Class 18 Flashcards
Cardiac surgery is never commonplace because of risks involved, for survival, & for person’s physical & mental health. Reasons for heart surgery include?
• Coronary artery disease
• Valve repair/replacement
• Repair of mural defect
• Repair of aneurysm in heart wall, proximal aorta
• Placement of pacemaker
• Atrial fibrillation treatments
• Heart transplant
What is open heart surgery?
Surgeries that are more extensive or require certain types of access to heart structures use open heart procedures. More “minimally invasive” ways of
operating on heart are being developed all the time & are used whenever possible to avoid open heart surgery.
• Sternotomy (sternum is sawed in half vertically)
• Ribcage is clamped open with retractor
• Heart-lung machine is required to keep blood circulating while heart is stopped
Open heart surgery is invasive & often prolonged.
Recovery can be very painful.
What are potential musculoskeletal issues following
open heart procedures?
• Can promote ongoing pain, compression, & degenerative changes in plane/gliding joints of spine & rib-spine articulations
• Can irritate musculature (esp. intercostals, paraspinals)
• Deep bruising can take a while to heal
• May cause alignment problems with sternal repair
• Person may struggle to feel comfortable moving trunk, as well as breathing deeply/freely (physical, psychological reasons)
Heart Surgery (Entry via the Diaphragm)
• Employed to address issues in lower aspects of heart
• Involves no bone fractures
• Incision in abdominal wall
Concern is more direct respiratory complications post-operatively.
Heart Surgery (Minimally Invasive Procedures)
Procedures included in this category use entry points between ribs & laparoscopic equipment. Are increasingly used for specific repair work & can sometimes be employed for bypass surgery. Smaller incisions & reduced overall tissue trauma make for less postsurgical pain & faster recoveries.
What is Coronary Artery Bypass Grafting (CABG)?
• Uses pieces of patient’s own blood vessels (usually saphenous vein in leg) to create detour that re routes flow of blood around blocked area of coronary artery. Diseased artery area will be filled to ensure it’s fully & stably occluded.
• Often requires open heart surgery, esp. if multiple bypasses are being done, in some cases minimally invasive approaches are possible.
• Sometimes other-sourced or synthetic blood vessels are utilized, usually blood vessel graft is sourced from patient’s leg, making for second postsurgical site.
What is Angioplasty?
Balloon-tipped catheter is inserted into damaged artery, & balloon is inflated. Balloon compresses plaque, pushing it against artery wall, to allow for freer blood flow.
Surgical entry point is via an incision in groin or wrist. Catheter is threaded through blood vessels to reach heart. Balloon structure may have medication coating.
What is Stenting?
Small wire mesh tube, called stent, is placed into damaged artery via catheter to support & stretch artery walls & provide for unrestricted blood flow. This is normally done in conjunction with angioplasty procedure.
Stent is left in blood vessel. Approximately 11% of angioplasties will re-occlude, whereas only about 5% will re-occlude if stent is used.
What is Directional Atherectomy?
Bladed catheter is used to cut away plaque in an artery. Plaque is removed when catheter is withdrawn from artery.
What are Complications/Ongoing Issues with Heart Surgeries?
List includes issues most concerning in postsurgical weeks, may be more prolonged, or permanent. It’s important to keep in mind that speed/quality of
postsurgical healing is influenced by how well heart is functioning following procedure.
• Postsurgical bleeding at site – may require additional procedure(s)
• Cardiac tamponade (from bleeding into pericardium)
• Thromboembolism risk (e.g., embolic stroke)
• Postsurgical infection: delays healing, promotes additional damage inside heart, can increase thromboembolism risk
• Ventricular fibrillation is dangerous complication
• Atrial fibrillation (A-fib) often onsets following heart procedures
• Wall scarring generated dysrhythmias
• Surgical or ischemic damage to heart
• Postop ↓ ribcage expansion can lead to restricted respiration, impaired perfusion, increased susceptibility to infection
• Severe pain can lead to person being unable unwilling to participate in postsurgical activity necessary for healing
• Inability to get restorative sleep
What are the Common Musculoskeletal Complications with heart surgery?
• Scar tissue caused adherences that can limit functional movements, cause pain
• Ongoing respiration limitations from physical & psychological factors
• Ongoing muscle irritation, underuse/overuse imbalances, etc.
• Osteoarthritic changes, esp. in spine, possibly shoulder
• Thoracic outlet syndrome &/or intercostal neuralgia
• Frozen shoulder, shoulder bursitis
• Ongoing neck issues, tension headaches
• Other chronic pain syndromes, incl. from sternum repair issues
• Hyperkyphosis, other postural issues
