Cardiovascular management after surgery Flashcards

1
Q

Preparing family

A

Prepare family for what the pt will look like in ICU

  • tubes, drains, not able to talk
  • time frames
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2
Q

Preoperative assessment for cardiac

A
  • CXR, urine sample, ECG, nasal and groin swabs
  • Any necessary consults e.g renal, endocrine
  • Spirometry
  • Height and weight
  • Allergies
  • Temperature, heart rate, resps, blood pressure
  • Capacity for ADLs, mobility
  • Recent infections
  • Bowel habits
  • Falls risk assessment
  • Pressure risk assessment
  • Discharge planning
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3
Q

Indications for coronary artery bypass grafts

A
  • triple vessel disease
  • left main disease
  • failure angioplasty
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4
Q

Cardiopulmonary bypass allows:

A
  • the heart to be stopped
  • blood to be warmed or cooled
  • oxygenation and pumping of blood continue
  • the longer the
    surgery the more complications
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5
Q

Benefits of full cardiopulmonary bypass

A
  • comfortable for surgeon
  • bloodless field
  • heart doesn’t move during surgery
  • myocardial protection
  • access to all vessels for total revascularisation
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6
Q

Risks of full cardiopulmonary bypass

A
  • aortic cannulation
  • cerebral emboli
  • dissection
  • complications of bypass
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7
Q

Off bypass coronary artery grafting

A

done on warm, beating heart

  • Eliminates complications of cardiopulmonary bypass
  • Eliminates need to cross clamp aorta
  • Potentially reduces transfusion rates
  • Potentially reduces cognitive dysfunction
  • Suturing more difficult
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8
Q

Graft harvest sites

A
  • left internal mammary (LIMA) - used to higher pressure so can withstand pressure
  • Saphenous vein - easily accessible
  • Radial artery - possible vasospasm
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9
Q

Valve anatomy

A
  • Tricuspid valve: between right atrium and ventricle
  • Mitral valve: between left atrium and ventricle
  • Aortic valve: between left ventricle and aorta
  • Pulmonary valve: between right ventricle and pulmonary artery
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10
Q

Valve Pathology

A
  • Normal aortic valve leaflets
  • Vegetations from endocarditis
  • Mitral stenosis
  • Floppy mitral valve leaflets
  • Marfans syndrome
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11
Q

Valve repair

A
  • where suitable, valve repair usually has better long-term outcomes for patients then valve replacement
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12
Q

Valve replacement with tissue valve

A
  • Known as a heterograft
  • Taken from pig, cow or human donors
  • Don’t last as long as mechanical valves
  • Long-term therapy with anticoagulant medication usually isn’t necessary
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13
Q

Clinical sequelae of cardiopulmonary bypass

A
  1. Haemodilution
  2. Hypothermia
  3. antigoagulation
  4. myocardial stunning
  5. atelectasis
  6. pleural effusion
  7. deep sternal wound infection
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