CV Medical & Surgical Management Part 2 - HF & heart transplant Flashcards
what kind of management is initially used for heart failure?
lifestyle modification and pharmacologic intervention
– management of likely HTN & CAD
what are the goals of pharmacologic management for heart failure?
– maintain
– fluid reduction to ____ preload
– increase ____ contractility and ___ afterload
– limit _____ action
– CO
– dec.
– LV ; dec.
– sympathetic NS action
what medications are used for managing heart failure?
diuretics
ACE/ARBs
BBs
antiarrhythmics
inotropes
if a patient with heart failure has the LV not functioning well enough, ____ can be used to supplement cardiac output
mechanical circulatory support (MCS)
- various devices can be inserted
what is an intra-aortic balloon pump (IABP)?
– where is it inserted?
device inserted in aorta with balloon attached which inflates during diastole and deflates before systole to improve blood flow & reduce workload of the heart
– inserted in femoral, axillary, or subclavian artery
what happens during ____ with an IABP?
– inflation
– deflation
– happens during diastole when heart relaxes –> blood goes to coronary arteries to provide optimal CO
– happens just before systole –> balloon deflates which decreases workload on the heart allowing it to pump blood out to the body easier
what is the procedure where a MCS is placed into the left ventricle so blood is mechanically pumped from LV to aorta at a set rate?
impella - used for HF
what are the benefits to an impella?
unloads the LF workload
decreases O2 demand
what is a left ventricular assist device (LVAD)?
– what do some patients refer to this as?
implanted MCS device that replaces the work of the LV –> motor that controls blood flow at a set rate
– “external heart”
** can only be used on the left ventricle
what patient population is a LVAD good for?
those with severe HF whose heart is too weak to pump on its own –> pumps the blood for the heart
what are 3 different reasons people would use an LVAD?
- bridge to transplant
- temporary ventricular rest
- “destination therapy” (long-term therapy)
** pts only live avg. 7 years with one of these
what are the components that make up a LVAD?
– weighs about _____ pounds
pump, drive line, controller, external power, batteries
– weighs 4-6 pounds
if you are a PT working with a pt with a LVAD, what is one thing you must remember before ambulating?
they don’t have a pulse – must monitor symptoms of exertion because you won’t be able to take normal vitals
what medications will a patient with heart failure AND using a LVAD likely be on?
typical regimen for HR PLUS
- lifelong anticoagulation
- aspirin or Plavix or both (anti-platelets)
- pulmonary HTN meds - reduce R heart workload
- supplements
what are some complications of LVAD?
- bleeding –> pt needs to be anticoagulated
- blood clots –> device can cause
- R sided HF –> device can alter normal RV function
- drive line infections
what are some barriers to heart transplants?
long transplant list
extensive screening process
expensive
avg survival rate - 12 years
indications for a heart transplant
end stage HF
congenital heart disorder
cardiomyopathy
what is the heart transplant process?
pt placed on list after candidacy
when organ is available, it is matched (blood type, age, size, etc.)
organ is preserved and transported
what medications are patients on after heart transplant?
immunosuppressants - prevent organ rejection
corticosteroids
antibiotics/antivirals
anti-hypertensives
insulin
statins
anticoagulation/anti-platelets
** many of these help with side effects of the other medications, reduce risk of CAD & rejection, & reduce illnesses
what are two major complications that often happen in the first 12 months following a heart transplant?
- infection - highest risk 12 months
- rejection - 50-80% in first 12 months
— symptoms: fever, fatigue, N/V, myalgias
a surgical procedure that removes plaque build up at the internal carotid & common carotid arteries to drastically reduce CVA risk:
carotid endarterectomy
implanted stent in carotid to open artery in area of atherosclerotic blockage
carotid stenting
what are indications for an abdominal aortic aneurysm (AAA) repair?
> 5 cm or high rate of growth
rupture or + symptoms
risk of dissection
what kind of surgical approach is used for AAA?
open surgical approach via an open laparotomy incision
– higher blood loss and complications
