Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

*CLINICAL EXERCISE PHYSIOLOGY > EXAM2/CH15- Revascularization of the Heart > Flashcards

EXAM2/CH15- Revascularization of the Heart Flashcards

1
Q

clinical procedures (for revascularization of the heart) may be elected for what 3 reasons

A

-restore myocardial blood flow
-symptom relief
-improved morbidity + mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

4 common procedure types for revascularization of the heart

A

-angiography
-percutaneous transluminal coronary angioplasty (PTCA)
-stent therapy
-coronary artery bypass surgery (CABG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

angiography

A

IMAGING technique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what procedure is PTCA usually paired with

A

stent therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the most invasive procedure for revascularization of the heart

A

CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how does a coronary angiography work

A

catheter is inserted in leg + guided up to the aorta ->
catheter tip stops at left coronary artery ->
contrast agent is injected into arteries + x-ray imaging shows stenosis in left coronary artery

-dye shows plaque buildup occurring in the vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

is coronary angiography an interventional procedure

A

NO, imaging
-it is done so the surgeon knows where they must intervene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is often the first line of intervention

A

PTCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is PTCA also known as

A

heart catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

where does cath go through in PTCA

A

-radial artery in arm
-femoral artery in leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

-plasty means

A

to redistribute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

percutaneous transluminal coronary angioplasty (PTCA)

A

-insertion of catheter to site of coronary lesion
-compression, redistribution, or removal of plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

various techniques of PTCA (3)

A

-balloon angioplasty
-atherectomy
-laser angioplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PTCA techniques

balloon angioplasty

A

balloon catheter inflated to stretch vessel + increase diameter
-as the balloon inflates, it pushes the plaque to the size of the vessel wall; opens up lumen to revascularize

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

-ectomy means

A

removal/cutting out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PTCA techniques

atherectomy

A

plaque removal using blade catheter
-catheter has a blade tip but also has a vacuum tip to capture the plaque being dislodged
-in this technique, we are CUTTING AWAY + actually removing the blood from the vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

is atherectomy common

A

not as common
-because higher risk of something going wrong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PTCA techniques

laser angioplasty

A

beam used to vaporize plaque into water + gas
-emits beam to remove plaque by turning it into a vapor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

is laser angioplasty common

A

not as common
-because ability to target a very small area with a laser is very hard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

after a PTCA procedure (balloon angioplasty, atherectomy, laser angioplasty), what do they do

A

put a bandaid over incision site
-typically outpatient so patient is in + out in 1 day
-femoral artery causes patient to be sore in groin area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PTCA indications

A

1-2 vessel involvement
EF ~ 55%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PTCA success

A

~85-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

who would we suggest a PTCA for

A

individuals that don’t have incredibly advanced plaque, but rather maybe only 1 area
-their heart must be relatively healthy, which we determine via ejection fraction (EF around 55%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why do we use EF as an indication for PTCA

A

because if they have a bad EF, using a stent won’t make a drastic difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
stent therapy- revascularization
reduces acute closure + restenosis of coronary arteries after PTCA
26
stent therapy- old method
bare metal stents + dual antiplatelet meds
27
stent therapy- new method
steel mesh- drug eluting stent + improved antiplatelet meds -coated in antiplatelet medication that directly targets the plaque buildup from the stent itself
28
what did the new method of stent therapy do
provided improvements in endothelial hyperplasia
29
endothelial hyperplasia
scarring around stent leading to partial or full restenosis -buildup of scar tissue within the endothelium -further contributes to the narrowing of the vessel but nowhere near degree of plaque buildup -still something we need to address
30
are stents a permanent fix
NO -for most individuals they will work for around 2-3 years if they are adhering to medications + other instructions -eventually the plaque will build up again + the stent will lose its effectiveness + we must go back in + remove the stent -when you remove a stent, we INCREASE endothelial hyperplasia again
31
what happens when you remove a stent
increases endothelial hyperplasia
32
2 types of stents
-mesh/latticed -coiled
33
the future of stent therapy
-stents from biodegradable polymer resins -will reduce the threat of endothelial hyperplasia + also late stent thrombosis -biodegradable stents would get rid of one of the aspects leading to endothelial hyperplasia since we wouldn't have to go back in + remove it -billions have been spent to try + create this but no luck yet -CURRENTLY no biodegradable stents in the market
34
coronary artery bypass surgery (CABG)- revascularization
-uses venous graft from an arm or leg or an aterial graft -creates bypass around damaged vessel
35
who is involved in a CABG
typically 1 cardiothoracic surgeon + another surgeon working somewhere else in the body to extract a vessel (aka graft)
36
where are vessels typically taken from in a CABG
-arm, leg, or mammary vessel -we can use EITHER veins or arteriers
37
which vessels are BEST for a CABG
mammary vessels -most resistant to atherosclerosis
38
CABG is reserved for which patients (4)
-unsuccessful PTCA -patients who are no longer candidates for angioplasty but still have target vessels offering preservation of left ventricular systolic function -multivessel disease no amenable to angioplasty or stenting -technically difficult vessel lesions (ex: on the curve of a vessel or in a distal location not readily amenable to angioplasty or stenting)
39
what % of PTCAs are unsuccessful
10-15%
40
sternotomy
cutting down the middle of the sternum
41
benefit of sternotomy
provides full access to heart
42
right anterior thoracotomy
access to heart through one of the ribs
43
mini-sternotomy
only cutting top/bottom half of the sternum to gain access to the heart
44
when would a right anterior thoracotomy or mini-sternotomy be used
only if the surgeon is confident exactly where it is, how advanced, etc. -most cardiothoracic surgeons will go with the full sternotomy in the case of if the condition was more advanced than they thought, it is better to have access to everything
45
protocol for CABG
-patient is given general anesthesia; ensures they will be asleep + pain free through the entire surgery -surgeon makes 8-10 inch cut in the chest -surgeon cuts through all or part of the patient's breastbone to expose the heart -once the heart is visible, the patient may be connected to a heart-lung bypass machine; the machine moves blood away from the heart so that the surgeon can operate; some newer procedures do not use this machine -surgeon uses a healthy vein or artery to make a new path around the blocked artery -surgeon closes breastbone with wire, leaving the wire inside the body; over time, the sternum will fuse back together -the original cut is stitched up
46
how many surgeons working concurrently during CABG
2
47
is the heart stopped during CABG
yes- necessary because it will be hard for surgeon to work on the heart while it is actively beating -they will shock the heart to make it stop + hook patient up to a heart-lung bypass to keep them alive while the heart is not actively beating -this is how an individual can be in surgery for a long time without the rest of their tissue becoming necrotic
48
what securements are used in CABG to attach the vessel
staples + stitches -these securements will become more permanent as these tissues fuse together
49
success rate of a revascularization procedure is predicted by which 3 things
-age -other existing comorbidities -severity + location of the lesion
50
as age increases, what does this mean for recovery
decreased chance at good recovery
51
how does severity + location of the lesion affect success rate
the bypass might not work due to increased severity
52
does everyone that needs a bypass get one
no -due to risk factors + how invasive the procedure is
53
restenosis
reduction in the diameter of the vessel lumen after angioplasty
54
what is the #1 concern after bypass surgery
restenosis (aka continued narrowing of the vessel)
55
how long do stents last
2-3 years -because the antiplatelet drug wears off
56
predictors of restenosis after PTCA
-degree of residual stenosis after PTCA -diameter of the parent vessel -number of diseased vessels -degree of reduction of the stenosis -presence or type of coronary dissection -presence of documented variant angina -presence of comorbid disease (ex: diabetes, hyperlipidemia) -optimal medical therapy + adherence
57
predictors of restenosis after stent
-lesion eccentricity -diameter of the parent vessel -type of vessel stented (artery vs. vein) -location of stent in vessel -presence of multiple stents -recurrence of unstable angina -presence of comorbid disease (ex: diabetes, hyperlipidemia) -optimal medical therapy + adherence
58
lesion eccentricity definition
greater expansiveness of the lesion -it goes further into depths of the vessel wall or farther length LESION ECCENTRICITY IS A PREDICTOR OF RESTENOSIS IN STENTS
59
exercise prescription after these procedures
-mobilization in hospital ASAP -cardiac rehab begins ASAP -educational focus on medications, home activities, + follow-up appointments
60
after hospital discharge, what 3 things should exercise focus on
-improved cardiac performance at rest + during exercise -improved exercise capacity (aerobic + strength) -improved angina-free exercise tolerance, much of which is attributable to peripheral muscular adaptations
61
after hospital discharge, which type of exercise is the main focus
aerobic exercise
62
what is the primary concern after a PTCA
restenosis
63
ExRx special considerations after a PTCA
-assess for signs/symptoms indicative of angina -initiate outpatient program as soon as they are discharged from the hospital or outpatient surgery facility
64
is cardiac rehab only prescribed for individuals that had surgery
no -also for patients at risk of MI
65
ExRx special considerations after a CABG
-incisional healing -sternal stability if open heart CABG -soreness/stiffness in chest/back -hypovolemia -low hemoglobin concentrations
66
special considerations after a CABG- hypovolemia
blood volume loss post-surgery (causes decreased cardiac output)
67
ExRx special considerations after a CABG- can exercise directly impact sternum
NO exercise should have direct impact on the sternum for these patients
68
ExRx special considerations after a CABG- everytime you breathe in...
puts pressure on your chest + causes pain
69
ExRx special considerations after a CABG- good movements to implement
shoulder circles/shoulders back to stretch the pec muscles
70
why do cardiac patients hunch over
because good posture pulls on chest muscles
71
hypovolemia leads to
-fatigue -lightheadedness
72
special considerations after a CABG- low hemoglobin concentrations
caused from blood loss during surgery

*CLINICAL EXERCISE PHYSIOLOGY (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions