Cardiac procedures Flashcards
What is coronary angiography?
Radio-opaque contrast is injected into a blood vessel and imaged using X-ray based techniques such as fluoroscopy – CT and MRI are common. Coronary angiography uses a catheter to access the coronary arteries through the wrist or groin.
What is PCI?
Percutaneous coronary intervention: used to treat narrowing of the coronary arteries of the heart. The process involves combining coronary angioplasty (using a balloon to widen arteries) with stenting.
What are the complications of coronary angiography and PCI? (x4 (x5))
Arterial puncture (bleeding, infection, thrombosis, dissection, pseudoaneurysm formation) plus cholesterol emboli, thromboemboli and vasospasm.
What is CABG?
Coronary artery bypass graft: heart is stopped, and blood pumped artificially by a machine outside the body (cardiac bypass). Meanwhile, patient’s great saphenous vein, radial artery or internal mammary artery is used as the graft to bypass the stenosed coronary vessels.
What are the indications for CABG? (x5)
- Left main stem disease (coronary artery disease of left coronary artery)
- Triple vessel disease involving proximal part of the left anterior descending artery
- Angina unresponsive to drugs
- Unstable angina
- If angioplasty is contraindicated or unsuccessful
What are the complications of CABG? (x5)
- Postperfusion syndrome (from microemboli entering the brain)
- STEMI due to embolism, hypoperfusion or graft failure
- Acute renal failure from embolism or hypoperfusion
- Stroke from embolism or hypoperfusion
- Vasoplegic syndrome
How does DC cardioversion work?
Direct current cardioversion: provide shocks to patients to restore normal heart rhythm. It does this by synchronizing the shock with the R wave of the cardiac cycle. Shocking outside of this period will put patient into VF.
What are the indications for DC cardioversion?
VF or VT. OR if medical treatment fails for AF, flutter, or supraventricular tachycardia.
What are the types of DC cardioversion? (x3)
- MONOPHASIC DEFIBRILLATORS see Fig 18.10
- BIPHASIC DEFIBRILLATORS see Fig 18.11: they use less energy and are just as effective
- AUTOMATIC EXTERNAL DEFRIBILLATORS are automatic
What is an implanted cardiac defibrillator?
Implanted device able to detect arrythmias and perform defibrillation.
How are ICDs implanted?
Similar to implantation of a pacemaker – the first component (battery and computer chip) are inserted under the skin in the upper left chest, and the second component (electrode wires) are connected to the first component and passed through a vein to the right chambers of the heart (usually ending in the apex of the RV).
What are the indications for implanted cardiac defibrillator?
People at risk of sudden cardiac death due to VF/VT, including prior MI.
What are the complications of ICD? (x4)
Infection at implantation site, pneumothorax (from vein puncture), embolism (leading to stroke etc), and ventricular perforation (leading to cardiac tamponade).
What is the difference between an ICD and pacemaker?
ICD treats dysrhythmias. Pacemakers provides electrical stimuli when the heart’s intrinsic myocardial electrical activity is inappropriately slow or absent.
What is a pacemaker?
Regulates the electrical conduction system of the heart to maintain an adequate HR. It does this by stimulating the atrium or ventricle with a short low voltage pulse when it detects bradycardia.
