Unit 3

PACEMAKERS
TYPES OF PACEMAKERS:

Internal pacemaker
 External pacemaker
• Internal leads are connected to the electrodes that directly contact the surface of the myocardium.

• The exact location of the pulse generator used in the internal pacemaker system depends on the
following factors.

1. Type and nature of the electrode used.

2.Nature of the cardiac problems.

3.Mode of operation of the pacemaker system.

•
• There is no external connection for applying power. So the pulse generator should
be completely self contained with a battery, which is capable of operating
continuously for a specified period.

•
EXTERNAL PACEMAKER

• It consists of an externally placed pulse generator circuit connected to the

electrodes placed on the myocardium.

• External Pacemakers are used in following cases.

Temporary heart irregularities or disorders.

Treating the patient from arrhythmias.
Treatment of coronary patient and during the cardiac surgery.
• It consists of pulse generators.
• They are placed m the body and connected normally to the electrode with the help
of wires introduced into the right ventricle.
• The pulse generator may be strapped to the lower arm of the patient.
PACING MODES
VENTRICULAR SYNCHRONOUS PACEMAKER
• They are preferred for short periods of AV block.
• Using sensing electrode heart rate is detected & is given to timing circuit of
pacemaker
• . If the heart rate is below a min rate then pacemaker is turned on.
• The lead used to detect the R wave is now used to stimulate the heart
• . If natural contraction occurs then asynchronous pacer's timing circuit is reset so
that it will tie its next pulse to detect the heart beat else produce pulse at its
present rate
DEFIBRILLATOR

•Defibrillation is a process in which an electronic device sends an

electric shock to the heart to stop an extremely rapid, irregular
heartbeat, and restore the normal heart rhythm.

•Defibrillation is a common treatment for lifethreatening

cardiac dysrhythmias, ventricularfibrillation, and pulse
less ventriculartachycardia.
 Ventricular fibrillation is a serious cardiac
emergency resulting from asynchronous contraction of
the heart muscles.
 Due to ventricular fibrillation, there is an
irregular rapid heart rhythm.

Fig. Ventricular fibrillation Fig. Normal heart beat

 Ventricular fibrillation can be converted into a
more efficient rhythm by applying a high energy
shock to the heart.

 This sudden surge across the heart causes all

muscle fibres to contract simultaneously.

 Possibly, the fibres may then respond to

normal physiological pace making pulses.

 The instrument for administering the shock is

called a DEFIBRILLATOR.
Two types of defibrillators
1. AC defibrillators
2. DC defibrillators

AC Defibrillators
An AC defibrillator is the oldest and simplest type.

In AC defibrillation, a shock of 50 Hz a.c frequency is applied to the

chest for a time of 0.25 to 1 second through electrodes.

The procedure of applying electric shock to resynchronize heart is

known as Countershock.
Defibrillation continues until patient responds to the treatment.

An AC defibrillator consists of a step-up transformer with primary and secondary

winding, and two switches.

A.C supply is given through switches and fuse to primary winding of the transformer
.
The timing circuit is connected with switch, which is used to preset the time for the
defibrillator to deliver shock to the patient.

A resistive and a simple capacitor network or monostable multivibrator forms the

timing circuit.

It is triggered with a foot switch or a push button switch.

Various tapping are available along the secondary winding.

They are connected to the electrodes that delivers electric shock to the
heart of the patient.

Voltage value ranging between 250 V to 750 V is applied for AC

external defibrillation.
Fu
se

TO electr0des

Switch Sxi!Ch Operating

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AC Defbrlllât0f
DC defibrillator does not produce side effects and produces normal heartbeat.

Ventricular fibrillation is avoided when high-energy shock is passed through

discharging capacitor that is exposed to heart or chest of the patient.

DC defibrillator consists of auto transformer T1 that acts as primary of the high

voltage transformer T2.

A diode rectifier rectifies the output voltage from T2. It is connected to

vacuum type-high voltage over switch.
At position 1, switch is connected to one end of the capacitor.

When connected in this position capacitor charges to a voltage.

A foot switch present on the handle of the electrode is used to deliver shock to the patient.

Now the high voltage switch changes it position to 2 that makes the capacitor to discharge
to the heart through electrodes.
To slow down the discharge from the capacitor an inductor L is placed in one of the
electrode lead.

This L induces a counter voltage that reduces the capacitor discharge value.
Fig: Schematic diagram of a DC Defibrillator
DIALYSIS MACHINE
• FUNCTIONs
• Reduces accumulation of waste products and water in the body
• Maintains normal pH value of blood
• Regulates constant blood pressure
• Maintains the creatinine and urea levels in urine
• Removes toxic substances from the body
HEMODIALYSIS

• The Hemodialysis name it self contains hemo means blood and

dialysis means the diffusion of solute molecules through a semi
permeable membrane.
• Semi permeable membrane is one that allows the passage of certain smaller
molecules of such crystalloids as GLUCOSE and UREA, but
prevents passage of larger molecules

Haemodialysis, is a process of purifying the blood of a person whose kidneys

are not working normally.
• Hemodialysis removes wastes and water by circulating blood outside the body through an
external filter, called a dialyzer, that contains a semi permeable membrane.

• The blood flows in one direction and the dialysate flows in the opposite
• The concentrations of solutes (for example potassium, phosphorus, and urea) are
undesirably high in the blood, but low or absent in the dialysis solution

• The dialysis solution has levels of minerals like potassium and calcium that
are similar to their natural concentration in healthy blood.
DESCRIPTION:
• Hemodialysis is diffusion across a semi permeable membrane

• The semi permeable membrane is used to remove the wastes

from the blood and at the same time correct the level of
electrolytes in the blood.

• Before Hemodialysis can be performed, a surgeon must make

a way for the blood to be pumped out of the body and then be
returned after it has been cleansed.

• To do this, the surgeon uses an artery and a vein in the

forearm.
• Arteries (which have muscles in their walls) bring oxygenated blood
to the body from the heart, and veins return blood to the heart, which
needs to have oxygen.
• The surgeon connects the radial artery in the forearm to a large vein
called the cephalic vein. This connection is called an arterio venous
shunt.
• A shunt carries something from one place to another. In this case
it carries blood from an artery to a vein.
• After this shunt is made, the veins in the forearm get big and
eventually form muscles in their walls like arteries.
• They are now strong and can be punctured many times for dialysis
PORTABLE HAEMODIALYSIS MACHINE
PROCEDURE:
STEPS
1. After the dialysis procedure has been done to a patient, the machine should get ready for
another new patient, we should clean the disposable tubing's and filter with sterilizing fluid
and should checked with a type of litmus test.
2. When the patient arrives, the parameters like weight, blood pressure and temperature are
measured.
3. For fistula procedure we have to connect to veins of arms or legs. For catheter
procedure we have to connect to large veins at chest.
4. Then the patient is connected to the machine with complete loop, then the timer and pump
are started.
5. Hemodialysis is under process.
6. Periodically for every half hour, the blood pressure is taken. If, low blood pressure can
cause cramping, nausea, shakes, dizziness, lightheadedness, and unconsciousness .
7. The amount of fluid to be removed is set by the dialysis nurse according to the patient's
"estimated dry weight."
8. At the end of the procedure time, the patient is disconnected from the plumbing. Needle
wounds are bandaged with gauze, held for up to 1 hour with direct pressure to stop
bleeding, and then taped in place.
9. Temperature, standing and sitting blood pressure, and weight are all measured again.
Temperature changes may indicate infection. BP discussed above. Weighing is to confirm
the removal of the desired amount of fluid.
10. Care staff verifies that the patient is in condition suitable for leaving. The patient must be
able to stand, to maintain a reasonable blood pressure, and be coherent.
RESPIRATOR

Respirators may provide the entire ventilation or assist respiratory activity.

A simple respirator consists of a reciprocating pump operated by electric motor
Pump draws air from atmosphere and pumps air into lungs.
Later the air is drawn out of the lungs with a small negative pressure.
Simple respirator is suitable only for external ventilation
• Respirators which incorporate electronic techniques ,to match
external ventilatory force with natural respiratory effort are called
synchronized respirators
• VENTILATORS
• Ventillator is used to provide oxygen enriched ,medicated air to
a patient at a controlled temperature
TYPES OF VENTILLATORS
Pressure Cycled Ventilators
In Pressure cycled ventilator,inspiration is terminated when
gaseous mixture or air pumped into the lungs reaches a predetermined
pressure.
These are simple in construction and reliable in operation.
• DIATHERMY
• Diathermy means thorough heating or produce deep heating
directly in the tissues of body

Applying heat to a particular area of the body increases the

temperature of tissues and hence flow of blood in that area.

In diathermy body becomes a part of electrical circuit and heat is

produced within the body
Heating of tissue is done by radiofrequency alternating current.

TYPES OF DIATHERMY

• Short wave Diathermy

• Microwave Diathermy
• Ultrasound Diathermy
• Surgical Diathermy
• SHORTWAVE DIATHERMY

Heating of tissues is carried out at a high frequency of 27.12 MHz and a

wavelength of 11m
Output power is 500W

When current with very high frequencies are used ,the motor
or sensory nerves are not stimulated and there is no
contraction of muscles.
Therefore there is no discomfort to the patient
• BLOCK DIAGRAM OF SHORTWAVE DIATHERMY

Monitor Control PanelIsolation Transformer

Power RF Oscillator To patient
Supply Electrodes

• High energy power supply is given to RF OSCILLATOR

• The output of RF OSCILLATOR is applied to a pair of patient
electrodes.
• With the help of Monitor Control Panel ,frequencies,wavelength
and output power can be controlled
• Isolation transformer keeps the patient circuit in resonance with
input circuit
• Any amount of detuning is monitored and carefully adjusted
during the treatment.
• RF energy heats the tissues and promotes the heating of
injured tissues and inflammations
• Patients electrodes(pads) are not directly in contact with the skin
• Usually layers of towels are interposed between metal and surface
of body
• TECHNIQUES OF APPLYING HEAT TO THE BODY

• CAPACITOR METHOD
• In CAPACITOR method pads form capacitor plates and body tissues between
the pads act as dielectric

• When RF current is applied to the pads ,dielectric loss of capacitor produces

heat in the intervening tissues.
• INDUCTIVE METHOD
• A flexible cable is coiled around the arm or knee of patients body
• RF current is passed through the cable
• As a result tissues get Deep Heated due to eddy current developed.
• ADVANTAGES
• The subjects body becomes part of electrical circuit and heat
is produced within the body
• Treatment can be done precisely
• Amount of heat can be adjusted by changing electrical parameters
of circuit
• No discomfort is caused to the subject
• DISADVANTAGES

• Tuning must be carried out carefully at the beginning of

treatment and continuously monitored during treatment
• There is no indication of amount of converted and absorbed heat
within the body tissues
• Intensity of treatment is dependent on the subjective sensation
of warmth felt by patient
• MICROWAVE DIATHERMY UNIT
Microwave diathermy consists in irradiating tissues of patients body
with very short wireless waves having frequency in microwave
region

Microwaves are a form of electromagnetic radiation with a

frequency range of 300 Hz to 30,000 MHz and wavelengths varying
from 10 mm to 1mm
The above figure is simplified circuit diagram of a
microwave diathermy machine

• The mains supply voltage is applied to interference suppression filter

• The filter helps to bypass the high frequency pick up generated by
Magnetron
Delay circuit is incorporated in the apparatus which connects the anode
supply to magnetron only after 3-4 minutes
The arrangement is such that a lamp lights up after 4 minutes
indicating that apparatus is ready to use
Magnetron filament heating voltage is obtained directly from
secondary winding of transformer
• The filament cathode circuit contains interference suppression filters
• Anode supply to magnetron can be either dc or AC
• A DC voltage is obtained by full wave rectifier followed by voltage doubler
circuit

• A fuse (500 mA) is inserted in anode supply circuit of the magnetron

output to safeguard the magnetron from excessive flow of current

• The magnetron is a high-powered vacuum tube that works as a self-

excited microwave oscillator.
• Crossed electron and magnetic fields are used in the magnetron
to produce the high-power output
• Skin should be dry as these as these waves are rapidly absorbed by water
• Duration of irradiation ranges from 10 to 25 minutes