2- coronary heart disease, revascularisation

Question 1

what is the surgical technique for CABG?

Answer 1

CABG = coronary artery bypass graft

• open to see median sternotomy (ribs split)
• take vein from leg (long saphenous vein) - reverse it co correct blood flow
• internal mammary artery used to stitch to coronary artery
• cardio-pulmonary bypass used to keep circulation
• heart protected by cold cardioplegia

Question 2

what is PCI technique?

Answer 2

PCI = Percutaneous Coronary Intervention

• vascular access
• anti-platelet drugs , anticoagulation w heparin (to prevent arterial thrombosis)
• catheter to ostium of coronary
• guidewire down vessel
• balloons threaded over wire
• sten(s) implanted
• balloon, catheter & wires removed

Question 3

what procedures to treat coronary artery blockage?

Answer 3

• CABG (coronary artery bypass graft)
• PCI (percutaneous coronary intervention)

Question 4

what is current practice for coronary heart disease angiography?

Answer 4

• defined by acute presentation
  
  • STEMI → immediate PCI <30 mins after hospital arrival
  • NSTEMI →angiography performed during hospital admission
• high risk stable patients (not acutely presenting but high risk)
• severe symptoms

Question 5

what determines suitability for revascularisation?

Answer 5

• multi vessel disease, diffuse or focal
• left main disease
• diabetes
• co-morbidities

Question 6

what should plan of action be for chronic stable angina?

Answer 6

revascularisation for severe symptoms or high risk

→CABG vs PCI should be determined by discussion with MDT (multi-disciplinary team)

Question 7

what should plan for acute coronary syndrome be?

Answer 7

angiogram with a view to revascularisation

Question 8

why
a) should
b) shouldn’t
you use radial artery access for CABG surgery?

Answer 8

should:
- dual supply to hand
- superficial
- compressible
- no adjacent nerve/vein

shouldn’t:
- smaller
- prone to spasm
- (asymptomatic) occlusion 5% (if stretch it too much)