Cardiac Revascularisation Flashcards
describe surgical technique for cardiac revasculairsation
coronary artery bypass (CABG); median sternotomy (cracking the sternum) long saphenous vein (leg) internal mammary artery (chest) cardio-pulmonary bypass cardioplegia overnight in ITU 7 days in hospital 2-3 months off work risk of graft disease 8-10 post op
most effective form of treatment
describe the complications of CABG
less blood supply to the sternum difficult to measure cognitive impairment death stroke MI atrial fibrillation infection cognitive impairment sternal malunion renal failure failure to recover
describe percutaneous coronary intervention complications
death stroke MI renal failure bleeding vascular complications stent thrombosis stent restenosis emergency CABG (decreases mortality rate)
describe percutaneous coronary intervention (PCI)
inserting a catheter through the skin in the groin or arm into an artery - providing vascular access
At the leading tip of this catheter, several different devices such as;
anti-platelet drugs, anticoagulation
catheter to ostium of coronary
a balloon
stent
cutting device (artherectomy device) can be deployed or removed.
preferred over thrombolysis, but not CABG
describe angiography
imaging test that uses X-rays to view your body’s blood vessels. The X-rays provided by an angiography are called angiograms
describe indications for angiography
high risk; defined by acute presentation STEMI - immediate PCI NSTEMI during admission high risk patients have better survival chance when treated immediately
severe symptoms
describe suitability for revascularisation
multi-vessel disease, diffuse or focal
left main disease
diabetes
co-morbidities
describe PCCI specific issues
dual anti-platelet therapy
vascular access
why is the radial artery used asaccess
dual supply to hand
superficial
compressible
no adjacent nerve/vein
however;
smaller
prone to spasm
asymptomatic occlusion
describe haematoma
localised bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries
describe cardiac revascularisation of STEMI
primary PCI
describe cardiac revascularisation of acute coronary syndrome
angiography with a view to revascularisation
describe cardiac revascularisation of chronic stable angina
revascularisation for severe symtpoms or high risk
CABG or PCL - determined by discussion
