CV Medical & Surgical Management Part 2 - HF & heart transplant

Question 1

what kind of management is initially used for heart failure?

Answer 1

lifestyle modification and pharmacologic intervention
– management of likely HTN & CAD

Question 2

what are the goals of pharmacologic management for heart failure?
– maintain
– fluid reduction to ____ preload
– increase ____ contractility and ___ afterload
– limit _____ action

Answer 2

– CO
– dec.
– LV ; dec.
– sympathetic NS action

Question 3

what medications are used for managing heart failure?

Answer 3

diuretics
ACE/ARBs
BBs
antiarrhythmics
inotropes

Question 4

if a patient with heart failure has the LV not functioning well enough, ____ can be used to supplement cardiac output

Answer 4

mechanical circulatory support (MCS)
- various devices can be inserted

Question 5

what is an intra-aortic balloon pump (IABP)?
– where is it inserted?

Answer 5

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

Question 6

what happens during ____ with an IABP?
– inflation
– deflation

Answer 6

– 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

Question 7

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?

Answer 7

impella - used for HF

Question 8

what are the benefits to an impella?

Answer 8

unloads the LF workload
decreases O2 demand

Question 9

what is a left ventricular assist device (LVAD)?
– what do some patients refer to this as?

Answer 9

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

Question 10

what patient population is a LVAD good for?

Answer 10

those with severe HF whose heart is too weak to pump on its own –> pumps the blood for the heart

Question 11

what are 3 different reasons people would use an LVAD?

Answer 11

1. bridge to transplant
2. temporary ventricular rest
3. “destination therapy” (long-term therapy)
   ** pts only live avg. 7 years with one of these

Question 12

what are the components that make up a LVAD?
– weighs about _____ pounds

Answer 12

pump, drive line, controller, external power, batteries
– weighs 4-6 pounds

Question 13

if you are a PT working with a pt with a LVAD, what is one thing you must remember before ambulating?

Answer 13

they don’t have a pulse – must monitor symptoms of exertion because you won’t be able to take normal vitals

Question 14

what medications will a patient with heart failure AND using a LVAD likely be on?

Answer 14

typical regimen for HR PLUS
- lifelong anticoagulation
- aspirin or Plavix or both (anti-platelets)
- pulmonary HTN meds - reduce R heart workload
- supplements

Question 15

what are some complications of LVAD?

Answer 15

• bleeding –> pt needs to be anticoagulated
• blood clots –> device can cause
• R sided HF –> device can alter normal RV function
• drive line infections

Question 16

what are some barriers to heart transplants?

Answer 16

long transplant list
extensive screening process
expensive
avg survival rate - 12 years

Question 17

indications for a heart transplant

Answer 17

end stage HF
congenital heart disorder
cardiomyopathy

Question 18

what is the heart transplant process?

Answer 18

pt placed on list after candidacy
when organ is available, it is matched (blood type, age, size, etc.)
organ is preserved and transported

Question 19

what medications are patients on after heart transplant?

Answer 19

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

Question 20

what are two major complications that often happen in the first 12 months following a heart transplant?

Answer 20

1. infection - highest risk 12 months
2. rejection - 50-80% in first 12 months
   — symptoms: fever, fatigue, N/V, myalgias

Question 21

a surgical procedure that removes plaque build up at the internal carotid & common carotid arteries to drastically reduce CVA risk:

Answer 21

carotid endarterectomy

Question 22

implanted stent in carotid to open artery in area of atherosclerotic blockage

Answer 22

carotid stenting

Question 23

what are indications for an abdominal aortic aneurysm (AAA) repair?

Answer 23

> 5 cm or high rate of growth
rupture or + symptoms
risk of dissection

Question 24

what kind of surgical approach is used for AAA?

Answer 24

open surgical approach via an open laparotomy incision
– higher blood loss and complications

Question 25

minimally invasive procedure for AAA that reinforces weakened section of aorta with stent graft:

Answer 25

endovascular aortic repair (EVAR)

Question 26

short term effects of EVAR:
long term effects of EVAR:

Answer 26

• faster recovery and lower mortality
• worse! re-do surgery

Question 27

what is embolectomy/thrombectomy/atherectomy?

Answer 27

removal of blood clot or athersclerotic plaque
done in a variety of ways

Question 28

what are peripheral revascularizations?

Answer 28

procedures that restore blood flow where it has been blocked/reduced due to PAD

Question 29

where can peripheral revascularizations take place?

Answer 29

anywhere in the body where there is a blocked area
– named anatomically by where they bypass