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Biotechnology and Global Health > Lecture 12: The Cardiovascular System and Biotechnologies > Flashcards

Lecture 12: The Cardiovascular System and Biotechnologies Flashcards

1
Q

What is CABG?

A

Coronary Artery Bypass Graph - a graph vessel from another area of the body is used to circumvent the occlusion and return blood flow. Requires open chest surgery.

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2
Q

What are indicators for the use of CABG?

A
  • Disease of the LMCA
  • Disease of all three coronary vessels (LAD, LCX, RCA)
  • Diffuse disease not amenable to treatment with a PCI
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3
Q

Know the steps for the CABG procedure.

A

Anesthesia –> Incision –> Open rib cage –> Pericardium is incised –>

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4
Q

What technology is necessary for the CABG procedure?

A

Heart-Lung (Bypass) Machine

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5
Q

What is the effectiveness of CABG?

A

> 500,000 CABG/year

  • 4-6 hour procedure
  • 5-7 day hospital stay
  • remain functioning for 10-15 y
  • There are initial risk but most are minimal with the exception of post-pericardiotomy syndrome
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6
Q

Know the comparison for hospital stay and restenosis between PCTA, Stent, and CABG.

A

Hospital Stay: PCTA Stent> CABG

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7
Q

Know the comparison for costs and cos-effectiveness between PCTA, Stents, and CABG.

A

Cost:

CABG>PCTA>Stent, Drug-eluting stents ~CABG

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8
Q

What is “off-pump”?

A

When a section of the heart is stabilized, no need for cardio-pulmonary bypass

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9
Q

What is MICS CABG?

A

Minimally Invasive Cardiac Surgery - 3 small incisions with pump to reduce stress

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10
Q

What are the benefits for MICS CABG?

A
  • No open sternum
  • No heart-lung machine
  • Reduces healing
  • Reduced risk of infection
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11
Q

How is heart failure treated?

A
  • Diet modification
  • Moderate exercise
  • Medication
  • Heart Transplant
  • Cardiac Assist Devices
  • Artificial Heart
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12
Q

What is Stage A Heart Failure?

A

There is no diagnosis or symptoms of heart failure but the risk is high due to different risk factors.

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13
Q

What is Stage B Heart Failure?

A

Heart failure diagnosed by an EF < 40%, but no past or current symptoms.

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14
Q

What are the typical therapies for Stage A Heart Failure?

A

Stop smoking, start exercise, treat risk factors,.

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15
Q

What are the typical therapies for Stage B Heart Failure?

A

Stage A therapies + surgical consultation for coronary artery revascularization and valve repair or replacement.

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16
Q

What is Stage C Heart Failure?

A

Heart failure diagnosed with past or current symptoms, including shortness of breath, fatigue, and reduced exercise tolerance.

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17
Q

What are the typical therapies for Stage C Heart Failure?

A

Stage A therapies, ACE inhibitors + beta blocker + diuretic and digoxin.
Restrict salt intake, monitor weight and restrict fluid intake.
+ Spironolactone when symptoms remain severe

18
Q

What is Stage D Heart Failure?

A

Advanced symptoms of heart failure after receiving optimal medical care

19
Q

What are the typical therapies for Stage D Heart Failure?

A

Stage A-C therapies +
Evaluation for other treatments: heart transplant, ventricular assist device, other surgeries, continuous IV infusion of inotropic drugs, and research therapies.

20
Q

What are the limitations of heart transplant?

A

Only about 2,500 donor hearts become available for transplantation each year

21
Q

What are the two types of MHC molecules and where are they found?

A

Class I MHC: found on all nucleated cells

Class II MHC: found on APC

22
Q

When is rejection highest?

A

Risk of rejection is highest right after surgery

23
Q

What is induction therapy?

A
  • Use of drugs to heavily suppress immune system right after transplant surgery.
  • Patients keep taking some anti-rejection drugs for the rest of their life.
24
Q

What is “immuno-compromised state”?

A

The recipient is susceptible to opportunistic viruses/diseases

25
Q

What is “graft-versus-host disease”?

A

It is caused by T-cells within the donor tissue that can cause tissue damage in the recipient.

26
Q

What is the state of cardiac assist devices today?

A
  • Ventricular Assist Devices ( VADs)
  • They can serve as a bridge (for more time to wait for decision/transplant)
  • Or as a destination (permanent therapy)
27
Q

What are the design requirements for artificial hearts?

A
  • Provide correct flow
  • Beat continuously
  • Response to change in biological demand (variable output)
  • Material
  • Small
  • Cannot heat beyond 41
  • Needs power source
28
Q

What is the state of the artificial heart today?

A
  • AbioCor is used as a destination therapy, completely external
  • SynCardia is used a bridge therapy
29
Q

What is the state of the SynCardia heart?

A
  • In clinical trials it has the highest bridge-to-transplant rate
  • 70% of patients who receive artificial heart survive transplant
30
Q

What is the state of the AbioCor heart?

A
  • It was the first self-contained artificial health, but only fit large patients and laster for about 18 months
  • The company has decided to change focus to VAD
31
Q

What can be done about CAD in the developing world?

A

Preventative measures

32
Q

How is CV health measured?

A
  • Auscultation
  • Blood Pressure
  • Serum Cholesterol
33
Q

What is auscultation and how is it used?

A

Listening to the sounds of the heart, such as for a “lub-dub”. Abnormalities can be found in children with congenital defects of adults with acquired health valve disease.
Limitation: In the developing world confirmation with a echocardiogram is difficult.

34
Q

How is blood pressure measured and used?

A

BP is measured using a sphygmomanometer.

Normal blood pressure is <120/80 Hg for adults. A bit above this number is pre–hypertension, more above this number is hypertension.

Based on the results advice can be given to change diet or other risk factors.

35
Q

What is LDL?

A
  • Low-Density Lipoprotein Cholesterol - “bad” cholesterol

- Cholesterol builds up inside blood vessels.

36
Q

What is HDL?

A
  • High-Density Lipoprotein Cholesterol - “good” cholesterol

- Removes cholesterol from vessels to liver for excretion

37
Q

How are serum lipid levels interpreted?

A

The optimal is LDL 60

38
Q

What is the success of preventive measures?

A
  • With a 10% drop in cholesterol levels, there is a decrease of 30% risk of heart attack.
  • Large percent of pop do not have their levels controlled
  • Limitation: Access to technology and money to pay for medications
39
Q

How do we say if something should be adopted in the developing world?

A

GNI per capita x3 is acceptable

40
Q

What are the challenges for Cardiothoracic surgery in the developing work?

A
  • Availability, not many centers
  • Number of surgeons decreasing
  • Malpractice on rise
  • Salary decreasing
  • Too many patients
  • Little access and funding
  • Salaries are low
41
Q

What are possible solutions for the challenges facing the developing world concerning cardiotoracic surgery?

A
  • Stop poaching doctors
  • Stop current approach (bringing few to US for treatment)
  • Moved towards in-country strategies

Biotechnology and Global Health (10 decks)

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