Interventional Cardiology Flashcards
What is percutaneous coronary intervention?
What are the two types of stents?
A non-surgical procedure that uses a catheter and balloon to place a stent to open up blood vessels in the heart that have been narrowed by plaque buildup
two types: bare metal and drug eluting
What is an endarterectomy?
Surgical removal of part of the inner lining of an artery, any obstructive deposits
most often performed in the carotid artery or femoral arteries
What tool is used to treat arrythmias after cardiac surgery that involves wires exiting through a mediastinal incision and is used to control heart rate and rhythm?
Temporary Epicardial Pacer
Where are pacemakers commonly inserted?
under the skin above and to the left of the heart with the electrodes inserted into a vein leading into the heart
What surgeries use a median sternotomy approach?
- coronary artery bypass graft (CABG)
- Valve replacement or repair (mitral or aortic)
- Heart Transplant
What surgeries use a thoracotomy approach?
- lobectomy
- lung transplant (bilateral aka ‘clamshell’ for COPD)
What are the two surgical approaches for a pulmonary lobectomy?
Thoracotomy anf video assisted thoracic surgery
What artery is used to access the heart during a transcatheter aortic valve replacement?
Femoral artery
What is the most commonly used vessel for grafts during a coronary artery bypass graft?
Saphenous Vein
How long do coronary artery bypass graft surgeries last?
How is the body supported while the heart is stopped during this procedure?
around 4 hours
a cardiopulmonary bypass machine that takes venous blood from right atrium and oxygenates the blood outside of the body-pts are supported by machine for around 90 minutes
What are the pros and cons of left internal mammary artery grafts (LIMA)?
Pros-remain open for longer than vein grafts (90% in 10 yrs compared to 66% for vein grafts) and also maintains endothelial function
Cons-limited length of vessel, may prolong surgery, there is a risk of sternal wound failure
True or False: Internal mammary arteries generally are not used for emergency CABG surgeries.
True
How many patients may develop a heart rhythm disturbance within the first 3-4 days post CABG surgery?
What is this disturbance correlated with?
~25% of patients
related to surgical trauma to the heart and most resolve one month after surgery
What is the most common circulatory assist device in critically ill patients with cardiac disease?
What does this device do?
Intra-aortic balloon pump
improves ventricular performance of a failing heart by facilitating an increase in myocardial oxygen supply and a decrease in myocardial oxygen demand
How does an intra-aortic balloon pump work?
Inflates at the onset of diastole, increasing the diastolic pressure and thus increase in coronary blood flow which improves myocardial oxygen supply
Deflates just before systole, thus reducing LV afterload, which decreased demand and improves cardiac output
What are the indications for cardiac transplantation?
- cardiogenic shock requiring continuous inotropic or mechanical support
- persistent NYHA functional class 4 symptoms refractory to treatment
- intractable angina
- intractable life-threatening arrythmias
- congenital heart disease w/ NYHA 3/4 symptoms refractory to treatment
What are the contraindications for cardiac transplantation?
- irreversible pulmonary vascular resistance
- malignancy
- active infection
- HIV/AIDS
Relative Contraindications
- age over 65
- poor controlled diabetes w/ organ damage/failure
- smoking
- unreliable caregivers
What is a status 7 on the UNOS priority status system for heart transplant?
patient is temporarily unsuitable for transplant
What are the physiological changes to the heart post transplant?
- transplanted heart is denervated
- higher resting HR (90-110bpm)
- absence of direct neural regulation of HR/SV
- absence of chest pain
How is exercise capacity affected in patient’s post heart transplant?
What contributes to these changes?
56% of patient exercise capacity is below 70% of predicted normal and only 13% achieve greater than 90% of predicted normal
Contributing Factors:
- transition from type 1 to type 2 fibers (especially for pts w/ previous long standing HF)
- neuro-hormonal changes from long standing HF resulting in elevated TPR
- Side effects of corticosteroids and immunosuppresive therapy
What are common complications post cardiac surgery?
- DVT
- Pericarditis
- Infection
- Sternotomy failure
- Pulmonary complications
- Deconditioning
- Reduced bowl motility
- chest wall pain and mobility issues
- neurocognitive decline
What sternal precautions need to be considered for patients who have recently undergone heart surgery, especially mediasternal surgeries?
- no traction forces on sternum for 6-8 wks
- no shoulder flexion or abduction over 90 deg.
- minimal or no push/pull (this means log rolling to get out of bed, use momentum to stand up, etc.)
- monitor incision at all times (30% mortality rate if skin opens and becomes infected)
- avoid valsalva
- encourage splinting chest w/ pillow when coughing
- no driving due to medications initially but also need to avoid chances of airbag deployment into chest for 4-6 wks
What therapy program should inpatient PTs first implement for post-op cardiac patients?
basic walking program and then discuss and obtain referral for cardiac rehab
What should be the goal for PT on day 0 of a post-op cardiac patient?
transfers to chair with RN in the morning
What should be the goal for PT on day 1 of a post-op cardiac patient?
transfers from sit to stand, get to doorway, pre gait training (afternoon ambulation)
What should be the goal for PT on day 2-3 of a post-op cardiac patient?
discontinue chest tubes and cardiac pacer, stairs assessment, independent ambulation assessment
What is the usual discharge time for a patient that had CABG surgery?
What about a patient who had a valve replacement surgery?
Pacemaker implant?
4-5 days
2-3 days
1-2 days
