Ischeamic Heart Disease: Revascularisation

Question 1

What are the steps involved in CABG?

Answer 1

• Median sternotomy: vertical incision made along the sternum, after which the sternum is divided to gain access to the chest and heart.
• Long saphenous vein, internal mammary artery- used as the bypass vessel
• Bypass done
• cardioplegia (temporary suspension of heart activity for surgery)
• Risk of graft disease 8-1-yrs

Question 2

What are some complications of CABG?

Answer 2

• Death, Stroke
• MI, AF
• Infection
• Renal failure
• infection, cognitive impairment, failure to recover

Question 3

What are the complications of PCI?

Answer 3

• Death, stroke
• MI
• Renal failure
• Bleeding

Question 4

What steps are involved in PCI?

Answer 4

• Vascular access
• Anti platelet, anti coagulant
• Catheter inserted into coronary ostium
• Balloon threaded over wire
• Stent implanted

Question 5

What are some indications of angiography?

Answer 5

• High risk

- Severe symptoms

Question 6

What are some complications of CABG?

Answer 6

• Stroke
• Contrast nephropathy
• Bleeding

Question 7

What factors affect re-vascularisation suitability?

Answer 7

• Multi-vessel disease
• Diabetes
• Left main disease
• Comorbidites

Question 8

Why’s the radial artery often used to gain access to the heart?

Answer 8

• Dual supply to hand
• No adjacent nerve/vein
• Superficial, compressible

Question 9

Check out this dank af summary of the lecture

Answer 9

1. Acute STEMI- PCI
2. Acute coronary syndrome- angiography with a view to revascularisation
3. Chronic stable angina- Re-vascularisation only in high risk, severe symptoms. CABG vs PCI should be discussed.