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
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
3
Q
Indications for coronary artery bypass grafts
A
- triple vessel disease
- left main disease
- failure angioplasty
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
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
6
Q
Risks of full cardiopulmonary bypass
A
- aortic cannulation
- cerebral emboli
- dissection
- complications of bypass
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
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
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
10
Q
Valve Pathology
A
- Normal aortic valve leaflets
- Vegetations from endocarditis
- Mitral stenosis
- Floppy mitral valve leaflets
- Marfans syndrome
11
Q
Valve repair
A
- where suitable, valve repair usually has better long-term outcomes for patients then valve replacement
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
13
Q
Clinical sequelae of cardiopulmonary bypass
A
- Haemodilution
- Hypothermia
- antigoagulation
- myocardial stunning
- atelectasis
- pleural effusion
- deep sternal wound infection