Exam 2 Flashcards
1
Q
as you age, does HR increase or decrease?
A
increase
2
Q
as you age, does compliance decrease or increase?
A
decrease
3
Q
as you age, does CO decrease or increase?
A
decrease
4
Q
what happens to BP as you age?
A
it increases
5
Q
what happens to baroreceptor activity as you age?
A
the baroreceptors have a decreased sensitivity, leading to orthostatic hypotension
6
Q
what does decreased baroreceptor sensitivity lead to?
A
orthostatic hypotension
decreased EF and CO
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
8
Q
what is the role of calcium?
A
controls permeability of cell membranes
9
Q
what is the role of potassium?
A
a mineral highly reactive in water, allowing it to conduct electricity
10
Q
what is the role of magnesium?
A
regulates heartbeat and normal nerve & muscle function, blood glucose regulation, immune system
11
Q
calcium and sodium are important for what?
A
conduction!
12
Q
cholinergic stimulation from parasympathetic input acts against the beta-adrenergic stimulation to cause an increase or decrease in HR?
A
decrease
13
Q
what electrolyte concentration provides the driving force of myocardial contraction?
A
calcium
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
15
Q
does calcium increase or decrease HR?
A
increased
16
Q
is potassium dominant inside or outside of the cell?
A
inside
17
Q
is sodium dominant inside or outside of the cell?
A
outside
18
Q
the flow of what 2 electrolytes is responsible for the stimulation causes contraction of myocardial cells?
A
sodium and potassium
19
Q
electrical stimulation makes the cell membrane more permeable to sodium ions causing them to go inward or outward?
A
inward
20
Q
electrical stimulation makes the cell membrane more permeable to potassium ions causing them to go inward or outward?
A
outward
21
Q
t/f: depolarization is electrical stimulation of myocardial cells that cause contraction when they are (+) on interior and (-) on exterior
A
true
22
Q
t/f: repolarization is when myocardial cells return to (-) interior and (+) exterior and muscle relaxation occurs
A
true
23
Q
what are the most important electrolytes for myocardial conduction and contraction?
A
potassium and sodium
24
Q
what is the sympathetic NT?
A
NE
25
what is the parasympathetic NT?
ACh
26
does activation of the sympathetic NS cause an increase or decrease in HR?
increase
27
does activation of the parasympathetic NS cause an increase or decrease in HR?
decrease
28
does the sympathetic NS cause an increase or decrease in conduction velocity through the AV node?
increase
29
does sympathetic stimulation cause an increase or decrease in myocardial contractility?
increase
30
what do sympathetic signals act on in the heart?
SA node, AV node, and ventricles
31
what do parasympathetic signals act on in the heart?
AV node
32
which part of the NS is activated by stress, activity, and emotions?
sympathetic
33
the vagus nerve acting primarily on the SA node is the main component of which part of the NS?
parasympathetic
34
t/f: parasympathetic activation inhibits rate of impulse formation and conduction velocity
true
35
does parasympathetic activation cause a fast or slow conduction through the AV node?
slow
36
activation of which part of the NS results in depression of the "automaticity" and "conductivity" of the heart?
parasympathetic
37
what ECG wave represents atrial depolarization electrically (& atrial contraction mechanically)
p wave
38
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)?
PR interval
39
what ECG wave represents ventricular depolarization & contraction?
QRS complex
40
what portion of the ECG is the flat part of isoelectric line representing the time between ventricular depolarization and beginning of repolarization?
ST segment
41
what ECG wave represents ventricular repolarization (return of potassium inward and sodium outward)?
T wave
42
what does a prolonged PR interval mean?
the depolarization from the atria to the ventricle is delayed
43
what does a shortened PR interval mean?
the depolarization bw the atria and the ventricle is too quick
44
what portion of the ECG represents total ventricular activity (ventricular contraction through ventricular repolarization)?
QT interval
45
what is sinus tachycardia?
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
46
what is atrial fibrillation?
NO P waves
varying RR interval
can appear in many ways depending on the HR
47
what is the most common arryhthmia?
a fib
48
what are the causes of a fib?
advanced age
CHF
cardiac surgery
metabolic/electrolyte imbalances (magnesium, sodium, and potassium)
renal failure
digoxin toxicity
stress or pain
49
what are the types of a fib?
paroxysmal and permanent
50
what is paroxysmal a fib?
going in and out of a fib
has controlled and uncontrolled periods
51
what is permanent a fib?
persistent, chronic pt always in a fib
52
can we see pts with controlled rate a fib for PT?
yes!
53
what is a fib with rapid ventricular rate?
rapid, uncontrolled contractions of the atria, so the atria doesn't completely fill the ventricles
54
when is a fib with RVR often seen?
in pts post cardiac surgery
55
if an a fib pt's HR goes over ___, stop interventions
130 bpm
56
t/f:pts with a fib w/RVR are at risk thrombus in the atria?
true
57
what kind of pulse would be felt in a pt with a fib w/RVR?
irregular inconsistent pulse
58
a fib can result in a decrease in what cardiac functions?
CO, filling, blood flow to the myocardium
59
why do you need to know if your pt is in a fib?
exercise prescription
thrombus risk
stroke risk
60
why do pts with a fib fatigue more quickly?
inadequate CO to meet the demands of the body
decreased muscle perfusion
decreased functional activity tolerance
61
why are pts with a fib more dyspneic?
they have inadequate gas exchange
62
what is demand ischemia?
the myocardium is demanding more O2 than it can get
63
CO can be decreased up to __% in a fib pts
30
64
t/f: a fib can lead to L and R HF over time
true
65
t/f: we usually find signs of HF, then discover the pt is in a fib
true
66
what are surgical interventions for a fib?
TEE/cardioversion
L atria appendage ligation
Lariat device
watchman device
ablation
surgical ex maze
67
what is TEE/cardioversion?
transesophageal echo
look at structures and pumping of the heart to check for clots
68
what is a L atrial appendage ligation?
taking off the appendage to decrease the risk of forming a thrombus and throwing a clot here
69
what is a lariate device?
tying off the left atrial appendage with non-invasive imaging
70
what is a watchman device?
a one time minimally invasive procedure where a device blocks off the L atrial appendage
catheter based intervention performed via the femoral artery
71
t/f: pts with a watchman device need to be on anticoagulants for life
false
72
what ablation?
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
73
what is surgical ex maze?
minimally invasive procedure where scars are created by incisions and cyroablations to block abnormal impulses and restore sinus rhythm
74
what is a pacemaker?
electronic pulse generator used to create an artificial AP to initiate myocardial depolarization
75
is a pacemaker permanent or temporary?
it can be either
76
what is a leadless pacemaker?
pacemaker with no wires placed directly in the RV that sends electrical impulses up to the RA to stimulate depolarization and electrical signal initiation
77
what are the indications for pacemaker placement?
SA node disorders
AV node disorders
tachyarrythmias
78
what are SA node disorders?
bradyarryhthmia/brachcardia
pauses
SSS
tachycardia syndrome
a fib
79
what are AV node disorders?
2nd and 3rd degree heart blocks
80
what are tacharrhythmias?
SVT
frequent ventricular ectopy
81
temporary pacemakers can pace the heart through what 3 routes?
1) epicardial
2) tranvenous
3) transcutaneous
82
is a temporary pacemaker generator located internally or externally?
externally
83
is a permanent pacemaker generator placed inside our outside the body?
inside the body
84
t/f: leads are placed transvenously in a permanent pacemaker
true
85
what kind of pacemaker shows one spike b4 the P wave on an ECG?
single chamber pacemaker
86
t/f: in a dual chamber pacemaker, one lead is in the RA and the other is in the RV
true
87
what kind of pacemaker shows two spikes, one b4 the P wave and one b4 the QRS complex on an ECG?
dual chamber pacemaker
88
what is a transcutaneous temporary pacemaker?
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
89
what is the most common indication for the use a transcutaneous temporary pacemaker?
bradycardia
90
what is an epicardial temporary pacemaker?
temporary pacing wires are loosely sewn to the epicardium during open heart surgery for ventricular pacing most times in an emergency situation following surgery
91
how is a permanent pacemaker placed?
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
92
what are the 3 modes of a pacemaker?
1) fixed rate
2) demand mode
3) synchronized mode
93
what is a fixed rate pacemaker?
discharges an electrical signal at a "pre-set" rate (usually 70-80 bpm)
paces regardless of pt's own electrical activity
94
what is a demand mode pacemaker?
discharges an electrical signal when the pt's HR drops below "pre-set" HR
95
what is a synchronized mode pacemaker?
paces in unison with the pt's underlying HR
96
what is an automatic implantable cardioverter defibrillator (AICD)?
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
97
t/f: pt's HR can override the pre-set HR on a AICD
false
98
when is an AICD indicated?
pts who've experienced and survived a cardiac arrest event that required external defibrillation
LVEF of <35% (KNOW THIS)
99
t/f: PPM and AICD can be implanted in the abdomen if more arm mobility is needed
true
100
do AICDs usually fire when a pt is conscious or unconscious?
unconscious
101
why are there precautions following placement of a PPM/AICD for at least 4 weeks?
to promote adhesion of wires in the myocardial tissue
102
what are the precautions following placement of a PPM/AICD?
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
are there precautions following leadless pacemaker placement?
no!
104
what is a life vest?
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
when is the only time a life vest should be removed?
during bathing
106
for which type of pacemaker would we defer PT?
temporary pacemaker awaiting a permanent pacemaker
107
what is a Holter monitor?
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
when can a Holter monitor be removed?
during bathing
109
what are the indications of a Holter monitor?
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
what is echocardiography?
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
what info is obtained from an echo?
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
what things can an echo diagnose?
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
what is contrast echocardiography?
an echo performed following injection of IV contrast to improve accuracy and visualization to assess myocardial perfusion and vent chambers
114
what things can a contrast echo help visualize?
myocardial perfusion
vent chambers
endocardial wall motion
vent wall thickness
calculation of EF %
potentially coronary flow and myocardial viability
115
what is a stress echo?
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
what is a TEE (trans esphageal echo)?
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
what is the single most important procedure that can be performed non-invasively to diagnose and treat pts with CAD?
exercise stress test
118
what does an exercise stress test reveal?
whether ischemia occurs during pathologic stress
119
what is intermittent exercise stress testing?
progressive workloads with short rest periods to recover or decrease fatigue
120
what is continuous exercise stress testing?
incrementally progressive workloads until the test must be ended by the pt symptoms or defined end point
121
what is an exercise stress test used to evaluate?
atypical chest pain
chest pain suggesting CAD
HTN w/activity
prognosis and severity of CAD
122
what is the difference bw maximal and submaximal exercise stress testing?
maximal is terminated at the end point of predicted max HR, while submax is terminated at a % of that predicted max HR
123
when is maximal exercise stress testing used?
to diagnose CAD and measure functional capacity
124
when is submax exercise stress testing used?
in cardiac rehab for post-MI and cardiac surgery
125
what is nuclear stress testing?
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
if you notice an area of ischemia on a nuclear stress test that doesn't disappear 4 hours after exercise, what does this mean?
there is irreversible scarring
127
if you notice an area of ischemia on a nuclear stress test that disappears 4 hrs after exercise, what does this mean?
the damage is reversible
128
when is pharmacological stress testing used?
when the pt is unable to perform an exercise stress test
129
what is a pharmacological stress test?
stress test in which meds are used to induce the effects of exercise to assess myocardial oxygen supply
130
what meds may be used in pharmacological stress testing?
adenosine
dipyridamole
dobutamine
Lexiscan
131
is a cardiac cath coronary angiography invasive?
yes
132
what are the indications of catheterization?
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
what is the most important indication for catheterization?
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
what is a cardiac cath?
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
what is the only test that provides the actual site,extent, and severity of artery obstruction in CAD? (KNOW THIS)
cardiac cath-coronary angiogram
136
what are the results of a cardiac cath used for?
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
t/f: a cardiac cath has greater predictive accuracy in assessment of CAD than exercise testing
true
138
what is a cardiac CT?
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
what is the 1st line of imaging utilized to rule out coronary ischemia in pts admitted w/chest pain?
cardiac CT
140
what are the types of cardiac CTs?
single photon emission CT
electron beam CT
141
what is a single photon emission CT (SPECT)?
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
what is an electron beam CT (EBCT)?
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
what is the gold standard for direct measurement of blood flow and metabolic assessment of the heart?
PET scan
144
what is a PET scan?
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
what is a cardiac MRI?
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
what is a MRA?
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
what are percutaneous revascularization procedures?
procedures performed via cardiac cath
involve balloon, peripheral arterial access site, and catheter
148
what are common access sites for PCI?
femoral, brachial, or radial
149
what is an atherectomy?
cleaning out plaque in large vessels
150
what are cardiac stents?
tiny mesh-like scaffolds placed w/in stenotic lesion
151
t/f: cardiac stents can cause scar formation, thrombi, or re-stenosis
true
152
what are drug eluding stents?
stents that are coated with antiproliferative drugs that get released into the intima layer of the artery to reduce re-occlusion
153
what is a percutaneous transluminal coronary angioplasty (PTCA)?
a balloon inflated to compress the lesion against the artery wall
154
what is a percutaneous transluminal coronary atherectomy?
cutting and excising the atheroma or lesion with a catheter device
155
is a percutaneous transluminal coronary atherectomy usually done in the coronaries?
no, they're too small, this is usually done in larger vessels
156
what are surgical interventions for common vascular disease?
carotid endarterectomy (CEA)
abdominal aortic aneurysm repair (AAA repair)
157
when is a AAA repair indicated?
when the aneurysm is greater than or equal to 5 cm or with rapid aneurysm enlargement
158
what is an open AAA repair?
very large abdominal incision made to expose the aorta
graft used to repair the aneurysm
standard procedure for repair
159
what is an endovascular AAA repair?
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
what are the 4 ways the chest can be opened up for thoracic surgery?
1) video assisted thoracoscopic surgery (VATS)
2) posterolateral thoracotomy
3) median sternotomy
4) clamshell or bilateral anterolateral thoracotomy
161
what thoracic surgery method is minimally invasive?
VATS
162
what surgical method is often used for lung surgery where you need to visualize more area?
posterolateral thoracotomy
163
what surgical method is primarily used for cardiac surgery where the chest is opened up?
median sternotomy
164
what surgical method is used for heart and lungs transplants?
clamshell/bilateral anterolateral thoracotomy
165
what is video assisted surgery?
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
when is video assisted surgery indicated?
to biopsy lung tissue
management of pulmonary blebs and emphysema (air/pus collection)
management of chronic pleural effusions
management of pneumothorax
lung cancer
167
what is chemical pleurodesis?
the visceral and parietal pleura are adgered together to prevent recurrent pleural effusion/pneumothorax
168
what is chylothorax?
lymph in the lungs
usually surgical complication
169
what is a pneumonectomy?
removal of the entire lung
170
what is a lobectomy?
taking out a lobe of the lungs bc the ca is isolated
171
what is a wedge resection?
taking out a wedge of the lungs like a wedge of cheese containing the tumor
172
what are the advantages of VATS?
decreased hospital stay(3-5 days)
decreased blood loss
decreased pain
increased pulmonary function
early mobilization
decreased inflammatory reaction
173
what are the complications of VATS?
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
what is the most common complaint after VATS?
ipsi shoulder pain
175
where are thoracic post-op chest tubes commonly placed?
in the pleural space or mediastenum
176
what is the point of putting in chest tubes post-op?
to evacuate fluid or air
to prevent lung collapse
177
does air tend to develop in the top of the lungs or the bottom of the lungs?
the top
178
does fluid tend to develop in the top of the lungs or the bottom of the lungs?
the bottom
179
t/f: the seal of the 3 chamber water seal drainage device creates resistance to the fluid and air leaving the chest
true
180
what is the point of the 3rd chamber in the 3 chamber water seal drainage device?
to decrease resistance and serve as a pressure regulator
181
where is the chest tube placed?
in the intercostal space and advanced several inches into the pleural space to drain fluid, pus, and blood
182
t/f: the chest tube suction provides pressure to pleural space to keep the lungs expanded if necessary
true
183
what are the types of chest tubes?
pleura vac
Thopaz drainage system
pneumostat
peur-ex catheter
184
what is a pleura vac
type of chest tube where a typical canister is utilized
185
can a pleura vac be placed on/off suction?
yes
186
t/f: clamping a pleura vac is equivalent to not having the chest tube
true
187
what is a Thopaz drainage system?
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
what is a pneumostat?
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
which types of chest tubes allow for easy and early mobilization?
thopaz drainage system and pneumostat
190
which types of chest tubes can a pt be d/c home with?
pneumostat and pleur-ex catheter
191
what is a pleur-ex catheter?
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
which type of chest tube is usually used for pts with frequent pleural effusions or aceites?
pleur-ex catheter
193
t/f: pts with chest tubes should not participate in PT
false, they can and should!
194
what can PTs do for pts with chest tubes?
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
what should you do if a chest tube dislodges from the pt?
cover the site, have PT exhale forcefully and lift your hand then replace your hand after exhale
196
what should you do if a chest tube is disconnected from the canister?
clamp the tubing or place open end in sterile water
197
what are the indications for cardiothoracic surgery?
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
what are the 3 types of cardiothoracic surgery?
1) off pump
2) pump assist
3) robotic
199
what is an off pump CABG?
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
what is a pump assisted CABG?
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
what is a robotic CABG?
minimally invasive via the L thoracotomy approach
option for PT requiring only 1 bypass graft
202
should a PT who needs multiple bypass grafts have a robotic CABG?
no!
203
only 20% of OHS are done using what technique in the US?
off pump
204
what physiological changes may occur during OHS?
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
changes of core body temp regulation in OHS is the effect of what things?
open thorax
anesthesia
proprofol
opioids
206
what does the drop in body temp during OHS cause?
vasodilation and depression of the sympathetic response
207
t/f: hypothermia protocol during OHS can put pts at risk for infection, arrhythmias, hypokalemia, coagulopathies, and even HF
true
208
what are hypodynamic changes during OHS?
decreased venous return
increased arterial BP
no HR changes
209
which surgical cut allows for full visualization of the heart?
median sternotomy
210
t/f: use of robotic CABG doesn't allow for good visualization of the R side of the heart
true
211
t/f: CABG have decreased mortality rate and less repeat revascularization than angioplasty or stenting
true
212
what is the optimal choice for management of CAD when 3/more coronary arteries are obstructed?
CABG
213
what is the safest and most reliable method of complete revascularization of an ischemic heart?
CABG
214
where are grafts for a CABG often harvested from?
saphenous vein, radial artery, or internal mammary arteries
215
with mediastinal drainage tubes, at least 1 tube is placed in the ___ space and 1 in the ____ space to drain fluid
pericardial, pleural
216
what are the potential cardiac surgery complications?
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
wound dehisence often occurs in what population?
noncompliant diabetic pts
218
t/f: all pts have increased blood glucose post-op
true
219
t/f: ensure or supplementation is ordered for every pt post-op bc of their lack of appetite
true
220
what are the types of valve surgeries?
percutaneous balloon valvuloplasty
annuloplasty
full valve replacement
221
what is a percutaneous balloon valvuloplasty?
minimally invasive use of a balloon to dilate a valve
222
what is an annuloplasty?
valve surgery that replaces the rim/ring of the valve that tears with overstretching or prolapse
223
what is a full valve replacement?
use of a metal replacement valve or tissue valve from a human, pig, or cow
224
which type of valve replacement requires a pt to be on anticoagulants for life?
mechanical (metal) valve
225
what are the risk factors for valvular heart disease?
hx of rheumatic fever
endocarditis
hypercholesterolemia
HTN
hx of IV drug abuse
congenital defect
226
what are the indications for valve surgery?
pt symptoms
extent of LV fxn
deg of regurgitation/stenosis on echo
2+ moderate to severe or worse to qualify
227
what valves can be repaired/replaced minimally invasively or via median sternotomy?
aortic, mitral, and tricuspid
228
what is a TAVR (transcatheter aortic valve replacement)?
minimally invasive approach that delivers fully collapsible replacement valve to the site via catheter
approved for inoperable aortic stenosis
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what are the indications for TAVR?
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
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what is normal aortic valve area?
3-4 cm
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what is normal mean pressure gradient?
3-5 mmHg
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what are the pros of TAVR?
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
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what are the cons of TAVR?
increased risk for stroke post-op
increased risk for vascular bleeding at cath site
need for permanent pacemaker
longevity of the valve is unknown
$$$$
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can pts be mobilized the same day of surgery with TAVR?
yes!
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t/f: we usually only see pts post TAVR with complications
true
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t/f: mortality rates are similar for TAVR and AVR
true
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t/f: strokes and TIA are more common in AVR than TAVR
false, they are more common in TAVR
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t/f: symptoms of TAVR are better 30 post, but similar to AVR 2 years post
true
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t/f: mortality rates of TAVR are better than medical therapy
true
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t/f: TAVR pts showed improved NYHA class vs medical therapy
true
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t/f: stroke rate was higher in medical therapy group than TAVR
false, TAVR is higher
