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Cardiopulm Test 1 > Cardiac Surgery Lecture 7 > Flashcards

Cardiac Surgery Lecture 7 Flashcards

1
Q

An angioplasty is typically done following what?

A

Imaging like coronary-angiogram or MRI to confirm the location of the blockage

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2
Q

What is an angioplasty?

A

Balloon tipped catheter goes through femoral artery

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3
Q

If you have an angioplasty what are your exercise precautions?

A

No vigourous exercise for 5-7 days

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4
Q

After they use the balloon in the angioplasty to push the plaque out of the way, what do they do next?

A

Put stent in to keep space open

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5
Q

What is the major risk involving angioplasty patients?

A

Bleeding

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6
Q

Any time we quickly re-establish blood supply the risk of _________ is increased

A

ventricular arythmias

This risk is present for about a day or 2

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7
Q

What is the problem with stents in coronary angioplasties?

A

Stents collect plaque and blockage can reappear

Drug eluting stents fix this problem by releasing drugs from the stent that stops blockages from occuring

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8
Q

How do hospitals manage the risk of bleeding for patients with angioplasty+stents

A

Continous pressure+ice pack for several hours to stop bleeding

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9
Q

Patient comes to you and says “I had an angioplasty 3-4 days ago!” in out patient, what do you say?

A

😡 GET OUT!!! GET OUT RIGHT NOW!!!!!!!! 😡

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10
Q

What is an arthectomy?

A

Simular to angioplasty. Now they have a drill that pushes through the plaque. For plaques that are thicker and larger

Note: still a risk of bleeding

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11
Q

True or false: Coronary Artery Bypass graph is a percutaneous surgery

A

False

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12
Q

Patient’s who have a coronary artery bypass graft have what precautions?

A

Sternal precautions

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13
Q

What are 3 places that surgeons can source a graft from for a CABG

A

Internal mammary artery

radial arteries

saphenous vein

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14
Q

What are the complications of a CABG

A

2-4% of paients have heart attack

-myocardial stunning

-arythmias

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15
Q

How can myocardial stunnng be managed after a CABG

A

Left ventricular Assistive Device

Inotropic medications

Intraaortic balloon pump

-neurological complications

-infection

-Renal Failure

Pericardial Effusion and Pleural effusion

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16
Q

Pleural effusions occur in __% of patients with a CABG

A

90%

THIS IS WHY NEED FOR MOBILIZATION IS CRITICAL

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17
Q

How long do sternal precautions last?

A

6-8weeks

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18
Q

If sternal precautions are too restricting what can happen?

A

frozen shoulder/adhesive capsilitis

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19
Q

when inspecting a patient with sternal precautions surgical scar what should you be on the look out for?

A

drainage of wound/pus

make sure bandages are clean and dry

Prevent infections! Infections will be catastrophic

Note: they can get gentle scar massage after a couple of days

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20
Q

What is an intra-aortic balloon pump

A

Restores cardiac output by inflating during diastole to allow blood to come in and DEFLATES during systole to push blood out.

Typically inserted through femoral artery

Note: can increased CO up to 40%. a rate of 1:1 inflation is considered full assistance

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21
Q

can someone with a femoral intraortic balloon pump be ambulated?

A

hellllll nawwww

but maybe an axillary one can be ambulated, just maybe

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22
Q

Itra-aortic balloon pump inflates during _____

deflates during _________

A

inflates during diastole

deflates during systole

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23
Q

what is the purpose of percutaneous procedures?

A

reestablish blood supply!

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24
Q

what is the purpose of an intraortic balloon pump?

A

help heart thats failing

25
Q

what is the most commonly replaced valve?

A

aortic valve

26
Q

true or false: most of the time physicians seek to repair the valve instead of replace it

A

true

why? because then they wont need blood thinners for the rest of their life. They would if it was a replacement

27
Q

What is the ross procedure?

A

using pulmonary valve to replace aortic valve

then pulmonary valve is replaced by donor

28
Q

true or false: tricuspid and mitral valve rarely need to be replaced

A

true

29
Q

What are the advantages of a bioproshesis instead of a mechanic valve?

A

reduces risk of stroke

Only patients with a mechanical valve will need blood thinners for rest of life!

30
Q

why is it hard/impossible to repair the aortic valve

A

pressure is too high

31
Q

what is the purpose of an annuloplasty?

A

flexible ring placed around mitral valve for support, reinforced annulus

prevents dilation of valve

32
Q

valve repair procedures are usually done how?

A

minimally invasive percutaneous procedure where a catheter goes through femoral vein

33
Q

what is the risk of catheter based valve repair procedures

A

risk of bleeding

fatigue may be issue

usually patients can go home from hospital after a day or 2

34
Q

what is “something to think about” when a patient is coming off of a heart/lung machine

A

fatigue may be issue

35
Q

True or false: Mitral valve repair typically does better than replacement

A

True

Also: Patients with repair dont have to use blood thinners for as long

36
Q

what is the problem with anticoagulation medication for long periods of time?

A

bleeding

37
Q

What is a cardiac ablation?

A

destroys ectopic cells in myocardium that cause arrhythmias
produces scar on myocardium

typically radiofrequency or cryotherapy

note: very good for a-fib, can be used for v-fib too

38
Q

What needs to happen before a cardiac ablation procedure

A

electrophysiological mapping to find the arrythmia

39
Q

Cardiac ablation patients typically need ____ days of rest

A

4-7 days of rest

40
Q

what is a pace maker primarily for?

A

slow rhythm and heart blocks

OR

fast rhythm in UPPER chamber

41
Q

whats the most important thing to know about a patients pacemaker

A

what their particular pace maker is for

  1. always works to maintain regular rate
  2. only works if rate is below certain amount
  3. or if they are used stop the atrias from going to fast
42
Q

what are the 2 kinds of pace makers

A

Unipolar- one electrode (- at myocardium and + at pacemaker box)

bipolar (Biventricular) - 1 lead on right atrium, 2 at ventricles, (3 total leads)

43
Q

what is an Implantable cardioverter defibrillator for?

A

Used to correct life threatening arrythmias (designed for fast ventricular arrythmias)

44
Q

What will you see on an ECG if the patient has a pacemaker?

A

Pacemaker spikes

if spike is infront of P-wave- the pace maker is working at atria

If spike is infront of QRS- pace maker is working at ventricles

45
Q

If a patient comes to PT and says theyve recently been shocked by their ICD what do u say

A

go talk to your physician before PT

46
Q

What is important to know for a patient with a pacemaker/ICD

A

Need to know at what heart rate their device is designed to deploy

stay 10-20 BPM below that

47
Q

Endocardial vs epicardial pace makers

A

endocardial- inside the right atrium and ventricle

epicardial- more often used in patients undergoing heart surgery often only used for temporary pacing

48
Q

If a patient has a surgically placed pace maker what is a common precaution associated with this

A

no raising arm overhead no contact sports

no lifting more than 10lbs

49
Q

What is a temporary ICD (vest)

A

patient who has had an MI in the past, there is a risk of arthmyias but as the heart heals the risk of arthymia drops

50
Q

When looking at a ECG for someone with a pacemaker, what does it mean if you see the pacemaker spike before the p wave?

what about QRS?

A

Before Pwave- atrial pace maker

before QRS- ventricular pace maker

51
Q

Abdominal aortic aneurysm repair is indicated for aneurysm’s larger than…

A

5cm

52
Q

If a patient get’s an abdominal aortic aneurysm repair where there is a midline incision at the xiphoid process, what is a common precaution youll see?

A

No thoracic extension 4-6 weeks

53
Q

If a patient has an abdominal aortic aneurysm repair, what does PT need to teach them?

A

bronchiole hygene techniques. this patient cannot use their abdominals to huff or cough!!! no huffing or coughing!

note: you can teach them how to huff later on

54
Q

Where is the incision for a posterolateral thoracotomy?

A

T4 and scapula to 5-6th intercostal space

divides the serratus anterior

makes it difficult to breathe

55
Q

where is the incision for an anterolateral thoracotomy?

A

4-5th intercostal space to midaxillary line
(pec major is incised, serratus anterior fibers separated)

56
Q

where is the incision for a lateral thoracotomy?

A

near nipple line extending toward scapula

57
Q

where is the incision for a thoracoabdominal incision?

A

8th,9th IC space at post axillary line to midline of abdomen

transection of : lats, SA, External oblique, rectus abdominus

note: with this patient you cannot activate these muscles too aggressively at first allow them to heal

58
Q

what are post-op difficulties for thoracoabdominal incision?

A

-coughing
-deep breathing
-thoracic extension

-80% experience ipsilateral shoulder pain, referred pain from phrenic nerve

NO AGGRESSIVE STRETCH OR STRENGTHENING

Cardiopulm Test 1 (11 decks)

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