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CPT II > CPT II - Midterm > Flashcards

CPT II - Midterm Flashcards

1
Q

What is automaticity?

A

Ability of muscle cells to generate their own action potentials

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2
Q

What is rhythmicity?

A

Action potentials that occur at regular intervals.

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3
Q

What is the function of the intercalated discs in the myocardium?

A

Gap junctions allow AP to spread and polarize all cells at the same time.

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4
Q

What is a vulnerable period for dysrhythmias in the heart cycle?

A

During relative refractory period

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5
Q

What does diastole look like on EKG?

A

Flat line (no electrical activity)

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6
Q

Where is the SA node?

A

At the base of the superior vena cava (right atrium)

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7
Q

How do you LOOK for cardiac output?

A

Signs and symptoms

Blood pressure

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8
Q

EKG only shows what kind of heart activity?

A

Electrical (not mechanical)

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9
Q

When does the SA node fire typically?

A

When ventricles fill to 80%

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10
Q

What is the AV junction?

A

Where AV node meets bundle of His (near tricuspid valve)

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11
Q

Dysrhythmias occur as a result from…

A

altered conduction, rhythmicity, or both

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12
Q

What is an ectopic rhythm?

A

Rhythm in which the origin is not the SA node

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13
Q

How do dysrhythmias occur?

A 
Hypoxia
Ischemia or Irritability
Sympathetic stimulation
Drugs
Electrolyte Disturbances
Bradycardias 
Stretch
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14
Q

How many electrodes are in a 12-lead EKG? What is the purpose of having so many?

A

10 - each lead has a different view of the heart

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15
Q

What is a bipolar lead?

A

1 positive and 1 negative electrode

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16
Q

What are the 3 bipolar leads?

A

Leads I, II, III

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17
Q

What are the 3 unipolar leads?

A

Leads aVR, aVL, aVF

augmented views - right, left, foot

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18
Q

What is a unipolar lead?

A

1 positive electrode and 1 reference point

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19
Q

How many views do you need to diagnose a heart condition by EKG?

A

All 12

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20
Q

Dysrhythmias occur as a result from…

A

altered conduction, rhythmicity, or both

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21
Q

What is an ectopic rhythm?

A

Rhythm in which the origin is not the SA node

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22
Q

How do dysrhythmias occur?

A 
Hypoxia
Ischemia or Irritability
Sympathetic stimulation
Drugs
Electrolyte Disturbances
Bradycardias 
Stretch
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23
Q

How many electrodes are in a 12-lead EKG? What is the purpose of having so many?

A

10 - each lead has a different view of the heart

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24
Q

What are the inferior view leads?

A

II, III, AVF

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25
Q

Limb leads record activity in what plane?

A

Frontal

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26
Q

Chest leads record activity in what plane?

A

Horizontal

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27
Q

How many chest leads are there and what are they made up of?

A

Six unipolar leads made up of a positive electrode and a reference point near the AV node (V1 -> V6)

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28
Q

What is the MCL1 lead commonly used for?

A

Monitoring. Similar to lead II but now using 5 electrodes instead of 3

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29
Q

Where is the MCL1 positive electrode placed?

A

Over the 4th intercostal space just to the right of the sternum.

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30
Q

Where is the MCL1 negative electrode placed?

A

2nd intercostal space midline on the upper left chest or outer third of the left clavicle

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31
Q

What are the anterior view leads?

A

V1, V2, V3, V4

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32
Q

What are the lateral view leads?

A

I, AVL, V5, V6

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33
Q

What are the inferior view leads?

A

II, III, AVF

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34
Q

What is Q-T syndrome?

A

Prolonged Q-T interval; more danger of repolarization (dysrhythmia)

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35
Q

What is the best method to determine rate via EKG? What is an ok alternative?

A

Count out beats on full minute of tape

Ok: 6 second strip

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36
Q

What are the 4 places of origin for action potential?

A

SA node
Atrium
Junction
Ventricles

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37
Q

What is the flat line of diastole also called?

A

isoelectric line

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38
Q

What is the difference between a segment and an interval?

A

Segment - straight line

Interval - 1 wave and 1 segment

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39
Q

What is the P-R interval? Normal value?

A

Beginning of P wave to the beginning of the QRS complex

Normal: < 0.20 ms (5 boxes)

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40
Q

What is the S-T segment? How can it indicate infarction/ischemia?

A

Plateau phase

Ischemia: > 2 mm elevation or depression from isoelectric line

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41
Q

What is the Q-T interval?

A

Ventricular depolarization and repolarization

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42
Q

What part of the EKG represents the shift from absolute to relative refractory period?

A

Q-T interval

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43
Q

What is Q-T syndrome?

A

Prolonged Q-T interval; more danger of repolarization (dysrhythmia)

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44
Q

Why is sinus tachycardia during exercise not a concern in healthy individuals?

A

Increased venous return prevents decrease in stroke volume

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45
Q

Time: 1 small square, 1 large square, 5 large squares

A

1 small = 0.04 s
1 large = 0.2 s
5 large = 1 s

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46
Q

What do you think if you can’t see a P wave on EKG?

A

Atrial rate is absent OR

Tachycardia is hiding it

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47
Q

When do you use the box method?

A

For regular rhythm only

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48
Q

What is the best method to determine rate via EKG? What is an ok alternative?

A

Count out beats on full minute of tape

Ok: 6 minute strip

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49
Q

Normal Sinus Rhythm

A 
Rhythm: regular
Rate: 60-100
P waves: normal
PR: normal
QRS: normal
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50
Q

What is a premature atrial contraction?

A

For one beat, somewhere in the atria, one site fires faster than the SA node.

Often once or twice per minute.

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51
Q

SInus Tachycardia

A 
Rhythm: regular
Rate: 100-150
P waves: normal
PR: normal
QRS: normal
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52
Q

Sinus tachycardia has the potential to decrease…

A

stroke volume (less time in diastole)

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53
Q

Why is an accelerated heart rate during exercise not considered sinus tachycardia diagnostically?

A

Increased venous return prevents decrease in stroke volume

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54
Q

Sinus Arrhythmia

A 
Rhythm: irregular
Rate: varies w/ breathing
P waves: normal
PR: normal
QRS: normal
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55
Q

How does the heart rate vary in sinus arrythmia?

A

Speeds up with inhalation

Slows down with exhalation

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56
Q

Premature atrial contraction

A 
Rhythm: Reg underlying, Irreg at PAC
Rate: Normal underlying
P waves: Normal underlying
PR: normal
QRS: normal
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57
Q

How can you see an atrial dysrhythmia

A

Presence of P wave but it looks abnormal

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58
Q

Every cell in the heart has the ability to be its own pacemaker. SA node is primary because…

A

it’s fastest

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59
Q

What is a premature atrial contraction?

A

For one beat, somewhere in the atria, one site fires faster than the SA node.

Often once or twice per minute. Generally benign.

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60
Q

Premature Junctional Contraction

A 
Rhythm: Regular underlying
Rate: N underlying
P waves: Before/During/After QRS
PR: Absent
QRS: normal
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61
Q

What does a retrograde depolarization look like?

A

Inverted wave

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62
Q

Premature Ventricular Contraction

A

Rhythm: regular underlying
Rate: N underlying
P waves: normal underlying, absent at PVC
PR: normal underlying, absent at PVC
QRS: normal underlying, wide/bizarre at PVC

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63
Q

Atrial Flutter

A 
Rhythm: regular or irregular
Rate: Atrial: 250-300
P waves: Flutter (F) waves
PR: non-discernable
QRS: normal
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64
Q

What is happening during atrial flutter?

A

Not all atrial depolarizations are getting through to the ventricles - several p waves before every QRS complex

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65
Q

Atrial Fibrillation

A 
Rhythm: Irregular
Rate: Uncontrolled > 100
P waves: Fibrillatory
PR: Absent
QRS: Normal
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66
Q

Unifocal vs. multifocal PVC

A

Unifocal: origin at one area

Multifocal: more than 1 area of origin

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67
Q

How can you determine a junctional dysrhythmia? Where does the AP originate?

A

No P wave; AP starts at the QRS complex (AV node)

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68
Q

Junctional Dysrhythmia

A 
Rhythm: regular
Rate: 40-60
P waves: absent
PR: absent
QRS: normal
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69
Q

Premature Junctional Contraction

A 
Rhythm: Regular underlying
Rate: 40-60 underlying
P waves: Before/During/After QRS
PR: Absent
QRS: normal
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70
Q

What does a retrograde depolarization look like?

A

Inverted wave

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71
Q

Premature Ventricular Contraction

A

Rhythm: regular underlying
Rate: N underlying
P waves: normal underlying, absent at PVC
PR: normal underlying, absent at PVC
QRS: normal underlying, wide/bizarre at PVC

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72
Q

Implication on stroke volume with PVCs?

A

Lose the atrial kick which may decrease stroke volume (ventricles don’t fill all the way)

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73
Q

What do you do if there are < 6 PVC per min? > 6 per min?

A

< 6 = treat and monitor

> 6 = don’t aggravate it further, could compromise CO

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74
Q

Signs of aggravation of PVC condition

A

Amount of PVCs per minute increase

PVCs come from different locations

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75
Q

Unifocal vs. multifocal PVC

A

Unifocal: origin at one area

Multifocal: more than 1 area of origin

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76
Q

Ventricular Fibrillation

A 
Rhythm: Absent
Rate: Absent
P waves: absent
PR: absent
QRS: fibrillatory
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77
Q

What is 3+ PVCs in a row?

A

Ventricular tachycardia

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78
Q

What is bigeminy?

A

Every other beat is a PVC

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79
Q

What is trigeminy?

A

Every third beat is a PVC

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80
Q

Multifocal PVCs look different from each other. What could they signify?

A

Increased irritation to the ventricles

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81
Q

Ventricular Tachycardia

A 
Rhythm: regular 
Rate: 100-250
P waves: absent
PR: absent
QRS: wide and bizarre
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82
Q

What is happening with ventricular tachycardia?

A

Site is so irritated, it takes over as primary pacemaker.

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83
Q

What is important to know about V-tach?

A

It is life-threatening!! Patient needs to get shocked out of it.

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84
Q

What is non-sustained ventricular tachycardia?

A

3+ PVCs in a row but resolves on its own.

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85
Q

Ventricular Fibrillation

A 
Rhythm: Absent
Rate: Absent
P waves: absent
PR: absent
QRS: fibrillatory
86
Q

What is happening during V-Fib

A

Heart trying to depolarize, but not able to (must de-fibrillate)

87
Q

What is R-on-T phenomena?

A

PVC occurs on the T-wave during the relative refractory period. May lead into V-Tach or V-fib

88
Q

What can an EKG diagnose?

A 
Ischemia/infarction
Hypertrophy/heart axis
Pericarditis
Adverse effects of drugs
Dyrhythmias
89
Q

What is a first degree heart block?

A

Lengthening of the PR interval (> 0.2 s). Everything else is normal or underlying.

90
Q

What is a second degree heart block (Wenckebach’s/Mobitz Type I)

A

Progressive lengthening of the PR interval until it drops a QRS, then it repeats. Usually due to a block within the AV node.

91
Q

What is a second degree heart block (Wenckebach’s/Mobitz Type II)

A

Non-conduction of the impulse through the AV node without a prolonged PR interval. Usually due to a block below the AV node.

92
Q

What is a third degree heart block?

A

No communication between the atria and the ventricles. Atrial rate and ventricular rate are independent of each other. QRS may be wide.

Atria and ventricles are both firing at their own inherent rate.

93
Q

What is a bundle branch block?

A

Delay in conduction through the bundle branches. Widened QRS but regular rhythm.

94
Q

Hallmark sign of a bundle branch block?

A

“Bunny ears” in QRS complex.

95
Q

What is asystole

A

No rhythm (flat line). Can’t be shocked out of this. Must be seen in more than 3 ways on EKG.

96
Q

How can you tell a pacemaker rhythm on EKG?

A

Presence of “pacer-spikes.”

97
Q

What can an EKG diagnose?

A

Ischemia/infarction

Hypertrophy/heart axis

98
Q

EKG paper speed

A

25 mm/sec

99
Q

P-wave represents atrial depolarization. How can you tell right from left atrium on EKG?

A

1st 1/2 is RA

2nd 1/2 is LA

100
Q

Normal length/amplitude of P-waves

A

Length: < 0.2 s
Amplitude: < 2.5 mm

101
Q

QRS represents…

A

Ventricular depolarization

102
Q

Normal QRS length

A

< 0.12 s

103
Q

What are pathological Q waves?

A

> 0.04 s and > 1/3 height of QRS complex

104
Q

T wave represents…

A

Ventricular repolarization

105
Q

Infarction is indicated by what kind of T wave?

A

Tombstone or inverted T wave

106
Q

What is a U wave

A

Represents abnormal electrolyte or ion concentrations

107
Q

PR interval represents…

A

AV node delay and atrial kick

108
Q

ST segment > 1-2 mm in deflection is diagnostic for

A

ischemia and/or MI

109
Q

QT interval represents…

A

beginning of ventricular depolarization to end of depolarization.

110
Q

QT interval can be prolonged by..

A

drugs, hypothermia, and electrolyte disturbances

111
Q

If during activity, there is a change in rhythm…

A

the activity should be stopped and both the rhythm and patient should be re-assessed.

112
Q

How could you break atrial tachycardia?

A

Vaga maneuvers (coughing, valsalva)

113
Q

What is the difference between sinus and atrial tachycardia?

A

Sinus: rate is 100-150
Atrial: rate is > 150

114
Q

Patients with A-fib will be on what kind of medication?

A

Anticoagulants to decrease risk for thrombi

115
Q

If patient has chronic a-fib, what kind of exercise can they tolerate?

A

May be able to handle rates > 100 bpm as long as venous return increases with activity

116
Q

What is a wandering atrial pacemaker?

A

Primary pacemaker shifts from focus to focus in the atria resulting in irregular rhythm. May lead to a-fib.

117
Q

Significance of premature junctional contraction?

A

Monitor, but generally benign.

118
Q

Significance of premature ventricular contraction?

A

Signifies irritability of ventricle and need to watch for progression. May signify the predisposition to more lethal dysrhythmias.

119
Q

Significance of ventricular fibrillation?

A

No cardiac output!! Needs immediate defib and CPR - no pulse

120
Q

Significance of idioventricular rhythm

A

Ventricles are only functioning electrical activity

121
Q

Is a first degree AV block benign or severe?

A

Usually benign but should be monitored by MD. No real significance unless accompanied by severe bradycardia.

122
Q

Significance of Type I 2nd degree block

A

Depends on symptoms. Will skip a beat but usually asymptomatic. Monitor.

123
Q

Significance of Type II 2nd degree block?

A

Depends on symptoms, but can lead to cardiac arrest, no cardiac output.

124
Q

Signs/symptoms of 3rd degree block?

A

Decreased cardiac output symptoms

125
Q

SBAR

A

Situation
Background
Assessment
Recommendation

126
Q

Keeping all 4 bed rails up or placing a tray close in front of a patient is considered to be…

A

restraints

127
Q

Risk factors for ICU psychosis

A 
Dementia
Alzheimer's
Substance abuse
Age
Chronic illness
Infection
Hypoxia
Metabolic disorders
Alteration in medication
128
Q

Critical illness polyneuropathy vs. mypopathy

A

Polyneuropathy: muscle weakness and sensory loss

Myopathy: steroid-induced myopathy, use of neuromuscular blocks, shutdown of muscular system

129
Q

Role of PT in acute care

A 
Minimize complications of immobility
Maintain strength and flexibility
Enhance pulmonary hygiene
Early mobility to prevent deterioration
OOB to enhance ventilation and perfusion matching
Consultant vs. direct intervention
130
Q

General guidelines for acute care

A 
THOROUGH chart review
Know your nurses
Know your equipment
Standard precautions
Inventory
Vitals, vitals, vitals
Anticipate events
Know your limits
131
Q

What is a Central Venous Catheter?

A

Catheter inserted in internal jugular vein (IVJ) or subclavian vein (SCV).

It can be used to monitor PAP, CVP, PCWP; put in medications; and take blood samples.

132
Q

What is PAP?

A

Pulmonary artery pressure

133
Q

What is CVP?

A

Central venous pressure (right atrium)

134
Q

What is PCWP?

A

Pulmonary capillary wedge pressure. Represents left atrial pressure via balloon inflation

135
Q

Problems associated with CVC?

A

Dysrhythmias

Limit cervical/shoulder ROM

136
Q

Activity implications of CVC?

A

Does not contraindicate activity - just be careful around it.

137
Q

An arterial line is usually placed in what artery?

A

Radial

138
Q

Purpose of an arterial line?

A

Continuous BP monitoring or arterial blood samples for ABG tests.

139
Q

A-line waveform should be…

A

nice and regular

140
Q

How do you protect an A-line? PT contraindications?

A

Protect: soft splint on wrist in 15 deg ext.

PT: no weight bearing or excessive wrist extension (radial) and no LE mobilization (femoral)

141
Q

An intracranial pressure monitor is used for what types of patients?

A

Head injury or surgery patients who are on bed rest.

142
Q

Normal ICP

A

0-15 mmHg

143
Q

4 types of intracranial pressure monitor

A

Epidural
Subdural/subarachnoid
Intraparenchymal
Intraventricular

144
Q

What is the equation for cerebral perfusion pressure (CPP)? Normal?

A

CPP = MABP - ICP

Normal: > 60 mmHg

145
Q

< 50 mmHg CPP means

A

decreased perfusion

146
Q

< 40 mmHg CPP means

A

completely inadequate perfusion

147
Q

ICP A-waves look like? Represent?

A

High spikes

Represent poor prognosis

148
Q

ICP B-waves look like? Represent?

A

Erratic

Represent respiratory changes

149
Q

Lumbar drain is used for…? Precautions?

A

Used for bedrest, monitoring/draining of CSF

Need HOB flat and spine precautions. Wait for this to come out before PT

150
Q

An intra-aortic balloon pump (IABP) is for a patient in critical status and assists with cardiac output. Where does it travel? How does it work?

A

Where: femoral artery into the aorta

Timed with cardiac cycle so that it inflates during diastole and deflates during systole. Aids in propulsion of blood

151
Q

Complications of hemodialysis

A

Hypotension
Dysrhythmias
Electrolyte imbalances
Decreased memory

152
Q

Cardiac effects of inactivity and bed rest

A 
Increased heart rate
Increased HR response to activity
Decreased VO2 max
Decreased CO
Decreased blood volume
153
Q

Hematologic effects of inactivity and bed rest

A

Decreased blood volume

Increased coagulation

154
Q

Respiratory effects of inactivity and bed rest

A

Increased respiratory rate
Risk for PE and atelectasis
Decreased pulmonary function
Poor pulmonary hygiene

155
Q

GI/urinary effects of inactivity and bed rest

A

Decreased appetite
Decreased bowel motility and glomerular filtration
Incontinence

156
Q

Endocrine effects of inactivity and bed rest

A

Altered hormonal response

Glucose intolerance

157
Q

Musculoskeletal effects of inactivity and bed rest

A

Weakness
Loss of motion
Osteoporosis

158
Q

Neurologic effects of inactivity and bed rest

A

Sensory and sleep deprivation
Compression neuropathy
Decreased balance

159
Q

Neurovascular effects of inactivity and bed rest

A

Orthostatic hypotension

160
Q

Integumentary effects of inactivity and bed rest

A

Skin breakdown, pressure ulcers

161
Q

Psychosocial effects of inactivity and bed rest

A 
Sensory deprivation
Depression
Boredom
Loss of control
Emotional liability
Irritability
162
Q

Lung transplantation is indicated for patients with…

A

irreversible, progressively disabling, end-stage pulmonary disease.

Patients have a life expectancy of less than 24 months. Other therapeutic options have failed.

163
Q

Ideal timing of lung transplant referral

A

When patients have less than 50% chance of surviving 2-3 years

164
Q

Lung transplant is indicated in 4 groups of patients:

A

Obstructive lung diseases
Cystic fibrosis
Restrictive lung diseases
Pulmonary vascular disease

165
Q

What type of patient gets the most transplants?

A

COPD/emphysema

166
Q

What is alpha-1 antitrypsin deficiency?

A

Nonsmoking emphysema

167
Q

Patient can’t have a lung transplant unless they can perform a…

A

6MWT

168
Q

Adherence to therapy after transplant is essential or…

A

organ rejection

169
Q

If a transplant patient can’t get off of a ventilator…

A

they will be put on the inactive list until they can get off of it and perform a 6MWT

170
Q

Transplant survival varies by

A 
Primary lung disease
Procedure type (single vs. double)
Recipient co-morbidities
Recipient age
Characteristics of donor lung
171
Q

Transplant patients must live within…

A

2 hours of transplant center.

172
Q

The Lung Allocation Score is calculated using

A

Waitlist urgency measure calculated using patient characteristics to determine probability of one-year survival if not transplanted

Post-transplant survival measure calculated based upon patient characteristics of surviving transplant for one year

Allocation score is computed by subtracting the two measures and then normalized

173
Q

What else determines transplant eligibility besides Lung Allocation Score?

A

Patient’s size and blood type

174
Q

Why does the LAS work so well?

A

It is based on severity, not amount of time on the list.

175
Q

What is the most typical lung transplant procedure?

A

Bilateral sequential or double lung transplant (BLT)

176
Q

Where are the incisions for lung transplant?

A

Thoracotomy for SLT - posterolateral or anterior axillary

Clam shell (bilateral transverse thoracosternotomy) for BLT

177
Q

What are the 3 main anastomosis during lung transplant?

A

Bronchus
Pulmonary artery
Pulmonary veins/left atrium

178
Q

Clinical implications of a thoracotomy?

A

Very painful - patient may resist taking deep breaths which is bad for pulmonary hygiene

179
Q

What is the leading cause of mortality post transplant?

A

Infection.

Patients must wear a mask when they leave a room or house, especially if construction is around (higher risk for fungal infection)

180
Q

Causes of post-transplant infection

A

Exposure of allograft to external environment
Blunted cough/pain due to lung denervation
Impaired mucociliary clearance
Narrowing of bronchial anastomosis
Transfer of organisms with donor lung

181
Q

What is acute antibody-mediated rejection

A

Occurs within 72 hours of transplant; primary allograft failure with severe hypoxemia.

182
Q

What is acute cellular rejection

A

Occur within the 1st year and often clinically unapparent except by transbronchial biopsy.

Symptoms: oxygen requirement, mild SOB, reduction in spirometry, fever, hypoxemia, diffuse pulmonary infiltrates.

Monitored by biopsies at 2-4 weeks post-op, then at 3 month intervals

183
Q

What is bronciolitis obliterates?

A

Cause of death for most transplant recipients surviving > 1 year

184
Q

What immunosuppressive drugs are used post-transplant. Why are they hard on the body?

A

Calcineurin inhibitors (cyclosporine)
Antiproliferative agents
Steroids

Transplants need a higher dosage of these drugs due to constant exposure

185
Q

Role of PT post-transplant

A 
Assess functional ability
Assess exercise tolerance (6MWT)
Supplemental oxygen needs
Musculoskeletal assessment
Optimize pulmonary hygiene/airway clearance
Outpatient pulmonary rehab
186
Q

Inotropes are…

A

medication support for heart failure

187
Q

Examples of surgical management for heart failure

A

CABG, stents, heart transplant

188
Q

Indications for cardiac transplant

A

End-stage cardiac disease

189
Q

What is a Status 1A in the UNOS system?

A

Sickest patients who need continuous inotropic support. They require invasive monitoring and could die within weeks. Receive ventricular assistive device support.

190
Q

What is a status 1B in the UNOS system?

A

Need inotropic support but don’t need to be in the ICU. Life expectancy is less than 1 month.

191
Q

What is status 7 in the UNOS system?

A

Patient was listed but then removed for the time being (stopped going to appointments, used drugs, cancer work-up)

192
Q

It is very rare to get a transplant unless you are classified as what status?

A

1A or 1B

193
Q

Acute heart rejection presents as…

A

low grade fever, fatigue, decreased exercise tolerance, and hemodynamic instability depending upon severity

194
Q

How does a heart transplant infection appear?

A

Fatigue, abdominal discomfort, fever

195
Q

PT interventions for heart transplant

A

Aerobic training
Monitoring exercise tolerance
Strength training (60-70%)

196
Q

Sternal precautions for heart transplant

A

Weight restriction of 5-10 lbs
No shoulder elevation > 90 deg
No horizontal abduction
No driving 6-8 weeks

197
Q

Heart transplant is denervated. Implications for workout?

A

Heart relies on catecholamines to increase heart rate which takes a lot longer. Patient needs at least a 10-15 minute warm-up and cool down.

Can’t stop abruptly - venous return can cause dysrhythmias.

198
Q

What is a VAD used for

A

Patients with heart failure but lower on the transplant list.

199
Q

What are the 4 types of VAD utilization?

A

Bridge to Transplant (BTT) - used to help them last until receive transplant

Bridge to Recovery (BTR) - used for temporary support when healing from viral cardiomyopathy, myocarditis, etc.

Bridge to Decision/Candidacy

Destination Therapy

200
Q

Why is it important to assess the right side of the heart when looking to put in an LVAD?

A

Device assists the left side only. Right side needs to work in order to pass blood to the left side.

201
Q

Evolution of LVAD devices

A

Pulsatile –> Axial flow –> centrifugal

202
Q

What is the Heartmate II?

A

Axial flow left VAD; designed to be smaller and more reliable than pulsatile pumps. Designed to spin and deliver as much as 10 L/min of CO.

203
Q

Clinical issue with the Heartmate II?

A

Blood flow is continuous, so no longer able to assess blood pressure or pulses.

204
Q

If a person has an LVAD and they are found to have ventricular tachycardia, what do you know about this patient?

A

The right atrium is not working.

205
Q

What is the Heartware HVAD pump?

A

Centrifugal pump sewn into the apex of the left ventricle. More reliable and less signs of infection since patient does not need a pump pocket.

206
Q

What is the Thoratec VAD?

A

Pneumatic device used for partial or total circulatory support. Capacity for flow output is up to 7.2 L/min. Usually used in BTR because it’s easier to remove.

Blood is ejected from sac using compressed air. There is a risk of kinking the cannula and it’s very loud/cumbersome. But it has a backup hand pump for emergencies.

Requires blood thinners.

207
Q

What should you know about performing CPR on a patient with a VAD?

A

HVAD is the only device you can do chest compressions on, since it’s sewn into the heart.

Otherwise, you need to decannulate the patient first.

208
Q

Aerobic exercise considerations for VAD patient

A

Use larger muscle groups
Promote increasing duration
Running/jumping is bad
Swimming is bad

209
Q

Flexibility/strengthening considerations for VAD?

A

Limits in forward bending and trunk rotation due to pump in abdominal wall

Include active shoulder forward elevation

Promote exercise using patient’s body weight, such as modified squats or progressive step heights.

210
Q

Terminating exercise with VAD

A

Subjective intolerance

Loss of “flash” with the thoratec VAD

LVAD flows below 3 L/min

Etiology: hypovolemia, vasodilation, arrhythmia

211
Q

What is the Cardiowest Total Artificial Heart?

A

Air driven pulsatile pump providing total support. Used for biventricular failure. It has the highest BTT success rate.

CPT II (2 decks)

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