CARDIOVASCULAR PROCEDURES AND INTERVENTION SURGERIES

Question 1

True or false: percutaneous & endoscopic CV procedures are considered “ closed” approach

Answer 1

true

Question 2

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 __________________

Answer 2

ANGIOGRAM

Question 3

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

Answer 3

Ballon angioplasty

Question 4

Potential complications of Percutaneous Transluminal Coronary Angioplasty

Answer 4

• Vessel recoil
• Restenosis

Question 5

Percutaneous Transluminal Rotational or Directional Atherectomy is

Answer 5

Plaque Removal using a special catheter that grinds away the plaque on arterial walls

Question 6

Potential complications of atherectomy procedure

Answer 6

• Unclear effectiveness in coronary arteries
• Restenosis, acute complications

Question 7

Answer 7

• Stents – Bare-Metal: in-stent restenosis; anti-clotting meds
• Drug Eluting Stents: markedly reduces the rate of re narrowing; use of anti-platelet therapy

Question 8

Intracoronary radiation therapy by the insertion of radioactive implants directly into the tissue.

Answer 8

Brachytherapy

Question 9

💡Brachytherapy

Radiation therapy aimed at restenosis has two purposes:

Answer 9

1. Treat restenosis itself
2. Prevent further restenosis

Question 10

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.

Answer 10

Transcatheter Aortic Valve Replacement

Question 11

when can aerobic and resistance training begin after Percutaneous & Endoscopic procedures?

Answer 11

almost immediately

Question 12

Generally, uncomplicated Percutaneous Coronary Intervention patients are discharged from hospital after ______ Percutaneous & Endoscopic

Answer 12

24 hrs

Question 13

Most frequently used incision for open heart surgery:

Answer 13

Sternotomy

Question 14

CABG, Valve Repair/Replacement, Aneurysm repair, Ventricular Assist Devices and Transplants are surgeries done via ______

Answer 14

Sternotomy

Question 15

Sternal Precautions

Answer 15

• 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

Question 16

Coronary Artery Bypass Graft uses which arteries?

Answer 16

• 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

Question 17

Performs work of the heart & lungs while they are stopped during “On-Pump” surgery to allow work on a “still” heart

Answer 17

Heart-Lung Machine

(As opposed to “Off-Pump” surgery where heart remains beating)

Question 18

After CABG Surgery mobilization starts as early as

Answer 18

24-48hrs POST

Aerobic training - within 20-25 bpm of RHR (NYP); 30 bpm (ACSM)

Question 19

Valve replacement types

Answer 19

• Human – homograft/allograft: lifespan ~10 yrs, now extending
• Animal – porcine, bovine: lifespan ~10 yrs, now extending
• Mechanical: durable but lifelong anticoagulants

Question 20

• Commissurotomy
• Decalcification
• Triangular resection
• Annulus Support
• Patched Leaflets

Answer 20

Valve Repair surgeries

Question 21

💡PT considerations

Activity after valve surgery

Answer 21

• 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

Question 22

a device that helps left ventricle pump blood to the aorta

Answer 22

LVAD: Left Ventricular Assist Device

Question 23

Left Ventricular Assist Device, indications:

Answer 23

• Severe hemodynamic compromise despite medication & other interventions
• Bridge to transplant
• Until heart able to pump effectively or during surgery, OR Long term treatment

Question 24

Left Ventricular Assist Device, PT considerations

Answer 24

• 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

Question 25

Heart transplant, **Orthotopic Approach:**

Answer 25

The more common of the two procedures, the orthotopic approach, requires replacing the recipient heart with the donor heart

Question 26

Heart transplant, **heterotopic approach.**

Answer 26

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.

Question 27

Heart Transplant, PT Considerations

Answer 27

* 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

Question 28

Heart transplant delayed response to exercise:

Answer 28

* 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

Question 29

Cardiac Transplant PT Considerations during exercise:

Answer 29

* 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)

Question 30

Thoracotomy, approach used for:

Answer 30

– Lung surgery – Aneurysm repair

Question 31

Video Assisted Thoracoscopy

Answer 31

– “minimally invasive” – Used for “smaller” lung surgeries – Similar concept as done with joints – Faster recovery time

Question 32

Thoracoabdominal Approach

Answer 32

* Very large incision * Increased pain w/ movement & coughing * Get the patients moving fast!

Question 33

PT considerations post **thoracotomy** and **thoracoabdominal** approaches

Answer 33

* **FUNCTIONAL MOBILITY** * Shoulder and Trunk ROM (to avoid adhesions) * Deep Breathing Exercises * Incentive Spirometry * Splinted Cough

Question 34

Answer 34

**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.

Question 35

Creates an artificial action potential to maintain a suitable HR or stimulate ventricles. May be used to treat **syncope**, **CHF** or **hypertrophic cardiomyopathy**

Answer 35

**Pacemaker**

Question 36

**Automatic Implantable Cardioverter Defibrillator** can have dual functions:

Answer 36

* Pace * Defibrillate

Question 37

this type of pacemaker can detects Vtach and/or Vfib and delivers a “shock” in attemting to “reset” the conduction system

Answer 37

Automatic Implantable Cardioverter Defibrillator

Question 38

PT considerations in patients with pacemakers:

Answer 38

* Use Borg Scale * Monitor systolic BP * Extended warm-up and cool-down

Question 39

PT considerations in patients with **Implantable Cardioverter Defibrillator:**

Answer 39

* Closely monitor for safe exercise * **Know limits and cutoff rates** so patient doesn’t receive shocks at high HRs

Question 40

# 💡 ROM? ⏱? PT considerations in patients p/o 1-2 days pacemaker implantation

Answer 40

* 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

Question 41

Answer 41

hypoglycemia

Question 42

Answer 42

hyperglycemia