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Cardiopulmonary I > CV Medical & Surgical Management > Flashcards

CV Medical & Surgical Management Flashcards

1
Q

management of hypertension:

A

lifestyle modification
pharmacologic intervention
weight loss
low sodium diet < 1500 mg/day

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2
Q

what is the goal of pharmacologic management for hypertension?

A

decrease fluid volume
increase vasodilation

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3
Q

what is the best combination of medications to manage hypertension? (3)

A

diuretics
ACE/ARB
Ca Channel blockers

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4
Q

what does a diuretic do?

A

stops Na and sodium reabsorption by kidneys –> more urination
– less blood is returning to the heart so less blood needs to be ejected

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5
Q

_____ diuretics are the most effective and most utilized
– inhibits movement of ___ and ____ across plasma membrane

A

loop
– K and Cl

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6
Q

if high dosages of diuretics are used, an imbalance in ______ can happen

A

electrolytes –> may have to replace electrolytes

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7
Q

diuretics end in -_____ in at least one of the names
– what is the exception?

A

-ide
– spironolactone (aldactone) –> “spirals” out of the typical -ide rule

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8
Q

what do ACE inhibitors do?

A

acts on RAAS to reduce fluid volume to reduce preload
inhibits angiotensin II (which narrows blood vessels) –> blood vessels stay dilated –> easier blood flow –> reduce strain on heart –> dec. BP

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9
Q

what patients should not take ACE inhibitors?

A

those with lung disease
*b/c ACE acts on smooth muscle

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10
Q

ACE inhibitors end in -____

A

-pril

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11
Q

what are ARBs?
– why are they safer for pts with lung disease?

A

acts on RAAS to prevent normal vasoconstriction
Ang I converts to Ang II BUT ang. II is blocked from distal receptors so it doesn’t affect the lungs (like ACE inhibitors)

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12
Q

ARBs end in -_____

A

-sartan

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13
Q

what do Ca channel blockers do?

A

stops Ca from entering the myocardium –> reduces strength of contractions –> allowing for vasodilation
it also decreases O2 demand so the LV doesn’t have to work as hard

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14
Q

common calcium channel blockers:

A

AMlodipine (Norvasc)
CARdene (Nicardipine)
CARdizem (Diltiazem)
VERApamil (Calan)
PROcardia (Nifedipine)

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15
Q

what are the goals of pharmacologic management for CAD?

A

decrease myocardial O2 demand
increase myocardial O2 supply
Strengthen LV contraction

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16
Q

what are the goals of surgical management for CAD?

A

reduce/remove atherosclerotic plaque
Bypass blocked arteries before progression to MI

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17
Q

what medications will help decrease oxygen demand in CAD?

A

beta blockers
Ca Channel blockers
nitrates

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18
Q

what medications will help increase oxygen supply in CAD?

A

thrombolytics
anti-platelets
anticoagulation

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19
Q

what medications will help increase LV strength in CAD?

A

inotropes

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20
Q

chronotropic drugs affect ______
inotropic drugs affect _______

A

heart rate
heart contraction

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21
Q

what do beta blockers do?

A

block epi & norepi from binding to Beta1 or Beta2 receptors

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22
Q

nonselective BBs block _______
Cardioselective BBs block ______

A

– both beta1 and beta2
– only block beta1 –> prevents unwanted respiratory involvement

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23
Q

beta blockers end in -_____

A

-lol

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24
Q

what do nitrates do?

A

rapidly dilate blood vessels and smooth muscle to dec. preload and afterload which decreases the oxygen demand

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25
Q

what is a common nitrate?

A

nitroglycerin (Nitrostat)

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26
Q

elimination of coronary thrombus:
1. _______ - accelerates clot breakdown
2. _______ - stops platelet adherence to the clot
3. _______ - prevents clot formation

A
  1. thrombolytics
  2. antiplatelets
  3. anticoagulation
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27
Q

thrombolytics end in -______

A

-ase

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28
Q

2 common anti-platelets:

A

Aspirin (acetylsalicylic acid)
Plavix (Clopidogrel)

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29
Q

what are common anticoagulants?

A

(IV Heparin)
Lovenox
Xarelto
Eliquis
Pradaxa
Coumadin
Angiomax
Arixtra

** I love Xarelto, every prada could… angio & ari **

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30
Q

Inotropic drugs:
– what do cardiac glycosides do?

A

dec. active transport of Na and K to inc. intracellular Na

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31
Q

Inotropic drugs:
– what do sympathomimetics do?

A

inc. sympathetic NS drive

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32
Q

inotropic drugs:
– what do phosphodiesterase inhibitors do?

A

inc. myocardial contractility without altering the Na-K pump

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33
Q

inotropic drugs:
– wha do arteriodilators do?

A

dec. afterload by dec. arterial resistance (SVR)

34
Q

what are common inotropes?

A

DIGoxin
MILrinone
DOButamine
HYDRAlazine
dopamine
levophed
epinephrine

35
Q

what is percutaneous coronary intervention (PCI)?
– goal is to:
– commonly used for what population?
– post-procedure, these patients are typically on what medication(s) to prevent thrombus complications?

A

catheter inserted via distal artery to access coronary arteries open narrowed or blocked arteries
– restore blood flow to cardiac muscle –> < 90 min.
– CAD patients
– 2 anti-platelet medications (aspirin & plavix)

36
Q

two types of PCI:
1. balloon angioplasty:
2. angioplasty w/ stent:

A
  1. catheter used to inflate a balloon to open a blocked artery
  2. stent is placed in place of the inflated balloon to keep the artery open
37
Q

what is a coronary artery bypass graft (CABG)?

A

open heart surgery often used for multiple blockages of the coronary arteries where a healthy blood vessel from another part of the body is attached above and below the blockage area in the heart to restore normal blood flow

38
Q

what are indications for CABG?

A
  • lesions threatening major portions of myocardium
  • multi-vessel disease, esp. L sided blockages
  • ongoing ischemia following MI
39
Q

where does the graft come from for a CABG?

A
  • internal mammary artery from internal chest wall
    OR
  • saphenous vein from leg
40
Q

what happens to the veins during CABG?

A

they are cauterized, flushed with heparin, and inverted for normal blood flow

41
Q

what is the most common approach to access the heart for a CABG?

A

sternotomy
– sternum wired closed
– soft tissue sutured and glued

42
Q

where does the incision start and end with a sternotomy?

A

start: suprasternal notch
end: xiphoid process

43
Q

why do we need cardiopulmonary bypass during a CABG?

A

it takes over the function of the heart and lungs during open heart surgery because the heart can’t move during surgical intervention but we need perfusion to the body and brain still during this time

44
Q

what is an off pump CABG?

A

type of coronary artery bypass surgery performed without cardiopulmonary bypass
– heart continues to beat while isolated portions are stopped via an electrical “starfish” to stabilize the portion being worked on

45
Q

Pros of off pump CABG:
Cons of off pump CABG:

A

– less expensive, no sternal precautions, faster recovery
– can only operate on L sided coronary arteries – heart accessed from L sided thoracotomy

46
Q

Post-Op goals timeline following CABG:
– straight from OR to _____
– within 6 hours of arriving:
– within 8 hours of arriving:
– within 12 hours of arriving:
– next morning:

A

– CVICU –> will be intubated & lots of lines & tubes
– extubated –> wean vent support & drips/sedation
– pt in chair position
– standing
– out of bed to chair for breakfast

47
Q

common complications of CABG:

A
  • pain
  • respiratory complications (15-20%)
  • impaired cognition/delirium (w/ CPB)
  • acute blood loss (cardiac tamponade)
  • increased risk of clots (post op CVAs)
  • dysrhythmias/ectopy
48
Q

valve repair/replacement is indicated for:

A

symptomatic valve dysfunction

49
Q

what is valvuloplasty?
– why would you choose this over a replacement?

A

minimally invasive repair to widen the valve using balloon catheter
– more risks associated with replacement

50
Q

valve replacement:
– types:
– often done in conjunction with ____
– open surgery requires _____

A

– mechanical or tissue (allograft or xenograft)
– CABG
– sternotomy

51
Q

what is transcatheter aortic valve replacement?

A

a minimally invasive procedure used to replace the aortic valve to widen it

52
Q

what is the process for TAVR?

A

a catheter is inserted via the femoral or radial artery
a new mechanical valve is placed inside the catheter and then expanded once in the correct location.
it pushes aside the old valve and now creates more space

53
Q

what is a good use of TAVR?

A

if a patient is high risk for open heart surgery –> this is minimally invasive
however, outcomes may not be as good

54
Q

what and who is an external pacer used for?
– is it temporary or permanent?

A

a temporary pacemaker on the outside of the body set as a backup in patients with bradycardia
– temporary –> wean away from it

55
Q

what is important to monitor with chest tubes/drains?

A

ensure no post op hematoma is formed

56
Q

what does a pulmonary artery catheter monitor/measure?

A

monitors heart function and pressures in heart and pulmonary artery

57
Q

explain the procedure for placing a PAC

A

inserted in Right side through internal jugular or subclavian –> floated down SVC –> through RA and RV –> into pulmonary artery

58
Q

where is an arterial line commonly placed?
what does it measure?

A

radial artery but also femoral or brachial
measures instant BP

59
Q

where is central venous catheter commonly placed?
what is it for?

A
  • IJ, subclavian, femoral vein
  • IV that allows for medications/fluids to be given directly
60
Q

your patient had a line extubated ~1 hour ago. should you:
a. perform mobility whenever
b. don’t perform mobility for the rest of the day
c. wait 1-3 hours longer before performing mobility

A

c. no mobility for 2-4 hours post-extubation to reduce risk of airway edema or stridor

61
Q

following central line removal, how long should you wait to perform mobility with that patient?
– why?

A

2 hours
– reduce risk of hematoma

62
Q

what is the first approach in managing dysrhythmias?

A

pharmacological management - stabilize cell membranes during AP by controlling movement of electrolytes

63
Q

what are other approaches taken to manage dysrhythmias?

A

pacemaker
internal cardiac defibrillator
other electrophysiologic procedures or surgeries

64
Q

different classes of dysrhythmia pharmacologic management & what they do:
– Class I: ______
– Class II: _____
– Class III: _______
– Class IV: ______

A

– Na channel blockers –> limits myocardial excitation and contraction
– beta blockers –> inhibit sympathetic nervous system
– K channel blockers –> prolongs refractory period. more difficult for myocytes to respond to stimulation
– Ca channel blockers –> slows conduction through AV node

65
Q

common antiarrhythmic medications:
– class I: Na channel blockers
– class II: beta blockers
– class III: K channel blockers
– class IV: Ca channel blockers

A

– lidocaine
– -lol
– Amiodarone
– AM, CAR, CAR, VERA, PRO

66
Q

what does a pacemaker do?

A

creates an action potential in necessary areas

67
Q

where is a pacemaker implanted?

A

– upper L chest
– inserted via cephalic vein through SVC

68
Q

where are the leads of a pacemaker placed if its:
– single chamber
– dual chamber
– biventricular

A

– R atrium
– R ventricle
– L ventricle

69
Q

indications for pacemaker use (3)

A

bradycardia
type II-III heart block
uncontrolled arrhythmias

70
Q

what are complications of a pacemaker?

A

infection
lead movement/migration
bleeding, blood clots
no MRI, TENS/NMES
caution near anything magnetic

71
Q

what is a leadless pacemaker?
– where is it placed?
– based off placement, where can the electrical activity influence?

A

fairly new device that does not require wired leads or L upper chest generator
– inserted via femoral vein & IVC directly into RV
– RV or LV

72
Q

true or false. you CANNOT see a pacemaker on an ECG

A

false - since it generates an electrical impulse, an atrial pacing strike and ventricular pacing spike can be seen on an ECG

73
Q

what is an internal cardiac defibrillator similar to?
– what arrhythmias is it used with?

A

– pacemaker
– used for Vtach or Vfib

74
Q

where are leads of an internal cardiac defibrillator inserted?

A

AV node
ventricles

75
Q

a patient with HF with EF ______ is indicated for an internal cardiac defibrillator

A

< 35%

76
Q

what is a short term, minimally invasive procedure that controls arrhythmias by creating scar tissue in the myocardium at areas called ectopic foci?

A

cardiac ablation

77
Q

what is a cryo-ablation procedure commonly used for Afib that creates a “maze” of scar tissue to block abnormal signals and allow normal conduction in a controlled manner?

A

maze procedure

78
Q

why does an atrial appendage become a problem, especially on the L side?

A

it is extra tissue that is expandable. if there are higher pressures on the L, the LAA can expand and become a reservoir for blood –> clots that can travel to the brain and cause a stroke

79
Q

in patients with Afib, clots can easily form in the left atrial appendage. what minimally invasive procedure “plugs” the appendage to prevent clot formation?

A

Watchman’s procedure

80
Q

if your patient has contraindications for use of Watchman’s procedure, what is an alternative option to help manage?

A

LAA or RAA surgical closure – atrial bulge can be surgically closed

81
Q

what does cardioversion accomplish?

A

electrophysiologically restores normal heart rhythm during MI or cardiac arrest situation – pt is conscious but sedation used

82
Q

what arrthymia is cardioversion frequently used with?

A

Afib with RVR if medications aren’t adequately controlling it

Cardiopulmonary I (22 decks)

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