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Clinical Pop > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

revascularization procedures: goals

A
  • restore myocardial blood flow
  • improve prognosis
  • —mortality
  • —morbidity
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2
Q

revascularization procedures: CABS

A

coronary artery bypass surgery

-more invasive

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3
Q

revascularization procedures: PCI

A
  • “by the way of skin”
  • percutaneous transluminal coronary angioplasy (PCTA)
  • silent therapy
  • PTCA with stent
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4
Q

How common in 2008?

A

CABS: 240,000 cases
PCI: 817,000 cases

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5
Q

Pathophysiology

A

ARTHERSCLEROSIS

FACTORS CONSIDERED FOR REVASCULARIZATION

  • significant lesions
  • —> 50% senosis
  • location of lesion
  • stability of plaque
  • prognosis
  • quality of life
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6
Q

CABS

A
  • using graft bypass area of occlusion

- —saphenous vein

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7
Q

Indication of CABS

A
  • re-stenosis after PCI
  • multi-vessel disease
  • offucult lesions
  • disease not amendable to PCI
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8
Q

CABS may involve

A

sterotomy
-avoided by recent technological advances

heart-lung bypass
-heart stops

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9
Q

Advances in CABS

A
  • mini-surgery
  • robotic technology
  • surgery on beating heart
  • —no heart lung bypass
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10
Q

Who Should Have CABS

A

primary for patients

  • post PCI with stenosis
  • multi-vessel disease not amenable PCI
  • difficult lesions
  • –bifurcations
  • –distal

other cases
-PCI

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11
Q

CABS OUTCOMES

A

INCREASED: senovial rate, F.C., left ventricular function, HR Max, RPP, quality of life

REDUCED: angina, ischemia, ST-segment depression

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12
Q

[CABS] Outcomes depend on

A
  • severity and location of lesion
  • age
  • comorbidities
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13
Q

[CABS] Re-occulsion rate

A

10% at 1 year
20% at 5 year
40% at 11 year

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14
Q

PTCA

A

widening narrowed or obstructed vessels

techniques

  • balloon dilations
  • –most common
  • rotational atherectomy
  • –central bulky lesions
  • directional atherectomy with laser
  • –large lesions
  • –high risk for damage to vessel
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15
Q

PTCA OUTCOMES

A

RELATIVELY SAFE
-patient often awake

RELIEVES
-angina

IMPROVES

  • quality of life
  • functional capacity

RESTENOSIS COMMON

  • within 6 months
  • 25% of patients

MEDICAL ATTENTION POST PCA IMPORANT
-behavioral modification
-
—physical activity smoking cessation, diet, weight loss, etc.

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16
Q

Complications of PTCA

A
  • acute vessel closure
  • chromic restenosis
  • thrombotic distal embolism
  • myocardial infarction
  • arrythymia
  • coronary artery dissection
  • bleeding
17
Q

Stent Therapy

A

A tube keeping arteries open

  • steel framework
  • eventually covered endothelium
  • drug-eluting
  • —reduce
  • ——acute complications
  • ——restenosis

Often used with PTCA

18
Q

Drug-Eluting Silent

A

Coated with slowly released medication

  • to prevent the growth of scar tissue in artery lining
  • –metal stents may cause tissue to grow over stent
  • ——leading to REBLOCKAGE
  • helps artery remain smooth and open
19
Q

Stent Therapy Outcomes

A 
RELIEVES angina
IMPROVES functional capacity and quality of life
RESTONSIS
-bare metal
---24-40%
-drug eluting
---40%
OUTCOMES depend on comorbidities
MEDICAL ATTENTION POST PTCA IMPORTANT
-medications
-behavior modification
----physical activity smoking cessation, diet, weight loss, etc.
20
Q

GXT Considerations: CABs

A

Hospital Stay post-CABs
-2-5 days

Submaximal
-predischarge

Symptom-limited
-3-4 weeks post-CABs

Wound Healing

  • chest
  • leg
21
Q

GXT Considerations: PTCA and Stents

A

Hospital stay post-PTCA

  • 1-2 days
  • often outpatient

GXT
-not important immediately

Symptoms
-may indicated re-stenosis

22
Q

Cardiac Rehabilitation-Impatient

A 
Components
-ambulation
-range of motion exercises
-education
for PCIs minimal
-some might be done at home
23
Q

Cardiac Rehabilitation-Outpatient

A
  • should start as early as possible
  • multifactorial
  • —education for patients and spouses
  • more room for improvement for CABs then PCI
  • exercise even without PCI
  • –start with lighter intensities
  • –increase intensity and volume progressively
24
Q

Benefits of Exercise

A 
Improvements
-cardiac function
-functional capacity
-less angina during exercise
-less re-stenosis post PCI
Less Mortality 
-8-17% reduction in mortality risk
---for every 1 MET improvement
-faster return to work
-less re-admission
-psychological benefits
---greater self-efficacy
---less depression and stress
25
Q

Special considerations for training

A
  • some patients may not seek lifestyle modification
  • progression for CABs patients usually sower

CABs

  • would healing
  • stability of sternum
  • hypopovolemia
  • low hemoglobin
  • outcomes of impatient rehab

PCI

  • restenosis common
  • —education on symptom identification

Comorbidities common

26
Q

Cardiovascular Training: Initial

A
  • based on clinical studies, not GXT
  • lower duration
  • lower intensity
  • increase gradually
  • monitoring of HR, BP, RPE, Angina, ECG
27
Q

Cardiovascular Training: Later

A
  • based on GXT
  • follow ACSM guidelines
  • progress gradually
  • consider status and goals of patient
28
Q

Flexibility Training

A
  • important component of early training
  • standard guidelines apply
  • may be performed while sitting, standing, supine
29
Q

Strength Training

A

Incorporated Gradually

  • based on clinical status
  • PCI patients
  • –often immediately
  • CABs patients
  • –after 4 weeks
  • –once wound is stable
  • –light weights
  • increase volume and intensity gradually
  • ankle or wrist weights
  • machines

Clinical Pop (6 decks)

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