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DPT 528 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

as you age, does HR increase or decrease?

A

increase

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2
Q

as you age, does compliance decrease or increase?

A

decrease

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3
Q

as you age, does CO decrease or increase?

A

decrease

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4
Q

what happens to BP as you age?

A

it increases

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5
Q

what happens to baroreceptor activity as you age?

A

the baroreceptors have a decreased sensitivity, leading to orthostatic hypotension

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6
Q

what does decreased baroreceptor sensitivity lead to?

A

orthostatic hypotension

decreased EF and CO

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7
Q

what is the role of sodium?

A

helps keep fluids in normal balance

plays a role in nerve & muscle function

important electrolyte in management of CHF

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8
Q

what is the role of calcium?

A

controls permeability of cell membranes

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9
Q

what is the role of potassium?

A

a mineral highly reactive in water, allowing it to conduct electricity

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10
Q

what is the role of magnesium?

A

regulates heartbeat and normal nerve & muscle function, blood glucose regulation, immune system

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11
Q

calcium and sodium are important for what?

A

conduction!

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12
Q

cholinergic stimulation from parasympathetic input acts against the beta-adrenergic stimulation to cause an increase or decrease in HR?

A

decrease

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13
Q

what electrolyte concentration provides the driving force of myocardial contraction?

A

calcium

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14
Q

what is influenced by beta adrenergic stimulation from sympathetic input which enhances its influx across cell membrane to INCREASE HR.

A

calcium concentration

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15
Q

does calcium increase or decrease HR?

A

increased

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16
Q

is potassium dominant inside or outside of the cell?

A

inside

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17
Q

is sodium dominant inside or outside of the cell?

A

outside

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18
Q

the flow of what 2 electrolytes is responsible for the stimulation causes contraction of myocardial cells?

A

sodium and potassium

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19
Q

electrical stimulation makes the cell membrane more permeable to sodium ions causing them to go inward or outward?

A

inward

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20
Q

electrical stimulation makes the cell membrane more permeable to potassium ions causing them to go inward or outward?

A

outward

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21
Q

t/f: depolarization is electrical stimulation of myocardial cells that cause contraction when they are (+) on interior and (-) on exterior

A

true

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22
Q

t/f: repolarization is when myocardial cells return to (-) interior and (+) exterior and muscle relaxation occurs

A

true

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23
Q

what are the most important electrolytes for myocardial conduction and contraction?

A

potassium and sodium

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24
Q

what is the sympathetic NT?

A

NE

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25
Q

what is the parasympathetic NT?

A

ACh

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26
Q

does activation of the sympathetic NS cause an increase or decrease in HR?

A

increase

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27
Q

does activation of the parasympathetic NS cause an increase or decrease in HR?

A

decrease

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28
Q

does the sympathetic NS cause an increase or decrease in conduction velocity through the AV node?

A

increase

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29
Q

does sympathetic stimulation cause an increase or decrease in myocardial contractility?

A

increase

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30
Q

what do sympathetic signals act on in the heart?

A

SA node, AV node, and ventricles

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31
Q

what do parasympathetic signals act on in the heart?

A

AV node

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32
Q

which part of the NS is activated by stress, activity, and emotions?

A

sympathetic

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33
Q

the vagus nerve acting primarily on the SA node is the main component of which part of the NS?

A

parasympathetic

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34
Q

t/f: parasympathetic activation inhibits rate of impulse formation and conduction velocity

A

true

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35
Q

does parasympathetic activation cause a fast or slow conduction through the AV node?

A

slow

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36
Q

activation of which part of the NS results in depression of the “automaticity” and “conductivity” of the heart?

A

parasympathetic

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37
Q

what ECG wave represents atrial depolarization electrically (& atrial contraction mechanically)

A

p wave

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38
Q

what portion of the ECG is an isoelectric line between P and Q wave that allows for the atria to contract and eject blood into the ventricles (atrial kick)?

A

PR interval

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39
Q

what ECG wave represents ventricular depolarization & contraction?

A

QRS complex

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40
Q

what portion of the ECG is the flat part of isoelectric line representing the time between ventricular depolarization and beginning of repolarization?

A

ST segment

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41
Q

what ECG wave represents ventricular repolarization (return of potassium inward and sodium outward)?

A

T wave

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42
Q

what does a prolonged PR interval mean?

A

the depolarization from the atria to the ventricle is delayed

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43
Q

what does a shortened PR interval mean?

A

the depolarization bw the atria and the ventricle is too quick

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44
Q

what portion of the ECG represents total ventricular activity (ventricular contraction through ventricular repolarization)?

A

QT interval

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45
Q

what is sinus tachycardia?

A

PR interval is normal

RR interval is shortened

P wave exists but as HR increases it may be buried or close to the previous T wave

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46
Q

what is atrial fibrillation?

A

NO P waves

varying RR interval

can appear in many ways depending on the HR

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47
Q

what is the most common arryhthmia?

A

a fib

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48
Q

what are the causes of a fib?

A

advanced age

CHF

cardiac surgery

metabolic/electrolyte imbalances (magnesium, sodium, and potassium)

renal failure

digoxin toxicity

stress or pain

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49
Q

what are the types of a fib?

A

paroxysmal and permanent

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50
Q

what is paroxysmal a fib?

A

going in and out of a fib

has controlled and uncontrolled periods

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51
Q

what is permanent a fib?

A

persistent, chronic pt always in a fib

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52
Q

can we see pts with controlled rate a fib for PT?

A

yes!

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53
Q

what is a fib with rapid ventricular rate?

A

rapid, uncontrolled contractions of the atria, so the atria doesn’t completely fill the ventricles

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54
Q

when is a fib with RVR often seen?

A

in pts post cardiac surgery

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55
Q

if an a fib pt’s HR goes over ___, stop interventions

A

130 bpm

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56
Q

t/f:pts with a fib w/RVR are at risk thrombus in the atria?

A

true

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57
Q

what kind of pulse would be felt in a pt with a fib w/RVR?

A

irregular inconsistent pulse

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58
Q

a fib can result in a decrease in what cardiac functions?

A

CO, filling, blood flow to the myocardium

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59
Q

why do you need to know if your pt is in a fib?

A

exercise prescription

thrombus risk

stroke risk

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60
Q

why do pts with a fib fatigue more quickly?

A

inadequate CO to meet the demands of the body

decreased muscle perfusion

decreased functional activity tolerance

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61
Q

why are pts with a fib more dyspneic?

A

they have inadequate gas exchange

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62
Q

what is demand ischemia?

A

the myocardium is demanding more O2 than it can get

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63
Q

CO can be decreased up to __% in a fib pts

A

30

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64
Q

t/f: a fib can lead to L and R HF over time

A

true

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65
Q

t/f: we usually find signs of HF, then discover the pt is in a fib

A

true

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66
Q

what are surgical interventions for a fib?

A

TEE/cardioversion

L atria appendage ligation

Lariat device

watchman device

ablation

surgical ex maze

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67
Q

what is TEE/cardioversion?

A

transesophageal echo

look at structures and pumping of the heart to check for clots

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68
Q

what is a L atrial appendage ligation?

A

taking off the appendage to decrease the risk of forming a thrombus and throwing a clot here

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69
Q

what is a lariate device?

A

tying off the left atrial appendage with non-invasive imaging

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70
Q

what is a watchman device?

A

a one time minimally invasive procedure where a device blocks off the L atrial appendage

catheter based intervention performed via the femoral artery

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71
Q

t/f: pts with a watchman device need to be on anticoagulants for life

A

false

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72
Q

what ablation?

A

invasive procedure performed in a cardiac cath lab

using hot or cold energy to create tiny scars in the heart tissue to block abnormal electrical signals to restore sinus rhythm

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73
Q

what is surgical ex maze?

A

minimally invasive procedure where scars are created by incisions and cyroablations to block abnormal impulses and restore sinus rhythm

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74
Q

what is a pacemaker?

A

electronic pulse generator used to create an artificial AP to initiate myocardial depolarization

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75
Q

is a pacemaker permanent or temporary?

A

it can be either

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76
Q

what is a leadless pacemaker?

A

pacemaker with no wires placed directly in the RV that sends electrical impulses up to the RA to stimulate depolarization and electrical signal initiation

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77
Q

what are the indications for pacemaker placement?

A

SA node disorders

AV node disorders

tachyarrythmias

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78
Q

what are SA node disorders?

A

bradyarryhthmia/brachcardia

pauses

SSS

tachycardia syndrome

a fib

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79
Q

what are AV node disorders?

A

2nd and 3rd degree heart blocks

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80
Q

what are tacharrhythmias?

A

SVT

frequent ventricular ectopy

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81
Q

temporary pacemakers can pace the heart through what 3 routes?

A

1) epicardial
2) tranvenous
3) transcutaneous

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82
Q

is a temporary pacemaker generator located internally or externally?

A

externally

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83
Q

is a permanent pacemaker generator placed inside our outside the body?

A

inside the body

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84
Q

t/f: leads are placed transvenously in a permanent pacemaker

A

true

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85
Q

what kind of pacemaker shows one spike b4 the P wave on an ECG?

A

single chamber pacemaker

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86
Q

t/f: in a dual chamber pacemaker, one lead is in the RA and the other is in the RV

A

true

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87
Q

what kind of pacemaker shows two spikes, one b4 the P wave and one b4 the QRS complex on an ECG?

A

dual chamber pacemaker

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88
Q

what is a transcutaneous temporary pacemaker?

A

externally placed pacemaker attached to a defibrillator used in emergencies that delivers an electrical current through the pt’s chest to stimulate the heart to contract

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89
Q

what is the most common indication for the use a transcutaneous temporary pacemaker?

A

bradycardia

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90
Q

what is an epicardial temporary pacemaker?

A

temporary pacing wires are loosely sewn to the epicardium during open heart surgery for ventricular pacing most times in an emergency situation following surgery

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91
Q

how is a permanent pacemaker placed?

A

battery pack under the skin of the L side of the chest

wires through the sup vena cava into the RA/RV/both transvenously

leadless is placed in the RV and sends signals up to the SA node to start depolarization

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92
Q

what are the 3 modes of a pacemaker?

A

1) fixed rate
2) demand mode
3) synchronized mode

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93
Q

what is a fixed rate pacemaker?

A

discharges an electrical signal at a “pre-set” rate (usually 70-80 bpm)

paces regardless of pt’s own electrical activity

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94
Q

what is a demand mode pacemaker?

A

discharges an electrical signal when the pt’s HR drops below “pre-set” HR

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95
Q

what is a synchronized mode pacemaker?

A

paces in unison with the pt’s underlying HR

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96
Q

what is an automatic implantable cardioverter defibrillator (AICD)?

A

like a pacemaker, but designed to detect life-threatening arryhthmias (SVT, VT, V-Fib) and correct them or protect against more of them

provides an electrical shock to the heart to convert pt out dangerous arrhythmias

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97
Q

t/f: pt’s HR can override the pre-set HR on a AICD

A

false

98
Q

when is an AICD indicated?

A

pts who’ve experienced and survived a cardiac arrest event that required external defibrillation

LVEF of <35% (KNOW THIS)

99
Q

t/f: PPM and AICD can be implanted in the abdomen if more arm mobility is needed

A

true

100
Q

do AICDs usually fire when a pt is conscious or unconscious?

A

unconscious

101
Q

why are there precautions following placement of a PPM/AICD for at least 4 weeks?

A

to promote adhesion of wires in the myocardial tissue

102
Q

what are the precautions following placement of a PPM/AICD?

A

no active shoulder flexion and abduction more than 90 deg on the ipsi side

sling for 1st 72 hours

no heavy lifting/excessive pushing and pulling with the ipsi arm

103
Q

are there precautions following leadless pacemaker placement?

A

no!

104
Q

what is a life vest?

A

a personal defibrillator worn by pt at risk for sudden cardiac arrest to constantly monitor the heart

if pt goes into life-threatening arrythmia, it delivers a shock to restore the heart to normal rhythm

bridge to AICD, transplant, or LVAD

105
Q

when is the only time a life vest should be removed?

A

during bathing

106
Q

for which type of pacemaker would we defer PT?

A

temporary pacemaker awaiting a permanent pacemaker

107
Q

what is a Holter monitor?

A

continuous 24 hr monitoring of the heart’s rhythm with multiple electrodes/leads on the chest recording activity on a digital device

device attempts to capture, recognize, and reproduce any arryhthmias

pt also documents symptoms and the times they occur at

108
Q

when can a Holter monitor be removed?

A

during bathing

109
Q

what are the indications of a Holter monitor?

A

to ID symptoms caused by arrhythmias

to describe arrhythmias noted with activity

to evaluate antiarrhythmic therapy and pacemaker functioning

to evaluate the need for placement of a permanent pacemaker

110
Q

what is echocardiography?

A

an US transducer emits high frequency sound waves and receives their echos when placed on the chest wall

shows real-time images of a beating heart

111
Q

what info is obtained from an echo?

A

size of vent cavity

thickness and integrity of interatrial and interventricular septa

functions of the valves

motions of individual segments of the vent walls

volumes of the LV

estimate of SV and EF

analyze motion of valves and heart muscle

112
Q

what things can an echo diagnose?

A

pericardial effusion

cardiac tamponade

mitral and aortic regurgitation, stenosis, or vegetation

hypertrophy or ischemia of myocardium

intracardiac masses

ventricular thrombi

pericarditis

aortic dissection

patency of CABG

113
Q

what is contrast echocardiography?

A

an echo performed following injection of IV contrast to improve accuracy and visualization to assess myocardial perfusion and vent chambers

114
Q

what things can a contrast echo help visualize?

A

myocardial perfusion

vent chambers

endocardial wall motion

vent wall thickness

calculation of EF %

potentially coronary flow and myocardial viability

115
Q

what is a stress echo?

A

echo performed during and/or immediately following exercise to evaluate ischemia induced wall motion abnormalities

may also use meds to induce effects of exercise without exercising the pt

116
Q

what is a TEE (trans esphageal echo)?

A

pt swallows a specialized probe that is advanced into the esophagus and behind the heart to view the heart, mediastenum, and functions of the heart

detects clots, masses, and tumors inside the heart

determines severity of valve issues

ID infection of the heart valves

ID aortic dissection

detect congenital conditions

117
Q

what is the single most important procedure that can be performed non-invasively to diagnose and treat pts with CAD?

A

exercise stress test

118
Q

what does an exercise stress test reveal?

A

whether ischemia occurs during pathologic stress

119
Q

what is intermittent exercise stress testing?

A

progressive workloads with short rest periods to recover or decrease fatigue

120
Q

what is continuous exercise stress testing?

A

incrementally progressive workloads until the test must be ended by the pt symptoms or defined end point

121
Q

what is an exercise stress test used to evaluate?

A

atypical chest pain

chest pain suggesting CAD

HTN w/activity

prognosis and severity of CAD

122
Q

what is the difference bw maximal and submaximal exercise stress testing?

A

maximal is terminated at the end point of predicted max HR, while submax is terminated at a % of that predicted max HR

123
Q

when is maximal exercise stress testing used?

A

to diagnose CAD and measure functional capacity

124
Q

when is submax exercise stress testing used?

A

in cardiac rehab for post-MI and cardiac surgery

125
Q

what is nuclear stress testing?

A

imagine performed immediately following exercise using thallium to determine the areas of ischemia and/or infarct and location

thallium will not be taken up in areas of poor coronary blood flow and can assess coronary perfusion

126
Q

if you notice an area of ischemia on a nuclear stress test that doesn’t disappear 4 hours after exercise, what does this mean?

A

there is irreversible scarring

127
Q

if you notice an area of ischemia on a nuclear stress test that disappears 4 hrs after exercise, what does this mean?

A

the damage is reversible

128
Q

when is pharmacological stress testing used?

A

when the pt is unable to perform an exercise stress test

129
Q

what is a pharmacological stress test?

A

stress test in which meds are used to induce the effects of exercise to assess myocardial oxygen supply

130
Q

what meds may be used in pharmacological stress testing?

A

adenosine

dipyridamole

dobutamine

Lexiscan

131
Q

is a cardiac cath coronary angiography invasive?

A

yes

132
Q

what are the indications of catheterization?

A

to establish or confirm cardiac dysfunction or heart disease

to demonstrate severity of CAD

to determine the extent of valvular dysfunction

to determine the optimal guidelines for exercise prescription, medical, an/or surgical management

133
Q

what is the most important indication for catheterization?

A

presence of symptoms
- (+) stress test results w/at least 25% drop in exercise duration from a previous test
- prolonged chest pain not alleviated by nitroglycerin
- change in angina
- increased angina symptoms despite med adjustment

134
Q

what is a cardiac cath?

A

insertion of a catheter into the CV system via the femoral, brachial, or radial arteries

fluoroscopic exam of arteries while injecting radioplaque contrast medium

135
Q

what is the only test that provides the actual site,extent, and severity of artery obstruction in CAD? (KNOW THIS)

A

cardiac cath-coronary angiogram

136
Q

what are the results of a cardiac cath used for?

A

to evaluate coronary anatomy

to perform revascularization procedure with balloon angioplasty or stents

to determine if further medical, surgical, or pharm treatments are warrented

137
Q

t/f: a cardiac cath has greater predictive accuracy in assessment of CAD than exercise testing

A

true

138
Q

what is a cardiac CT?

A

3D images created to look at coronary arteries with the use of IV dye

primarily used to ID masses in the CV system and detect aortic aneurysms or pericarditis

139
Q

what is the 1st line of imaging utilized to rule out coronary ischemia in pts admitted w/chest pain?

A

cardiac CT

140
Q

what are the types of cardiac CTs?

A

single photon emission CT

electron beam CT

141
Q

what is a single photon emission CT (SPECT)?

A

used to detect and quantify myocardial perfusion defects and contractility defects utilizing radioactive isotopes

assesses R and L vent EF, regional wall function, and ventricular volumes

142
Q

what is an electron beam CT (EBCT)?

A

noninvasive 10 minute scan of 40 slices through the heart every 3-6 mmm

used to detect calcium in coronary arteries (location, extent, and density) and quantify coronary atherosclerosis

143
Q

what is the gold standard for direct measurement of blood flow and metabolic assessment of the heart?

A

PET scan

144
Q

what is a PET scan?

A

nuclear technique using a specialized camera and tracer to create images of tissue viability

can ID several LV dysfunctions to determine candidacy for revascularization or transplant

145
Q

what is a cardiac MRI?

A

less expensive alternative to PET scan

used to evaluate morphology, cardiac blood flow, and myocardial contractility

may be contraindicated for pts w/pacemakers, stents, surgical clips, mechanical heart valve, or any other metal devices

146
Q

what is a MRA?

A

magnetic and radio wave energy is used to obtain images of blood vessels with IV contrast

can assess for aneurysms, dissections, or stenosis and locate blockages

147
Q

what are percutaneous revascularization procedures?

A

procedures performed via cardiac cath

involve balloon, peripheral arterial access site, and catheter

148
Q

what are common access sites for PCI?

A

femoral, brachial, or radial

149
Q

what is an atherectomy?

A

cleaning out plaque in large vessels

150
Q

what are cardiac stents?

A

tiny mesh-like scaffolds placed w/in stenotic lesion

151
Q

t/f: cardiac stents can cause scar formation, thrombi, or re-stenosis

A

true

152
Q

what are drug eluding stents?

A

stents that are coated with antiproliferative drugs that get released into the intima layer of the artery to reduce re-occlusion

153
Q

what is a percutaneous transluminal coronary angioplasty (PTCA)?

A

a balloon inflated to compress the lesion against the artery wall

154
Q

what is a percutaneous transluminal coronary atherectomy?

A

cutting and excising the atheroma or lesion with a catheter device

155
Q

is a percutaneous transluminal coronary atherectomy usually done in the coronaries?

A

no, they’re too small, this is usually done in larger vessels

156
Q

what are surgical interventions for common vascular disease?

A

carotid endarterectomy (CEA)

abdominal aortic aneurysm repair (AAA repair)

157
Q

when is a AAA repair indicated?

A

when the aneurysm is greater than or equal to 5 cm or with rapid aneurysm enlargement

158
Q

what is an open AAA repair?

A

very large abdominal incision made to expose the aorta

graft used to repair the aneurysm

standard procedure for repair

159
Q

what is an endovascular AAA repair?

A

minimally invasive option

small incision made in the groin

instruments inserted through a cath in the femoral artery and threaded up into the aorta of aneurysm

stent and graft utilized to repair the area

160
Q

what are the 4 ways the chest can be opened up for thoracic surgery?

A

1) video assisted thoracoscopic surgery (VATS)
2) posterolateral thoracotomy
3) median sternotomy
4) clamshell or bilateral anterolateral thoracotomy

161
Q

what thoracic surgery method is minimally invasive?

A

VATS

162
Q

what surgical method is often used for lung surgery where you need to visualize more area?

A

posterolateral thoracotomy

163
Q

what surgical method is primarily used for cardiac surgery where the chest is opened up?

A

median sternotomy

164
Q

what surgical method is used for heart and lungs transplants?

A

clamshell/bilateral anterolateral thoracotomy

165
Q

what is video assisted surgery?

A

2 port holes used

lower incidence of post-op complications

epidural block used to decrease pain and muscles spasms post-op

post-op chest tubes drain fluid

166
Q

when is video assisted surgery indicated?

A

to biopsy lung tissue

management of pulmonary blebs and emphysema (air/pus collection)

management of chronic pleural effusions

management of pneumothorax

lung cancer

167
Q

what is chemical pleurodesis?

A

the visceral and parietal pleura are adgered together to prevent recurrent pleural effusion/pneumothorax

168
Q

what is chylothorax?

A

lymph in the lungs

usually surgical complication

169
Q

what is a pneumonectomy?

A

removal of the entire lung

170
Q

what is a lobectomy?

A

taking out a lobe of the lungs bc the ca is isolated

171
Q

what is a wedge resection?

A

taking out a wedge of the lungs like a wedge of cheese containing the tumor

172
Q

what are the advantages of VATS?

A

decreased hospital stay(3-5 days)

decreased blood loss

decreased pain

increased pulmonary function

early mobilization

decreased inflammatory reaction

173
Q

what are the complications of VATS?

A

pain

blood loss

pulmonary infection

atelectasis

pneumothorax

subcutaneous emphysema (air leaking into the subcutaneous tissues)

respiratory failure

prolonged air leak

cardiac arrhythmias

renal dysfunction

shoulder pain

174
Q

what is the most common complaint after VATS?

A

ipsi shoulder pain

175
Q

where are thoracic post-op chest tubes commonly placed?

A

in the pleural space or mediastenum

176
Q

what is the point of putting in chest tubes post-op?

A

to evacuate fluid or air

to prevent lung collapse

177
Q

does air tend to develop in the top of the lungs or the bottom of the lungs?

A

the top

178
Q

does fluid tend to develop in the top of the lungs or the bottom of the lungs?

A

the bottom

179
Q

t/f: the seal of the 3 chamber water seal drainage device creates resistance to the fluid and air leaving the chest

A

true

180
Q

what is the point of the 3rd chamber in the 3 chamber water seal drainage device?

A

to decrease resistance and serve as a pressure regulator

181
Q

where is the chest tube placed?

A

in the intercostal space and advanced several inches into the pleural space to drain fluid, pus, and blood

182
Q

t/f: the chest tube suction provides pressure to pleural space to keep the lungs expanded if necessary

A

true

183
Q

what are the types of chest tubes?

A

pleura vac

Thopaz drainage system

pneumostat

peur-ex catheter

184
Q

what is a pleura vac

A

type of chest tube where a typical canister is utilized

185
Q

can a pleura vac be placed on/off suction?

A

yes

186
Q

t/f: clamping a pleura vac is equivalent to not having the chest tube

A

true

187
Q

what is a Thopaz drainage system?

A

chest tube draining the pleural and mediastinal space that allows for early and easy mobilization after surgery

has self-suction

can objectively monitor air leaks through regulated negative pressure system

188
Q

what is a pneumostat?

A

chest tube that’s a drainage valve/device used to transition off traditional chest tubes or treat a penumothorax

allows for early and easy mobilization after surgery

allows pt to be d/c home with the chest tube if necessary

189
Q

which types of chest tubes allow for easy and early mobilization?

A

thopaz drainage system and pneumostat

190
Q

which types of chest tubes can a pt be d/c home with?

A

pneumostat and pleur-ex catheter

191
Q

what is a pleur-ex catheter?

A

chest tube used to control uncomfortable and painful symptoms of pleural effusions or malignant ascites/effusions

decreases the need for repeat thoracentesis and paracentesis

active vacuum tech lets pts drain quickly and comfortably w/o need for gravity

192
Q

which type of chest tube is usually used for pts with frequent pleural effusions or aceites?

A

pleur-ex catheter

193
Q

t/f: pts with chest tubes should not participate in PT

A

false, they can and should!

194
Q

what can PTs do for pts with chest tubes?

A

education on splinted cough

deep breathing exercises

diaphragmatic breathing

inspiratory and expiratory muscles trainers

all to help with lung expansion, drainage, improved gas exchange, and improve thoracic expansion

195
Q

what should you do if a chest tube dislodges from the pt?

A

cover the site, have PT exhale forcefully and lift your hand then replace your hand after exhale

196
Q

what should you do if a chest tube is disconnected from the canister?

A

clamp the tubing or place open end in sterile water

197
Q

what are the indications for cardiothoracic surgery?

A

CAD

mitral valve regurgitation vs stenosis

aortic valve stenosis or bicuspid valve regurgitation

endocarditis

aortic arch repair

aortic aneurysm or dissection

mediastinal mass removal

thymectomy

198
Q

what are the 3 types of cardiothoracic surgery?

A

1) off pump
2) pump assist
3) robotic

199
Q

what is an off pump CABG?

A

the heart is stabilized and continues to beat on its own during surgery

HR is slowed to allow for grafts to be attached

decreased risk for CVA, memory issues, delirium, etc

decreased need for blood transfusions

decreased LOS in hospital

200
Q

what is a pump assisted CABG?

A

heart is cannulated and placed on a cardiopulmonary bypass

can cause post perfusion syndrome

the machine responsible for blood getting to the body, brain, etc

201
Q

what is a robotic CABG?

A

minimally invasive via the L thoracotomy approach

option for PT requiring only 1 bypass graft

202
Q

should a PT who needs multiple bypass grafts have a robotic CABG?

A

no!

203
Q

only 20% of OHS are done using what technique in the US?

A

off pump

204
Q

what physiological changes may occur during OHS?

A

core body temp regulation changes (hypothermia during surgery to protect against ischemia)

metabolic dysfunction of the CNS

systemic inflammatory response

changes in consistency of blood and blood volume

hypo-perfusion (systemic or local)

hypodynamic changes (decreased venous return, increased arterial BP, absence for HR changes)

205
Q

changes of core body temp regulation in OHS is the effect of what things?

A

open thorax

anesthesia

proprofol

opioids

206
Q

what does the drop in body temp during OHS cause?

A

vasodilation and depression of the sympathetic response

207
Q

t/f: hypothermia protocol during OHS can put pts at risk for infection, arrhythmias, hypokalemia, coagulopathies, and even HF

A

true

208
Q

what are hypodynamic changes during OHS?

A

decreased venous return

increased arterial BP

no HR changes

209
Q

which surgical cut allows for full visualization of the heart?

A

median sternotomy

210
Q

t/f: use of robotic CABG doesn’t allow for good visualization of the R side of the heart

A

true

211
Q

t/f: CABG have decreased mortality rate and less repeat revascularization than angioplasty or stenting

A

true

212
Q

what is the optimal choice for management of CAD when 3/more coronary arteries are obstructed?

A

CABG

213
Q

what is the safest and most reliable method of complete revascularization of an ischemic heart?

A

CABG

214
Q

where are grafts for a CABG often harvested from?

A

saphenous vein, radial artery, or internal mammary arteries

215
Q

with mediastinal drainage tubes, at least 1 tube is placed in the ___ space and 1 in the ____ space to drain fluid

A

pericardial, pleural

216
Q

what are the potential cardiac surgery complications?

A

clinical complications (long boring list that I hope we don’t need to know)

hyperglycemia

delirium

sleep deprivation

decreased deep breathing/normal breathing

a fib/arrythmias

decreased appetite

decreased b/b fxn

sternal wound infection or dehisence (wound opening)

217
Q

wound dehisence often occurs in what population?

A

noncompliant diabetic pts

218
Q

t/f: all pts have increased blood glucose post-op

A

true

219
Q

t/f: ensure or supplementation is ordered for every pt post-op bc of their lack of appetite

A

true

220
Q

what are the types of valve surgeries?

A

percutaneous balloon valvuloplasty

annuloplasty

full valve replacement

221
Q

what is a percutaneous balloon valvuloplasty?

A

minimally invasive use of a balloon to dilate a valve

222
Q

what is an annuloplasty?

A

valve surgery that replaces the rim/ring of the valve that tears with overstretching or prolapse

223
Q

what is a full valve replacement?

A

use of a metal replacement valve or tissue valve from a human, pig, or cow

224
Q

which type of valve replacement requires a pt to be on anticoagulants for life?

A

mechanical (metal) valve

225
Q

what are the risk factors for valvular heart disease?

A

hx of rheumatic fever

endocarditis

hypercholesterolemia

HTN

hx of IV drug abuse

congenital defect

226
Q

what are the indications for valve surgery?

A

pt symptoms

extent of LV fxn

deg of regurgitation/stenosis on echo

2+ moderate to severe or worse to qualify

227
Q

what valves can be repaired/replaced minimally invasively or via median sternotomy?

A

aortic, mitral, and tricuspid

228
Q

what is a TAVR (transcatheter aortic valve replacement)?

A

minimally invasive approach that delivers fully collapsible replacement valve to the site via catheter

approved for inoperable aortic stenosis

229
Q

what are the indications for TAVR?

A

severely calcified aortic valve leaflets with decreased systolic motion

aortic valve area of less than 0.1 cm^2

mean pressure gradient greater than 40 mmHg

NYHA class 2 or greater CHF

230
Q

what is normal aortic valve area?

A

3-4 cm

231
Q

what is normal mean pressure gradient?

A

3-5 mmHg

232
Q

what are the pros of TAVR?

A

decreased LOS in hospital (2-3 days)

improved QOL

extended life of elderly with high risk for surgical AVR

early mobilization

improved symptoms (decreased DOE)

increased activity tolerance

233
Q

what are the cons of TAVR?

A

increased risk for stroke post-op

increased risk for vascular bleeding at cath site

need for permanent pacemaker

longevity of the valve is unknown

$$$$

234
Q

can pts be mobilized the same day of surgery with TAVR?

A

yes!

235
Q

t/f: we usually only see pts post TAVR with complications

A

true

236
Q

t/f: mortality rates are similar for TAVR and AVR

A

true

237
Q

t/f: strokes and TIA are more common in AVR than TAVR

A

false, they are more common in TAVR

238
Q

t/f: symptoms of TAVR are better 30 post, but similar to AVR 2 years post

A

true

239
Q

t/f: mortality rates of TAVR are better than medical therapy

A

true

240
Q

t/f: TAVR pts showed improved NYHA class vs medical therapy

A

true

241
Q

t/f: stroke rate was higher in medical therapy group than TAVR

A

false, TAVR is higher

DPT 528 (9 decks)

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