Blue Book

Question 1

Indications for IABP

Answer 1

• unstable angina
• acute myocardial infarction
• cariogenic shock
• mechanical complications following MI
• adjunct to PTCA (angioplasty)
• adjunct to cardiac catheterization
• bridge to cardiac transplant
• operative support

Question 2

Absolute contraindication for IABP

Answer 2

• thoracic or abdominal aortic aneurysm

- occluded aorta

Question 3

relative contraindication for IABP

Answer 3

• AI
• severe peripheral vascular disease
• disease not able to be treated

Question 4

what are some complications seen with IABP

Answer 4

• limb ischemia
• thromboembolism
• aortic dissection
• vascular injury
• infection
• balloon rupture
• thrombocytopenia

Question 5

what are the two techniques for insertion for an IABP

Answer 5

percutaneous insertion

femoral artery cutdown

Question 6

what’s the difference between timing and trigger of an IABP

Answer 6

timing: the relationship b/w the balloon’s inflation and deflation and the heart’s systole and diastole
trigger: the events or signals, whether from the arterial pressure waveform, the EKG waveform, or the internal rate, which are used to institute inflation and deflation of the balloon

Question 7

when does balloon inflation occur?

Answer 7

at the closure of the aortic valve, which is represented by the dicrotic notch

Question 8

what happens during inflation of the balloon?

Answer 8

an increase in diastolic pressure due to the displacement of volume. this increase in diastolic pressure leads to increased coronary perfusion

Question 9

when does deflation occur?

Answer 9

just prior to systole

Question 10

what happens when deflation occurs?

Answer 10

sudden decrease of pressure within the aorta that causes decreased aortic end diastolic pressure, which equals to decreased after load

Question 11

what does the result of decreased after load with the help of an IABP result in?

Answer 11

reduction in myocardial work, oxygen consumption, and an increase in cardiac output

Question 12

what should happen if inflation occurs too early?

Answer 12

• resistance to systolic ejection with a greatly increased after load
• premature closing of the aortic valve
• reduction of left ventricle empyting
• reduction of CO
• increased cardiac workload and oxygen consumption

Question 13

what should happen if inflation occurs too late?

Answer 13

• would be late in the diastolic portion of the cardiac cycle which limits the amount of augmentation that can be achieved and reduces coronary perfusion

Question 14

what depends more on the timing of the balloon? inflation or deflation?

Answer 14

deflation

Question 15

when using conventional timing, when does deflation occur?

Answer 15

end of diastole during the isovolumetric contraction

Question 16

how is it determined the proper deflation timing?

Answer 16

evaluating the assisted aortic end diastolic pressure to ensure that it is less than the unassisted aortic end diastolic pressure

also the assisted systole should be less than the systole prior to the augmentation

Question 17

when does real timing deflation occur?

Answer 17

occurs at each QRS

Question 18

what should happen if early deflation occurs?

Answer 18

provide a lesser level of reduction in end diastolic pressure

after load reduction is decreased and there may be retrograde flow in the aorta which can cause angina

Question 19

what should happen if late deflation occurs?

Answer 19

causes the balloon to remain inflated into the next systolic ejection

causes the heart to work much harder

myocardial work, oxygen consumption, cardiac output are increased

Question 20

what is the frequency ratio weaning?

Answer 20

method in which the ratio decreases from 1:1 to 1:2 to 1:4 and so on

Question 21

what is volume weaning?

Answer 21

the balloon volume is decreased by a small portion (20-25% of the total volume) and after evaluating, additional volume is removed