Cardio and Vascular Test on 10/7 Flashcards
Anastomosis
surgical connection made between two tubular structures
arrythmia
irregularity or loss of rhythm of the heartbeat
arteriosclerosis
arteries become thick and stiff, hardening of the arteries
atherosclerosis
buildup of fats, cholesterol and other substances in/ on artery walls (plaques)
asystole
without a heartbeat, failure of hearts electrical system
autogenous
originating within the body
bifurcation
separation into two branches, point of forking
bradycardia
slow heart rate, fewer than 60 beats per min
cannula
tube or sheath allowing escape of fluid
cardiac output
amount of blood pumped by the heart over one minute (L/min)
cardiopulmonary
pertaining to the heart and lungs
costal
relating to the ribs
cyanosis
slightly blue-gray discoloration of skin
reduced amounts of O2 in blood
hemoglobin= O2 carrying protein in RBC’s
empyema
pus in blood cavity, especially pleural cavity
fibrillation
rapid and random, tremulous, ineffectual contractions of the heart
defibrillation
stopping fibrillation of heart through use of drugs, physical, or electrical means
diastole
relaxation of the heart muscle, refilling of the chambers
ectopic beat
single heartbeat occurs to quickly or to slowly, an extra or skipped beat
embolus
matter in blood vessel
fat globule, air bubble, piece of tissue, clump of bacteria, foreign object, or clot
endocardial
within heart or arising from inner lining of the heart
extracorporeal
outside of the body
heart block
disruption in electrical impulses controlling the heart.
hypoxia
lack of an adequate amount of O2 in inspired air, reduced oxygen content or tension
intercostal space
space between the ribs
lumen
space within an artery, vein, tube
metabolic acidosis
excessive acidity of body fluids resulting from an increase in acids other than carbonic acid (carbon dioxide in water solution)
myocardial
pertaining to the heart muscle
myocardial infarction (MI)
acute condition in which heart muscles die from ischemia and may lead to sudden cardiac death
occlusion
abnormal closure of a passageway such as a blood vessel
plaque
patch or atherosclerosis consisting of cholesterol, lipids, cellular debris that forms in the inner layers of the walls of the arteries
pleura
serous membrane enclosing the lungs and lining the walls of the thoracic cavity
pleura space
aka intrapleural space
potential space between parietal and visceral pleura
pleural effusion
abnormal accumulation of fluid in the pleural space
What does PVC stand for?
premature ventricular contractions
What is a PVC?
cardiac arrythmia characterized by a ventricular beat preceding the expected electrical impulse; may be a precursor of ventricular tachycardia or fibrillation
septum
wall dividing two cavities, such as chambers of the heart
stenosis
constriction or narrowing of a passageway
systole
contraction of the heart muscle; pushing blood forward
tachycardia
fast hear rate; more than 100 beats per min
thrombus
blood clot that obstructs a blood vessel or a cavity of the heart
trabecula carinae
thick muscular bands attached to inner walls of the ventricles of the heart
vasoconstriction
narrowing of the caliber (diameter) of a blood vessel
what is the thoracic cavity?
anatomic space superior to abdominal cavity
What are the two membranes the thoracic cavity is divided into?
mediastinum (heart)
right and left pleural spaces (lungs)
What is the pericardium of the heart?
2-layer sac surrounding the heart (remember balloon image)
What are the 2 layers that cover the heart?
parietal- outside lining the mediastinum
visceral- inside lining the heart
What structures are in the mediastinum?
great vessels
trachea
esophagus
phrenic nerve
vagus nerve
thymus gland
What are the great vessels?
aorta
pulmonary arteries
pulmonary veins
vena cavas
what does the phrenic nerve do?
diaphragm activity (1 on each side of the heart)
what does the vagas nerve do?
innervates the heart, lungs, and digestive tract
what does the thymus gland do? What happens over time?
produces immune system cells
atrophy and declines with age
How many chambers are in the heart? What are they?
4
right atrium
right ventricle
left atrium
left ventricle
what does the right atrium do?
collects deoxygenated blood
What does the right ventricle do?
circulates deoxygenated blood to the lungs for oxygenation
What does the left atrium do?
collects oxygenated blood from lungs
what does the left ventricle do?
pushes oxygenated blood to the body
What is the apex of the heart
bottom tip of heart
right and left ventricle meet
What are the layers of the heart?
epicardium
myocardium
endocardium
Describe the epicardium layer of the heart
along visceral pericardium
protective outer layer
describe the myocardium layer of the heart
muscular middle layer
describe the endocardium layer of the heart
inner most layer, surface of the chambers
What are the 4 valves of the heart?
aortic
mitral
pulmonary
tricuspid
Where is the aortic valve? Which way is blood moving?
between left ventricle and the aorta
oxygenated blood goes to body
Where is the mitral valve?
between left atrium and left ventricle
oxygenated blood from atrium to ventricle
Where is the pulmonary valve?
between right ventricle and pulmonary artery
deoxygenated blood going to lungs
Where is the tricuspid valve?
between right atrium and right ventricle
deoxygenated blood from atrium to ventricle
What structures make up a valve?
leaflets/cusps
chordee tendinea
papillary muscles
What are leaflets/cusps?
flaps of tissue that comprise each valve
What are the chordee tendinea?
fibers that prevent leaflets from prolapsing
What does prolapse mean?
opening backwards
What are the papillary muscles?
anchor points of chordee tendinea in walls of ventricles
Explain the vena cava:
how many? size? flood flow?
superior and inferior
largest vein in body
returns deoxygenated blood from body
Explain the aorta:
size? blood flow?
largest artery
oxygenated blood to the body
Explain pulmonary arteries:
blood flow?
deoxygenated blood to the lungs
Explain pulmonary veins:
blood flow?
oxygenated blood from lungs to heart
What are the atria and ventricles doing when in systole and diastole?
atria in systole then ventricles are in diastole
What is blood flow through the heart? body to body
superior/inferior vena cava
right atrium
tricuspid valve
right ventricle
pulmonary valve
pulmonary arteries
lungs
pulmonary veins
left atrium
mitral valve
left ventricle
aortic valve
aorta
What is the coronary circuit?
arteries and veins running through the heart muscle
what does the coronary circuit supply?
blood, nutrients, O2
Where do the coronary arteries originate? How many main coronary arteries are there?
root of the aorta
2 right and left
Where do the coronary veins terminate?
coronary sinus at back of heart
(a duct that empties into right atrium)
What does the left coronary artery do?
feeds the left side of the heart
What 2 arteries come off of the left main/coronary artery?
lefts anterior descending artery
circumflex artery
What does the left anterior descending artery do?
LAD feeds the anterior portion of the left heart
What does the circumflex artery do?
feeds the posterior portion of the left heart
What does the right coronary artery do?
feeds the right side of the heart
Heart function is controlled by what system
nervous system
What 5 structures comprise the electrical system of the heart?
SA node
AV node
Bundle of His
L/R bundle branches
Purkinje fibers
What is the SA node?
sinoatrial node
pacemaker”
60-100 normal range
causes contractions of atria
What is the AV node?
atrioventricular node
between atria and ventricles
(Allows relaxation)
What is the Bundle of His?
funnels impulses to fibers of the ventricles
What are the L and R bundle branches?
carry impulses to Purkinje fibers of respective ventricle
What are the Purkinje fibers?
cause contraction and relaxation of the ventricles
What is an angiography?
injection of radiopaque dye used in conjunction with x-ray to view vessels and tributaries
What can the angiography detect?
tightening (stenosis) and widening (aneurysm) of vessels
What are the 2 types of angiography?
arteriography
venography
What is a arteriography?
specifically observes the arteries
What is a venography?
specifically observes the veins
What is the MRI used for ?
takes time
extremely detailed (heart, vessels, and organs
What is the CT scan used for?downfall?
faster
less detailed
exposure to radiation
What is a transesophageal echocardiogram? How is it done?
TEE
ultrasound of the heart
through the mouth into esophagus-behind the heart
blood flow
What is heparin sodium used as? How is it administered? How is it calculated?
anticoagulant
IV at beginning of case
by patient weight
topically in irrigation
What is Protamine Sulfate used as? when is it given? How is it calculated?
Heparin antagonist
end of surgery
calculated according to amount of Heparin used
Why is Lidocaine 1% given? How is it administered? what is another name?
anti-arrhythmic
by IV
xylocaine
What is cardioplegia used for? When is it given? What is it made up of? How is it administered?
directly to coronary vessels to stop heart during surgery
periodically throughout the case
potassium and nutrients
heart-lung machine by perfusionist
What are inotropic drugs?
increase blood output
What are 2 inotropic drugs for heart cases?
dopamine
epinephrine
What does dopamine do to the heart?
increases heart rate and contraction strength
What does epinephrine do to the heart?
increases heart rates and causes vasoconstriction
(Adrenaline)
What is Atropine used as? What can it treat?
anticholinergic- inhibits parasympathetic nervous system
bradycardia
What is Papaverine used for?
antispasmodic- treats vessel spasm
vasodilator to relax blood vessels
What is sodium bicarbonate used for?
metabolic acidosis
What is a coronary artery disease?
tightening (sclerosis) of the coronary arteries= restricted blood flow to heart muscles
What is a myocardial infarction?
heart attack
decrease or blockage of blood to the heart
What is cardiomyopathy? What are two ways it presents?
muscular disease- inefficient blood pumping
thickening/stiffening of muscles
dilation of the chambers
What is congestive heart failure?
not enough blood pumped to meet body’s needs
What are common causes of congestive heart failure?
coronary artery diseases
high blood pressure
poorly controlled diabetes
What are signs and symptoms of coronary heart failure?
short of breath
coughing
fatigue
fluid collection in legs
What are two conduction disorders of the heart?
atrial fibrillation
ventricular fibrillation
What is atrial fibrillation? What are major risks?
beating of atria is irregular
“quivering”
clot formation/ stroke
What is ventricular fibrillation of the heart?
beating of ventricles is irregular
rapid and incomplete
What are three congenital diseases of the heart?
patent ductus arteriosus
coarctation of the aorta
tetralogy of Fallot
What is patent ductus arteriosus?
defect when the hole between the aorta and the pulmonary valve do not close (usually within 24 hours of birth)
What is a coarctation of the heart?
a stricture of the aorta preventing blood flow to the body
What are the 4 main points about Tetralogy of fallot?
most common cyanotic congenital anomaly
- hole between ventricles
-aorta gets blood from both ventricles
-hardening of pulmonary artery
-enlarged right ventricle -
What are 4 inflammatory diseases of the heart? what are they caused by?
endocarditis, myocarditis, pericarditis, and rheumatic disease
infection, IV drug use, autoimmune disease, chemicals or medications,
What is a valvular disorder of the heart?
disrupted function of the valves
What can cause valvular disorders?
thickening (stenosis) of the leaflets
prolapse of leaflets
damage to leaflets, chordee tendinea, or papillary muscles
What is an ascending aortic aneurysm? What can cause it?
weakening of walls of the aorta
formation of a sac/ bulge
smoking, chronic high BP, hardening of artery, genetic defects
What is a median sternotomy incisional approach? What instrument is used to make incision? What can be accessed? What position is patient in?
from sternal notch to xyphoid
sternal saw
heart and great vessels
supine
What incisions are used in a thoracotomy incisional approach? What position is patient in? What can be accessed?
trans or subcostal incision
lateral or supine with bump under patient
lung surgery
What is a mini thoracotomy incisional approach? What kind of surgeries are done? What position is the patient in?
small incision then thoracotomy incision
minimally invasive valve and bypass surgeries
lateral or supine with a bump under patient
What cavities can be accessed in a thoracoabdominal incision? What procedures is done? What position is the patient in?
allows access to thoracic and abdominal cavities
aortic aneurysms extending into both cavities
lateral
What is a clamshell thoracotomy incision?
emergency incision allows access into entire thoracic cavity
What position is a patient in for a percutaneous incision? What technique is used? What procedures is it used for?
supine position
seldingers technique
cardiac catheterizations: angiography, coronary stents, valve replacements
What is a PTCA procedure? Where is it usually performed?
percutaneous transluminal coronary angioplasty
minimal invasive trats narrowed coronary arteries
cath lab
How is a PTCA procedure performed?
a balloon cath is inserted in peripheral artery
inflated to compress plaque to walls
stent may be placed
What is a cardiopulmonary bypass procedure? What is usually administered?
way to divert blood from heart and lungs- open surgery
cardioplegia stops heart beats
What is the cardiopulmonary bypass machine?
“the pump” or “heart-lung machine”
collects patients blood
filters and oxygenates it
pumps back to patient
In a cardiopulmonary bypass machine procedure what blood is collected and where is cannula placed?
venous blood
in vena cava
In a cardiopulmonary bypass machine procedure how is blood returned to patient?
arterial cannula
in aorta
In a cardiopulmonary bypass machine procedure what vessels can be used for cannulation?
femoral
subclavian
In a cardiopulmonary bypass machine procedure what must the patient be on? (med) and why?
heparin for whole surgery
to minimize blood clots
What is the cannulation technique?
placement of cannulas for CPB procedure
What are the steps in a cannulation technique?
purse string suture placed in vessel (prolene)
create incision and place cannula
cinch down purse string with a tourniquet
remove cannula and use purse string to close hole in vessel
What is an aortic cross clamping technique?
used in conjunction with heart lung machine
isolates heart from blood flow
cardioplegia injected into coronary arteries to provide nourishment
What is a coronary artery bypass grafting procedure?
CABG
divert blood flow beyond a blockage in a coronary artery “bypass”
delivers more blood to the heart
Where can vessels come from when doing a CABG
left internal mammary artery lima)
Greater saphenous vein
Radial artery
What is a valve repair and replacement procedure? Which valves?
corrects stenotic, prolapsed, or damaged heart valve
aortic, mitral, tricuspid, pulmonary
what kind of suture is used in a valve repair and replacement procedure?
prolene
What are mechanical valves replaced with?
titanium
What are tissue valves replaced with?
heterograft created from pericardium of cow (bovine) or pig (porcine)
What kind of incisions are traditionally used to perform valve repair/replacement?
open sternotomy
cardiopulmonary bypass
minimally invasive
What is the name of the minimally invasive procedures to do a valve repair/replacement?
TAVR
DaVinci Robot
What does TAVR stand for?
transcatheter aortic valve replacement
What are the steps for a TAVR?
expandable valve implant loaded onto a balloon
catheter fed through vessel to aortic arch
inflate balloon
places new valve and crushes diseased one
Is a CPB needed for a TAVR procedure?
No
Is a CPB needed for a DaVinci robot procedure?
yes
What is an ascending aortic aneurysm repair?
resection of diseased ascending aortic tissues
What are the two types of procedures to do an ascending aortic aneurysm repair?
bentall procedure
debakey procedure
What are conduction disorders of the heart?
disruptions in the electrical impulses of the heart
chronic arrythmias
What are 3 ways to control arrythmias of the heart?
implantable cardioverter defibrillator (ICD)
pacemaker
radiofrequency ablation
What is an implantable cardioverter defibrillator (ICD)?
battery powered/ implant
shocks when arrythmia is detected
“reboots” the system
What is a pacemaker?
battery powered/ implant
increases heartrate
can be temporary
What is radiofrequency ablation?
heat device destroys small amounts of tissue
interrupts pathways causing arrythmias
usually when medicine doesn’t work
What is pericardial effusion?
collection of fluid around the heart
blood, serous fluid, infection
Why are pericardial effusions drained?
to restore heart function
diagnostically to test for infection
emergent procedure
How are pericardial effusions drained?
percutaneously (by needle and syringe)
incision just above the xyphoid
What are 3 cardiac support devices?
Extracorporeal membrane oxygenation (ECMO)
Intra-aortic balloon pump (IABP)
Ventricular assist device (VAD)
What is an extracorporeal membrane oxygenation device? What is the patient on for duration?
(ECMO)
cardiopulmonary support for severely ill patients
form of life support
“portable”
patient is heparinized
What is an intra-aortic balloon pump?
IABP
short term device to help heart recover from surgery or cardiac arrest
How does an intra-aortic balloon pump work? Where is it placed?
balloon inflates and deflates to increase blood flow to the coronary arteries
descending aorta via femoral artery
What is a ventricular assist device?
VAD
battery powered implant to help patients with advanced heart failure
Who would receive a VAD? How long can patient be on device? What must patient be on?
waiting for heart transplant
survival up to 5 years
anticoagulation therapy- heparin
What is a cell saver?
suction device
collects blood from field
spins blood to separate RBC’s
RBC’s back to patient via IV
What are internal defibrillators?
paddles for delivering shock directly to heart
What are pledgets?
soft material on a suture- prevents from tearing through the tissue
What are suture boots? what instrument is used to pass them onto field?
rubber booties for tagging sutures (prolene)
on a mosquito
What is an aortic punch? What procedure is it used in?
used to punch hole in aorta for bypass graft anastomosis
CABG
What is a doppler? What is used on patient’s skin?
ultrasonic high frequency to assess blood flow through a vessel
gel
What space are the lungs contained in?
plueral space
How many lobes are in the left lung? How many in the right lung?
left 2
upper/ superior
lower/ inferior
right 3:
upper/ superior
middle
lower/ inferior
What separates the lobes of the lungs?
fissures
What two layers cover each pleural space?
visceral layer- closest to organ
parietal layer- outer
What does the pleural fluid in the chest cavity do?
lubrication and hydration of tissues
What does the trachea bifurcate to form?
left and right bronchi which carry air to the lungs
The Left and right bronchi subdivide into what?
bronchioles- tiny passageways
Where do the bronchioles terminate at?
the alveoli- grapelike clusters
What is the helium?
structure/ notch that pulmonary vessels. nerves, and bronchi enter the lung
What position is a patient when in an open thoracotomy? What kind of incision?
lateral or supine with a bump
costal- sometimes remove rib
What are 2 minimally invasive thoracic surgery approaches?
VATS and robotic assisted
What is a VATS surgery?
video assisted thoracic surgery
What is a bronchoscopy surgery?
visualization of the trachea and the bronchi
removal of foreign bodies
remove clots/ mucous
biopsies
What are the two types of bronchoscopes?
rigid and flexible
What is a mediastinoscopy procedure? Where is the incision placed?
examination of the mediastinal cavity
the sterna notch
why perform a mediastinoscopy procedure?
biopsy of lymph nodes for lung or esophageal cancer
How are specimens for a mediastinoscopy handled?
place on tefla and label
do not crush or damage
What is a pneumothorax?
air in the pleural cavity
what is atelectasis?
collapsed lung
What can cause a pneumothorax?
trauma
lung surgery
COPD
What is a hemothorax?
collection of blood
What can cause a hemothorax?
trauma
surgery
What is a pleural effusion?
collection of pleural fluid
What can cause a pleural effusion?
heart failure
cancer
infections
Whatcan cause atelectasis?
pneumothorax
hemothorax
pleural effusion
What is thoracentesis?
removal of fluid from the pleural space
What is thoracentesis a treatment for?
pleural effusion
hemothorax
What would the fluid from thoracentesis be biopsied for?
cancer
infection
What is lung decortication?
removal of fibrotic pleura covering chest wall or lungs
What can cause lung decortication?
disease
infection
trauma
age
What is pleurodesis?
treatment to make lung stick to chest wall
irritate the pleura to cause massive inflammation
What is empyema?
accumulation of purulent fluid and infected material in pleural cavity
What is the most common carcinoma?
lung cancer
especially in USA
What are the four types of lung resections?
wedge
segmentectomy
lobectomy
pneumectomy
What is a wedge lung resection?
wedge of lung for smaller localized tumors
What is a segmentectomy lung resection?
larger resection then a wedge but not the whole lobe
What is a lobectomy lung resection? How is the resection named?
removal of entire lobe
for which lobe is taken “right upper lobectomy”
What is a pneumonectomy lung resection?
remove entire lung
What instrument are most lung resections performed with?
staplers
What is individually stapled when doing a lung resection?
individual pulmonary vessels and bronchus
What class is a lung resection?
class 2
What is a lung transplant?
replacement of one or both lungs
What severe lung diseases do patients have that would receive a lung transplant?
cystic defects
COPD
birth defects
with a heart transplant
What is a pectus excavatum?
congenital condition
sternum sunken into chest
What is the name of the procedure to repair pectus excavatum?
nuss procedure
What is a nuss procedure?
repair pectus excavatum
thoracoscopic treatment
steel bars into sternum for 3 years
Where are chest tubes placed after a thoracic surgery
1 low to drain blood and fluid
1 high to restore negative pressure
What is used to suture chest tubes in place?
nylon, silk,ethibond
What is a water sealed chest tube? How does it work?
suction pulls air from chest
through a chamber with water
water serves as a valve that prevents air from going back to chest
3 things to consider with chest tubes are?
never connect to the neptune
keep below patient chest level
mat use heparin so blood can be returned to patient
What is the circulation of blood through the vessels?
heart
arteries
arterioles
capillary bed
venules
veins
Arteries are smaller or larger then veins
smaller
What are the 3 layers of the arteries and veins?
tunica intima (inside)
tunica media
tunica adventitia (outside) tunica media
What are the 5 parts of the aorta?
aorta root (valve from heart)
ascending branch
aortic arch
descending (thoracic) branch
abdominal aorta
What 3 branches come off of the aortic arch?
brachiocephalic (right common carotid and right subclavian)
left common carotid
left subclavian
What arteries come off of the subclavian artery?
axillary
brachial- radial and ulnar
What arteries come off of the abdominal aorta?
renal
common iliacs (bifurcation)
What are the major arteries off of the common iliacs?
femoral
popliteal
a/p tibials
dorsalis pedis
What are the major veins called superior and inferior to the heart?
vena cava
superior (from head and arms) and inferior (from the body)
What are the 3 major veins above the vena cava?
internal jugular
external jugular
brachiocephalic
What does the hepatic portal vein connect?
abdomen to the liver
What are the 2 veins in the leg?
greater saphenous- upper
lesser saphenous- posterior
What is an abdominal aortic aneurysm?
enlarged section of aorta
What is an arteriovenous fistula?
AV Fistula
fistula between artery and vein (dialysis site)
What is an embolectomy?
removal of clot in vascular system
What is a thrombectomy?
removal of a clot
What catheter can be used in a thrombectomy or embolectomy?
fogarty catheter
What is a fogarty catheter? What is used to fill the balloon
ballon tipped catheter placed past the clot so can pull out
use saline or heparin to fill ballon
No air bubbles
What are vena cava filters?
Filter placed in inferior vena cava to prevent clot from migrating to the heart
What is a carotid endarterectomy?
removal of plaque from arteries
If there is plaque in the arteries what could the patient be experiencing?
transient ischemic attacks (TIA)
what tools are used in a carotid endarterectomy?
blade?
clamps
other tools
11 or 12
kellys (clamp vessels)
mosquitoes
vessel loops as a shunt
elevator freer
What is a vascular bypass?
bypass of occluded arteries to restore blood flow
What graft is used for a vascular graft?
greater saphenous (homograft)
synthetic tube
What are some possible complications of vascular bypass?
stenosis of graft
false aneurysm
What is vein ligation and stripping?
tx for varicose veins
incision to remove twisted veins
