Exam 2: Wk 1: Surgical Tx Of Pts With CAD Flashcards
3 major purposes of GXT
- detect ischemic heart disease under controlled conditions
- detect exercise endured arrhythmias
- evaluate hemodynamics during exercise
Pharmacological Stress testing (ALTERNATIVES TO GXT)
Dipridamole and Adenosine: dilate healthy arteries (unhealthy arteries do not dilate)
Dobutamine: increases mVO2
Echocardiography
Noninvasive realtime imaging of valve function and dimensions of the heart
Ultrasonographic imaging of heart
Transesophageal Echocardiography (TEE)
Goes down esophagus to get a better view without the ribs being in the way
Rapid Computed tomography views what ?
Early calcification of coronary vessels
Thallium 201
Injection of thallium 201 (stress test)
Shows size of heart chambers, how effective heart pumps, myocardial profusion, or scarring
- taken up by metabolically active myocarditis in proportion to blood flow
Cold spots found in thallium 201 stress test indication
- indicative of ischemia if DURING exercise
- no viable myocardium if they occur AFTER exercise
Angiogram
When a dye is injected into a vessel and X-rays are used to determine blood flow in coronary arteries
Ventriculography
- determines a patients cardiac function by measuring how much blood is pumped out
- estimates SV, Ejection fraction, chamber pressures, and presence of stenosis or regurgitation
Tests for ventricular size and function
- chest X-ray
- muga
MUGA
Multi-gated acquisition scan
- used to calculate LV EF
- noninvasive
- radioactive tracer injected
SPECT or PET
Myocardial perfusion imaging (GAMMA ray detection)
CABG - coronary artery bypass graft
Creation of bypasses around the narrowed areas using grafts
- uses saphenous vein in leg
Consequences of CABG Saphenous VG
- infection of chest and LE from length of procedure and hemotoma; patient may be unwilling to move affected LE
What is an alternative to CABG saphenous VG ?
Using the radial artery or internal mammary arteries
MIDCAB - minamilly invasive direct coronary artery bypass
Much smaller incision ; surgery similar to arthroscopic surgery
PCI or PTCA
Balloon tipped catheter inserted into the occluded vessel and inflated to restore patency of vessel (long term affects not as good as CABG)
STENT
Wire device placed with balloon tipped catheter opened within the occluded vessel to maintain patency (may be coated to reduce risk of reocclusion)
How many hours of bed rest after CABG
3 hours to prevent bleeding and hematoma at the groin due to vascular access
