15, 15, 15, 14, 14, 14, 14, 14, 14, 13, 13, 13, 12, 11, 11, 10, 9, 9, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8,8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8, 8];

%%%%Taticardia ventriculkar polimorfica%%%%

% x=[128, 128, 128, 128, 102, 102, 102, 128, 153, 153, 128, 77, 77, 102, 153, 179, 179, 102, 51, 51, 102, 179, 204, 179, 77, 26, 51, 128, 204, 230, 153, 51, 0, 51, 153, 230, 230, 128, 26, 0, 77, 179, 255, 204, 102, 0, 26, 102, 204, 230, 179, 77, 0, 51, 128, 204, 204, 128, 51, 26, 77, 153, 204, 179, 102, 51, 51, 102, 153, 179, 153, 102, 77, 102, 128, 128, 128, 128, 102, 102, 128];

Extrasistoles ventricular-Paro

%%%%%%Extrasistoles ventriculares%%%%%

% x=[18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 22, 21, 20, 19, 18, 18, 17, 17, 16, 16, 15, 15, 15, 13, 11, 11, 11, 9, 9, 7, 7, 5, 3, 3, 1, 1, 0, 0, 1, 1, 3, 3, 3, 5, 7, 7, 9, 10, 10, 11, 13, 15, 17, 17, 18, 19, 23, 26, 30, 34, 39, 43, 48, 52, 56, 59, 62, 64, 65, 64, 63, 61, 58, 55, 51, 47, 42, 38, 33, 29, 25, 20, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18, 18];

%%%%%%PARO%%%%%

%x=[128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128, 128];

Subsequently, port B is defined from 0 to 3 as input for the selection of the pathology by means of a dipswitch; and port B from 4 to 7 as output for the LED indication of each selection.

After this, by means of 'if' is selected I have printed the pathology by the D port, the 'if' must contain each port B defined previously and equal to '0' or '1' depending on the state of the switch

PACEMAKER.

DESFIBRILLATOR.

ARDUINO

CONCLUSIONS

1. By means of a patient simulator, the graph of the ECG signal was designed at 60, 100, 120 beats per minute; as well as graphics of other pathologies.

2. The appropriate treatment for different cardiac pathologies was analyzed, using for this a pacemaker with frequency of 1Hz and a defibrillator with 3 discharges.

3. The medical equipment used to synchronize the heart rate, in pathologies such as tachycardia and bradycardia is the pacemaker, due to the frequency of its pulse train; Likewise, the defibrillator is used in situations that require a greater emergency.

REFERENCES

1. Rodríguez, R. O., de Juan Montiel, J., Pascual, T. R., Ruiz, A. B., & de Miguel, E. M. (2000). Guías de práctica clínica de la Sociedad Española de Cardiología en marcapasos. Revista Española de Cardiología, 53(7), 947-966.

2. Morillo, C. A., & Guzmán, J. C. (2007). Taquicardia sinusal inapropiada: actualización. Revista Española de Cardiología, 60(Supl. 3), 10-14.

3. Hernández Madrid, A., Escobar Cervantes, C., Blanco Tirado, B., Marín Marín, I., Moya Mur, J. L., & Moro, C. (2004). Resincronización cardíaca en la insuficiencia cardíaca: bases, métodos, indicaciones y resultados. Revista Española de Cardiología, 57(07), 680-693.

4. Calandre, L. (1921). Bradicardia congénita con bloqueo cardíaco intermitente. Arch Cardiol Hematol, 2(4), 225-232.