Ischemic heart disease - revascularisation Flashcards
How is a coronary artery bypass carried out?
There is a median sternotomy (sawing through the mediastinum)
The long saphenous vein is harvested from the leg
The internal mammary artery is then put in while the heart is stopped
What is the prognosis of a coronary artery bypass graft?
Generally has a slightly better survival rate than similar treatments, particularly in very high risk people, in low risk people medical therapy is more effective
Complication of CAGB
- death
- stroke
- MI
- atrial fibrilation
- infection
- cognitive impairment
- sternal malunion (worse blood supply to the sternum)
- renal failure
What the technique of carrying out PCI?
Vascular access Anti-platelet drugs, anticoagulation Catheter to ostium of coronary Guidewire down vessel Balloons threaded over wire Stent(s) implanted Balloon, catheter, wires removed
What are high risk indications for angiography?
acute presentation STEMI and NSTEMI or
high risk stable patients
severe symptoms
What makes patients suitable for revascularisation?
- multi-vessel disease either diffuse or focal
- left main disease
- diabetes
- co-morbidities
What are the complications of angioplasty?
- stent won’t be installed properly and will cause either
stent thrombosis
stent restenosis
only treats some of the atheroma so still risk of future events
What is the current treatment options of ischemic heart disease?
CABG
angioplasty (PCI)
thrombolysis (not favoured due to the high risk of haemorrhage)
PCI is favoured over thrombolysis in treating MIs unless there is a large delay
How are the vessels accessed?
Radial artery (favoured)
femural artery
brachial artery
What are the pros and cons of using the radial artery?
Pros - Dual supply to hand - Superficial - Compressible - No adjacent nerve / vein Cons - Smaller - Prone to spasm - (asymptomatic) occlusion 5%
What treatment should be used for chronic stable angina - severe symptoms or high risk?
CABG or PCI to be determined via discussion
