Cardiac Interventions

Question 1

Cardiac Catheterization

Answer 1

Insertion site: femoral, bracial, some radial
PCI: Angioplasty + stenting
PCI: Atherectomy - cutting/grinding the plaque

Question 2

Cardiac Cath + PCI Considerations

Answer 2

Pre-OP: (no metformin 24 hrs b/4, kidney functions)
Iodine allgeries
pulses
tele monitor
vital, IV access

Post-OP:
Pulses , bleeding, UO
Flat bedrest
no showers 2 dys
no repetitive movement
check flank bleeding

Works? Stemi: norm EKG, troponin plateau
Works? NStemi: troponin plateau

Question 3

CABG

Answer 3

• Saphenous vein graft (leg)
  internal mammary artery, radial artery
• Bypassing 1+ arteries

(Pt maintenance is same for valve replacement ( mechanical or biological)

Edu/Expectations:
* expect a chest tube + ventilator
* rewarm pt
* Monitor kidney function
* risk for stroke from mobilizing plaque ( speech, mobility, LOC)
* Cardiac rehab, aspirin, etc

** Post Complications**:
Cardiac tamponade
infection ( incisions: chest tube, heart, donor site)
Impaired peripheral circulation
* donor site- elevated !
* prevent dependent positions

mechanical- clot prob ( lifelong), anticoag therapy
bio- animal, less clotting, more need for replacement, no anticoag

Question 4

Cardiac Tamponade

Answer 4

Blood accumlates in pericardial sac -> impaires plumping/ expansion
S/S: decrease CO, decrease BP, JVD, pulsus paradoxus, muffles heart sounds
* Poor perfusion !!
* Emergency
* Becks Triad: decrease CO/ BP + JVD + muffled heart sounds

Question 5

Aorta Disorders

Answer 5

Aortic Anenrysms
* ballooning of artery: thoracic, thorabdominal , abdominal
* Usually asymptomatic until rupture - bleed out- DIC ( s/s: back/ flank/abd pain to rupture, pulsatile mass)
* Dx: CT, MRI, US, angiography
* No contact sports, no rubbing
* treat w/ surgery

Question 6

Aorta Disorder

Normal Range

Answer 6

Size: < 3cm
Treatment: none

Question 7

Aorta Disorder

Small Range

Answer 7

Size: 3-4 cm
Treatment: US Q 12 mos

Question 8

Aorta Disorder

Medium Range

Answer 8

Size: 4-4.5 cm
Treatment: US Q 6mos.

Question 9

Aorta Disorders

Large Range

Answer 9

Size: > 5 cm
Treatment: Vascular specialist

Question 10

Urgent Repair, going to blow

Answer 10

> 8 cm

Question 11

Saccular

Answer 11

Most popular, outpouching outside the sac, bleeding in thoracic cavity

Question 12

Dissecting

Answer 12

two placings, how big the opening depends on how much blood

Question 13

False

Answer 13

no as lethal, blood is in the sac, light or taut

Question 14

Surgical treatment of AAA

Answer 14

Endovascular repair, gaining access through the femoral artery, stent to the aorta