CARDIOVASCULAR PROCEDURES AND INTERVENTION SURGERIES Flashcards
True or false: percutaneous & endoscopic CV procedures are considered “ closed” approach
true
during a cardiac catheterization, contrast dye injected and x-ray are taken as the contrast material moves through the chambers, valves, and vessels
THIS PART IS CALLED __________________
ANGIOGRAM
Percutaneous Transluminal Coronary Angioplasty (Aka: Percutaneous Coronary Intervention) uses a _______ to keep the fatty plaque compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart
Ballon angioplasty
Potential complications of Percutaneous Transluminal Coronary Angioplasty
- Vessel recoil
- Restenosis
Percutaneous Transluminal Rotational or Directional Atherectomy is
Plaque Removal using a special catheter that grinds away the plaque on arterial walls
Potential complications of atherectomy procedure
- Unclear effectiveness in coronary arteries
- Restenosis, acute complications
- Stents – Bare-Metal: in-stent restenosis; anti-clotting meds
- Drug Eluting Stents: markedly reduces the rate of re narrowing; use of anti-platelet therapy
Intracoronary radiation therapy by the insertion of radioactive implants directly into the tissue.
Brachytherapy
💡Brachytherapy
Radiation therapy aimed at restenosis has two purposes:
- Treat restenosis itself
- Prevent further restenosis
A surgery performed on a beating heart in select patients with severe Aortic Stenosis or Pulmonary Valve Congenital Defects who are not candidates for traditional open chest or are high risk.
Transcatheter Aortic Valve Replacement
when can aerobic and resistance training begin after Percutaneous & Endoscopic procedures?
almost immediately
Generally, uncomplicated Percutaneous Coronary Intervention patients are discharged from hospital after ______ Percutaneous & Endoscopic
24 hrs
Most frequently used incision for open heart surgery:
Sternotomy
CABG, Valve Repair/Replacement, Aneurysm repair, Ventricular Assist Devices and Transplants are surgeries done via ______
Sternotomy
Sternal Precautions
- Avoid lifting heavy objects
- Avoid bilateral overhead activities or unilateral ROM if pain. HOWEVER, ROM definitely OK and recommended to
- Avoid pushing or pulling heavy objects
- Avoid sports
- Avoid driving
- Avoid repetitive or sustained arm movements
- Sternal Click/Sternal Instability avoid adhesions
- Splinted Cough
- Incentive Spirometer
Coronary Artery Bypass Graft uses which arteries?
- Internal Mammary Artery: most commonly used; best long-term results
- Saphenous Vein: minimally invasive nowadays
- Radial Artery
- Gastroepiploic Artery to stomach & Inferior Epigastric Artery to abdominal wall less commonly used
Performs work of the heart & lungs while they are stopped during “On-Pump” surgery to allow work on a “still” heart
Heart-Lung Machine
(As opposed to “Off-Pump” surgery where heart remains beating)
After CABG Surgery mobilization starts as early as
24-48hrs POST
Aerobic training - within 20-25 bpm of RHR (NYP); 30 bpm (ACSM)
Valve replacement types
- Human – homograft/allograft: lifespan ~10 yrs, now extending
- Animal – porcine, bovine: lifespan ~10 yrs, now extending
- Mechanical: durable but lifelong anticoagulants
- Commissurotomy
- Decalcification
- Triangular resection
- Annulus Support
- Patched Leaflets
Valve Repair surgeries
💡PT considerations
Activity after valve surgery
- Generally same guidelines as post-CABG
- However, these patients MAY have had greater activity restrictions and/or longer periods with symptoms prior to surgery
- This lower functional capacity MAY require valve surgery patients to start at a lower level and progress more slowly
a device that helps left ventricle pump blood to the aorta
LVAD: Left Ventricular Assist Device
Left Ventricular Assist Device, indications:
- Severe hemodynamic compromise despite medication & other interventions
- Bridge to transplant
- Until heart able to pump effectively or during surgery, OR Long term treatment
Left Ventricular Assist Device, PT considerations
- Sternal Precautions Apply
- Pts usually severely deconditioned & weak with prolonged hospitalizations
- Need Borg scale to monitor level of exertion (NYP 11, others 13-14)
- Watch out for the driveline, sutured in, pt’s may wear an abdominal binder, can’t get wet.
- Batteries last 10 hours
- Pts get “dry” and need to drink water, especially prior to exercise, to maintain CO
Heart transplant, Orthotopic Approach:
The more common of the two procedures, the orthotopic approach, requires replacing the recipient heart with the donor heart
Heart transplant, heterotopic approach.
Heterotopic transplantation, also called “piggyback” transplantation, is accomplished by leaving the recipient’s heart in place and connecting the donor heart to the right side of the chest.
Heart Transplant, PT Considerations
- Massive anti-rejection drugs given; biggest risk is rejection
- Exercise Intolerance
- Loss of muscle mass and strength
- Decreased or diminished autonomic cardiac innervation
- Side effects of immunosuppressive medication:
- Dyslipidemia, HTN, obesity, diabetes
Heart transplant delayed response to exercise:
- In response to sub-maximal exercise CO increase is achieved by increase in SV, not H
- At higher work rates, myocardium responds with tachycardia
- Post-exercise HR remains elevated for longer period because of lack of parasympathetic innervation
Cardiac Transplant PT Considerations during exercise:
- Use RPE or dyspnea as guidelines
- Longer periods of warm-up and cool-down
- Progressive aerobic exercise
- Long term resistive exercise
- Monitor BP, side effects of meds, signs of exercise intolerance (may signal rejection)
Thoracotomy, approach used for:
– Lung surgery
– Aneurysm repair
Video Assisted Thoracoscopy
– “minimally invasive”
– Used for “smaller” lung surgeries
– Similar concept as done with joints
– Faster recovery time
Thoracoabdominal Approach
- Very large incision
- Increased pain w/ movement & coughing
- Get the patients moving fast!
PT considerations post thoracotomy and thoracoabdominal approaches
- FUNCTIONAL MOBILITY
- Shoulder and Trunk ROM (to avoid adhesions)
- Deep Breathing Exercises
- Incentive Spirometry
- Splinted Cough
Endarterectomy
surgical removal of part of the inner lining of an artery, together with any obstructive deposits, most often carried out on the carotid artery or on vessels supplying the legs.
Creates an artificial action potential to maintain a suitable HR or stimulate ventricles. May be used to treat syncope, CHF or hypertrophic cardiomyopathy
Pacemaker
Automatic Implantable Cardioverter Defibrillator can have dual functions:
- Pace
- Defibrillate
this type of pacemaker can detects Vtach and/or Vfib and delivers a “shock” in attemting to “reset” the conduction system
Automatic Implantable Cardioverter Defibrillator
PT considerations in patients with pacemakers:
- Use Borg Scale
- Monitor systolic BP
- Extended warm-up and cool-down
PT considerations in patients with Implantable Cardioverter Defibrillator:
- Closely monitor for safe exercise
- Know limits and cutoff rates so patient doesn’t receive shocks at high HRs
💡 ROM? ⏱?
PT considerations in patients p/o 1-2 days pacemaker implantation
- Limited UE ROM immediately post implantation, pt may be in a sling for 1-2 days
- Limited UE ROM above shoulder to 90 deg in first 2 weeks
hypoglycemia
hyperglycemia
