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Perf Tech 3 > 16. Alt Approaches- Exam 4 > Flashcards

16. Alt Approaches- Exam 4 Flashcards

1
Q

total Prevalence of Heart Disease in the U.S. (2006)

A

81,100,000 (>30% of the population) has some form of heart disease

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2
Q

Age 60 or older Prevalence

A

38,100,000

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3
Q

Hypertension (systolic >140; diastolic >90) Prevalence

A

74,500,000

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4
Q

Coronary heart disease Prevalence

A

17,600,000

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5
Q

myocardial infarction Prevalence

A

8,500,000

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6
Q

angina pectoris Prevalence

A

10,200,000

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7
Q

Congestive heart failure Prevalence

A

5,800,000

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8
Q

Stroke Prevalence

A

6,400,000

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9
Q

Congenital cardiovascular defects Prevalence

A

650,000 – 1,300,000

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10
Q

what is the prevalence trend for CVD in males and females

A

males are at higher risk btwn 20-60 yrs old

females are at higher risk btwn 60-80+ years old

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11
Q

how does the prevalence of CVD compare to cancer, DM, HIV, accidents, ect

A

CVD has the higherest prevalence of them all

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12
Q

what is the 1st, 2nd and 3rd lead causes of death for MALES

A
  1. CVD/CHD
  2. Cancer
  3. Accidents
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13
Q

what is the 1st, 2nd and 3rd lead causes of death for FEMALES

A
  1. CVD/CHD
  2. Cancer
  3. Chronic lower respiratory disease
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14
Q

what is the Life Expectancy in the U.S.

A

77.7 years

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15
Q

Elimination of all forms of cardiovascular disease would increase average by?

A

7 years

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16
Q

Elimination of all forms of cancer would increase the average by?

A

3 years

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17
Q

what was the total CV procedures performed in 2002

A

6,813,000 [higher for males]

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18
Q

what was the total surgical procedures performed in 2002

A

709,000 [higher for males]

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19
Q

what was the total angioplasty procedures performed in 2002

A

1,204,000 [higher for males]

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20
Q

what was the total CV disease cost in 2006

A

503.2 billion

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21
Q

what was the total heart disease cost in 2006

A

316.4 billion

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22
Q

what was the total CAD disease cost in 2006

A

81.1 billion

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23
Q

Year?

Dr. Werner Forssmann – First documented human cardiac catheterization

A

1929

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24
Q

Year?

Cournand & Richards – Employ cardiac catheter as diagnostic tool for the first time

A

1941

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25
Q

Year?

Forssmann, Cournand & Richards – Share the Nobel Prize

A

1956

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26
Q

Year?

Dr. Mason Sones – Developed the concept of the diagnostic coronary angiogram

A

1958

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27
Q

Year?

Dr. Charles Dotter – Introduced the concept of transluminal angioplasty

A

1964

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28
Q

Year?

Dr. Rene Favaloro – Performs first saphenous vein graft surgery in Cleveland

A

1967

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29
Q

Year?

Andreas Gruentzig – Performs first peripheral human balloon angioplasty

A

1974

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30
Q

Year?

Andreas Gruentzig – Presents results of animal studies of coronary angioplasty at the American Heart Association meeting

A

1976

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31
Q

Year?

Gruentzig, Myler & Hanna – First intraoperative human coronary balloon angioplasty (San Francisco)

32
Q

Year?

Andreas Gruentzig – First cath lab PTCA on awake patient (Zurich)

33
Q

Year?

Myler & Stertzer – First PTCA cases performed in America (San Francisco & New York)

34
Q

Year?

Over-the-wire coaxial balloon systems introduced – steerable guide wires developed

35
Q

Year?

Coronary atherectomy devices introduced

36
Q

Year?

Puel & Sigwart - First use of stents in humans reported

37
Q

Year?
number of interventional devices invented, perfected and approved (lasers, rotational atherectomy devices, intravascular ultrasound, stents)

38
Q

Year?

Over one million angioplasties performed world-wide – most common medical intervention in world

39
Q

Year?

Almost two million angioplasties performed world-wide

40
Q

Percutaneous Transluminal Coronary Angioplasty (PTCA)=

A

balloon advanced to level of blockage – balloon inflated – plaque pushed back against vessel wall / small cracks created with the plaque (plaque fissures) / artery stretched

41
Q

Stenting=

A
  • balloon advanced to level of blockage – balloon inflated to deploy the stent
  • bare-metal versus drug-eluting stents
42
Q

what are the 5 Criteria for Angioplasty

A
  1. Balloon can be passed through the blockage
  2. Blockage can be reached by the catheter
  3. Blocked vessel is not the left main (original use for one or two vessel disease – now being applied to multi-vessel cases)
  4. Patient is not in heart failure
  5. Patient is having a heart attack (if treatment can begin within two to six hours of onset)
43
Q

what are the 6 Advantages of Angioplasty

A
  1. Less invasive than bypass surgery
  2. Relatively low risk
  3. Relatively low cost
  4. Local anesthesia versus general
  5. Percutaneous incision
  6. Patient able to return to normal activity shortly after procedure (most go home after 24 hours – return to normal activity within one week)
44
Q

name 5 Risks/Complications of Angioplasty

* more on slide 18

A
  1. Damage to the insertion artery by the catheter
  2. Damage to the coronary artery by the catheter
  3. Sudden vessel closure
  4. Stents may cause clot formation
  5. Need for emergency bypass surgery
45
Q

Sudden vessel closure occurs in ___% of patients with PTCA only

46
Q

since Stents may cause clot formation, what is the treatment to avoid that

A
  • -most patients placed on antiplatelet therapy including aspirin and clopidogrel ticlopidine (Plavix & Ticlid)
  • -must continue therapy for at least one year – additional benefit has been shown if therapy started one to three days before procedure
47
Q

the Need for emergency bypass surgery occurs in ___% of PTCA patients and ___% with stenting

A

2 - 5% for PTCA

0.5% with stenting

48
Q

Restenosis Rates with PTCA

A

10% to 40% during the first six months

49
Q

Restenosis Rates with bare metal stents

A

30% to 50% during first six months

50
Q

Restenosis Rates with drug eluting agent

A

7% to 15% during first six months

51
Q

what are 3 Patient Restrictions Following Angioplasty

A
  1. Refrain from lifting heavy objects, engaging in strenuous exercise or sexual activity for at least 24 hours
  2. Increased fluid intake first 24 hours – help remove dye
  3. Most patients will receive some sort of anti-platelet therapy
52
Q

what % of the stent insertions follow plaque treatment with PTCA or atherectomy

53
Q

does one size stent fit all? what must the stent do?

A

One size does not fit all

  • -stent must cover the complete length of the blockage
  • -stent must be fully expanded so there are no gaps between the surface of the plaque and the stent
54
Q

where is it Difficult to stent plaque

A

plaque occurring at the bifurcation of two vessels

55
Q

when is the stent is covered with a thin layer of endothelial cells

A

Within four to six weeks

56
Q

Drug-Eluting Stents=

A

Bare-metal stent coated with slow-to-moderate-release drug formulation that is embedded in a polymer

  • -restenosis not a recurrence of CAD – actually bodies response to the “controlled injury” of angioplasty
  • -restenosis characterized by growth of smooth muscle cells (i.e. scar formation)
57
Q

Boston Scientific Drug-Eluting Stent

A

Taxus paclitaxel-eluting stent

-chemotherapeutic drug

58
Q

Johnson & Johnson / Cordis Drug-Eluting Stent

A

Cypher sirolimus-eluting stent

-immunosuppressive agent

59
Q

Medtronic & Guidant Drug-Eluting Stent

A

have drug-eluting stents in the early stages of clinical trials (2006 at the earliest)

60
Q

Drug-Eluting Stents have the biggest impact on what patient population? what the potential market?

A

Biggest impact may be on patients with diabetes

Potential market - - - $5 billion annually

61
Q

Atherectomy: Currently used as adjunct to what?

A

PTCA and stent placement

62
Q

Atherectomy may work best on complex lesions such as (4)?

A

heavily calcified / fibrotic / undilatable lesions
ostial & branch-ostial lesions
chronic total occlusions
in-stent restenosis

63
Q

Atherectomy actually does what?

A

Actually removes plaque material

64
Q

Directional Atherectomy=

A
  • Percutaneous over-the-wire cutting and retrieval system
  • Cutting window placed toward the plaque – balloon inflated pushing plaque into cutting cup – cutter rotates at 2,000 RPM – advanced by physician
65
Q

Rotational Atherectomy=

A
  • Elliptical-shapes brass burr coated with 5-10 micron diamond chips
  • Rotates at 140-190,000 RPM
  • Saline flush solution infused into the plastic sheath around the drive shaft to minimize frictional heat
  • Burr ablates and pulverizes inelastic plaque tissue – 5 micron particles eventually removed by reticuloendothelial system
66
Q

Transluminal Extraction Atherectomy=

A
  • Percutaneous over-the-wire cutting and aspiration system
  • Head with two stainless steel blades – turn at 750 RPM
  • Lactated Ringers solution flushed into area creates particulate slurry that is suctioned back through the catheter
67
Q

what are the problems with laser therapy

A

precise control of laser

right laser for the type of plaque

68
Q

Transluminal Angiogenesis=

Aka: Transmyocardial revascularization

A

Improve blood flow to an area of the heart where surgery or angioplasty may not reach.
-May be option for patients who are not candidates for angioplasty or surgery

69
Q

Transluminal Angiogenesis: where is the incision made

A

Done through L. Chest incision or midline inscision

-Could be done in conjunction with angioplasty or surgery

70
Q

Transluminal Angiogenesis: Use a CO2 laser to make ____ mm channels in myocardium. What do the outer and inner channels do?

A

20-40 mm

  • -Outer channel closes and inner channel open to inside the heart
  • -May promote the growth of small new blood vessels
71
Q

what are the 5 Surgical Techniques

A
  1. CABG with CPB
  2. CABG w/o CPB (MIDCAB or OPCAB)
  3. CABG with assisted CPB= PADCAB (perfusion assisted direct coronary artery bypass)
  4. Minimal CABG with CPB (Portal-access)
  5. Robotically assisted
72
Q

OPCAB uses what special instruments

A

Genzyme
Guident (Ultima II)
Medtronic (Octopus 2)

73
Q

Percutaneous Valves: Mitral=

74
Q

Percutaneous Valves: Aortic=

A

Edwards SAPIEN
Medtronic CoreValve
Sorin Perceval (investigational)

75
Q

what are the 4 options for percutaneous aortic valves insertion

A

Tranfemoral
Transapical
Subclavian
Direct Aortic

Perf Tech 3 (15 decks)

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