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CardioPulmonary > Lecture 16: Cardiac and Surgical Conditions > Flashcards

Lecture 16: Cardiac and Surgical Conditions Flashcards

0
Q

As a PT, what do you need to be considerate of when dealing with a patient with a pacemaker?

A

You must be monitoring BP and S&Ss to ensure the pacemaker is adapting to exercise

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1
Q

What is a risk of having a pacemaker?

A

They can fail

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2
Q

How can you tell if a pacemaker has failed?

A

If the patient’s heart rate is <40 bpm

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3
Q

What 5-6 structures does the RCA (right coronary artery) supply?

A
  1. Right ventricle
  2. Right atria
  3. Inferior wall of Left ventricle
  4. Bundle branches
  5. AV node
  6. (If right dominant) SA node
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4
Q

What does “Right dominant” heart mean and what is its prevalence?

A

The RCA (right coronary artery) supplies both the AV and SA node. Occurs in 55-75% of the population

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5
Q

What does “Left dominant” heart mean and what is its prevalence?

A

The LCA (Left coronary artery) supplies the SA node instead of the RCA. Occurs in 24-45% of the population.

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6
Q

What does the LAD (Left anterior descending artery) supply?

A

The anterior wall of the left ventricle

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7
Q

What is known as “The widow maker”?

A

Occlusion of the LAD (left anterior descending artery) which will lead to death.

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8
Q

What 2-4 structures does the LCX (Left circumflex artery) supply? (Include prevalence)

A
  1. Left atria
  2. Posterior and lateral walls of the left ventricle
  3. SA node (45% of population)
  4. AV node (10% of population)
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9
Q

What is a CABG?

A

Coronary artery bipass graph: It is a graph of a vein or artery used to go around an occluded artery or vein.

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10
Q

What is an indication for having a CABG?

A

Medication is inadequate to treat the problem

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11
Q

What 5 vessels are typically used for a CABG?

A
  1. Saphenous vein
  2. Left internal mammary artery (LIMA)
  3. Brachial artery
  4. Radial artery
  5. Gastric artery
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12
Q

What 3 pieces of equipment may be hooked up to a patient who has undergone a median sternotomy?

A
  1. Mediastinal tubes
  2. External temporary pacing wires
  3. Intra-aortic balloon pump
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13
Q

When are temporary pacing wires usually removed?

A

Within 2 days of a median sternotomy

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14
Q

What does an intra-aortic balloon pump do?

A

Assists the left ventricle

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15
Q

What do we need to be cautious about with patients who have temporary pacing wires.

A

We cannot work with patients who have had temporary pacing wires removed in the past 4 hours.

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16
Q

What are the 6 sternal precautions after a median sternotomy?

A
  1. Do not push or pull for mobility
  2. Do not push or lift > 5-10 lbs for 6-8 weeks
  3. Do not hyperextend your shoulder
  4. No trunk rotation for several weeks
  5. No driving for several weeks
  6. No unilateral shoulder flexion >90 degrees
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17
Q

What is a PT consideration of patients with an intra-aortic balloon pump?

A

Do not flex the hip! It is inserted through the femoral artery. Ankle pumps all the way!!!

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18
Q

What 4 interventions will we be using with median sternotomy patients and why?

A
  1. Compressive socks - to reduce edema
  2. Deep breathing and coughs - prone to atelectasis
  3. Check incision site often - diabetics have poor healing, prone to dehiss
  4. Ambulate or do ankle pumps - prone to DVTs
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19
Q

How is a minimally invasive surgical procedure different from a median sternotomy?

A
  1. Video thorascopy used
  2. Shorter bypass
  3. Incision is made through intercostal space
  4. No cardiopulmonary bypass machine is needed.
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20
Q

What are 3 kinds of graft replacements and what are they?

A
  1. Prosthetic/mechanical - Artificial
  2. Xeno graph - From animal
  3. Homograph - From cadaver
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21
Q

Which graph types does not require anti-coagulation and why?

A

Xeno graph and homograph - because dead tissue does not elicit an immune response.

22
Q

If the saphenous vein was used in a CABG procedure, what is an additional precaution that both you and the patient must be aware of?

A

Don’t let them cross their legs Post-op

23
Q

What is dehiscence?

A

When a patient splits open the skin over their median sternotomy

24
Q

What are two downfalls of prosthetic/mechanical valve replacements?

A

Requires lifetime anticoagulation medications

No contact sports because the valves can become dislodged

25
Q

What is a benefit for having a Xenograft?

A

No anti-coagulation medications are required because the tissue is dead (no antibody response)

26
Q

What is the benefit of using a homograft?

A

There is no anti-coagulation

27
Q

What is the Ross procedure used for?

A

Aortic valve replacement. The patient’s pulmonary valve is moved to the aortic valve position and a xenograft is placed into the pulmonary valve position.

28
Q

There are (6) types of valve repair procedures. List them.

A

(1) Commissurotomy
(2) Decalcification
(3) Triangular resection of the mitral valve repair
(4) Annuloplasty
(5) Patched leaflets
(6) Bicuspid aortic valve repair

29
Q

What is done during a commisurotomy?

A

A valve repair that separates fused valves, a catheter is used to physically push apart the fused valves

30
Q

What is done during a decalcification valve repair?

A

Removal of the calcified material on the valve

31
Q

What is done during a triangular resection mitral valve repair?

A

This is to repair a floppy mitral valve
A portion of this floppy valve is removed and the leaflet is sown together to make the valve smaller and be able to close better

32
Q

What is done during an annuloplasty?

A

This procedure prevents regurgitation

A tissue or synthetic ring is sewed around a valve annulus which is too wide

33
Q

What is done with a patched leaflets valve repair?

A

This is when the surgeon repairs holes or tears with a synthetic patch or a pericardium patch

34
Q

What is done during the bicuspid aortic valve repair?

A

Normally the aortic valve should have 3 leaflets, so the bicuspid aortic valve (a congenital defect) will need to be reshaped.

35
Q

What are the PT implications of valve repair

A

(1) Risk for atelectasis because these procedures use a medial sternotomy
(2) The longer the length of the surgery, the greater the risk is for atelectasis
(3) INR needs to be between 2 to 3 for these patients
(4) Valve replacement patients (all cardiac surgery patients) are at increased risk for orthostatic hypotension

36
Q

What are temporary pacemakers (“pacing wires”)?

A

Wires put in place during surgery and are taped down and then removed 1 to 2 days after surgery

37
Q

What does AICD stand for?

A

Automatic implantable cardiac defibrilator

38
Q

What is an AICD?

A

A device that provides a defibrillation if the patient has history of life threatening arrhythmias

39
Q

What should a patient with an AICD be educated on?

A

If the patient feels a pounding or fluttering in his/her chest, they need to sit down - otherwise they will fall down
The ICD will provide an automatic defibrillation and it feels like a horse kicking them in the chest.

40
Q

What does IABP stand for?

A

Intra-aortic Balloon pump

41
Q

What is IABP?

A

A temporary measure to augment stroke volume and maintain good BP

42
Q

How is the catheter ballon in the IABP placed into the aorta?

A

It is inserted through the femoral artery

43
Q

What happens to the balloon in the IABP during systole? During early diastole? During late diastole?

A

During systole: balloon collapses
During early diastole: the balloon is inflating
During late diastole: the balloon is fully inflated and then immediately deflates for systole
> This will create a negative pressure pulling the blood out of the ventricle > reducing afterload

44
Q

What is the ratio of balloon inflation to heart beat for an IABP?

A

May be 1:1 to 1:8

1:1 would be the initial setting and then the patient could be weaned off the IABP slowly by reducing the ratio to 1:8

45
Q

When is an IABP used?

A

Used during/post-op cardiac surgery to maintain the BP

Or when the patient is waiting for heart transplant

46
Q

What are the PT implications if the patient is currently using IABP?

A

No hip flexion (bed is flat) > that means no sitting
Utilize ankle pumps and side rolls
Monitor vital signs just in case the device fails

47
Q

What does VAD stand for?

A

Ventricular Assist device

48
Q

What is a VAD?

A

A mechanical pump used to bypass a failing ventricle (move blood straight to the aorta)

49
Q

What are the three types of VAD?

A

(1) RVAD - right ventricle –> aorta
(2) LVAD - left ventricle –> aorta
(3) BiVAD - both ventricles –> aorta

50
Q

What are the types of patients that may be using a VAD?

A

(1) Patients waiting for a heart transplant
(2) Patients that are ineligible for heart transplants (because of other co-morbidities
(3) Chronic cardiomyopathy patients

51
Q

What are the PT considerations with working with a patient who uses a VAD?

A
  • Pumping is happening continuously (there will be a mean BP, not a SBP/DBP)
  • Look for S&S of inadequate blood flow: faint, dizzy, pale
  • VAD can be internal or external
52
Q

If the patient is on an external VAD, Can the patient get out of bed?

A

Most likely not, it depends on the patient’s stability. You can still perform bed exercises with this patient, just be very careful not to pull external lines.

CardioPulmonary (13 decks)

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