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Cardiopulmonary Lecture Test 2- Lauryl > Medical and Pharmacological Mgmt of CVD > Flashcards

Medical and Pharmacological Mgmt of CVD Flashcards

1
Q

Defibrillation occurs with what two heart problems? Is the heart beating before a person needs to be defibrillated?

A

Ventricular Tachycardia and Ventricular Fibrillation; no the heart is not beating before defibrillation

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2
Q

Contrast thrombolytic vs anti-thrombolytic therapies.

A

Thrombolytic: dissolves clot; 1st line with acute MI (within 4-6 hrs); includes streptokinase, lanoteplase, reteplase, staphylokinase.

Anti-Thrombolytic: Prevents any more clotting; given AFTER thrombolytics; includes aspirin, warfarin, heparin- injectable only!

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3
Q

What are the other meds associated with emergency management?

A
  1. Cholesterol/Lipid Mgmt: Statins
  2. Anti-Coagulants: Plavix and Coumadin
  3. Diuretics: Lasix, pulls extra fluid from CHF
  4. ACE Inhibitors: Decrease BP
  5. Beta Blocker: block epin. and keep slow HR
  6. Ca Channel Blocker: decrease vasospasm
  7. Cardiac Glycosides: Increase force of contraction (Digoxin)
  8. Ant-arrhythmias
  9. Nitrates: Decrease angina
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4
Q

Name the 5 classes of anti-arrhythmias, what they effect, and drugs include in each class.

A

Class I: Affects sodium- lidocaine and procanamide
Class II: Anti-sympathetics- most beta blockers -alol
Class III: Affects Potassium- Amiodarne and abutilide
Class IV: Affects calcium at AV node- verapamil
Class V: Unknown- Adenosin & Digoxin

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5
Q

CABGs include what two kinds of grafts?

A
  1. Saphenous vein: 81% patency at 10 yrs, longer with 2 veins to supply from, 10 yrs post= 44% have atherosclerosis
  2. Internal mammary artery: 96% patency at 10 years, atherosclerosis rare, short and only 1 to supply from
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6
Q

What method does the surgeon use for a CABG?

A

Anastomose to aortic root and create direct revascularization
– IMA to site distal to lesion

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7
Q

Give the 3 criteria needed for selection of patients for CABG. How many of these are needed to be considered?

A

1) 2 vessels with left ventricular dysfunction
2) Unstable angina not responding to meds
3) Emergency after an MI

–Only need one of these criteria

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8
Q

What are some of the post-op complications from a CABG?

A

Bleeding, Altered BP, cardiac arrhythmias, renal dysfucntion, infection, fluid & electrolyte imbalance, hemodynamic instability, pulmonary dysfunction, neurological events, blood clots

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9
Q

Is there a direct relationship between age and mortality after a CABG?

A

Yes, the older a patient is the higher their likelihood of death post CABG

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10
Q

What is a common complication of a bypass with older patients?

A

Stroke

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11
Q

Give the name of the surgical procedure that inflates a balloon in a stenotic area for 1-3 minutes at 60-80 psi.

A

Percutaneous Transluminal Coronary Angioplasty (PTCA)

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12
Q

How often does restenosis occur within patients who have a PTCA?

A

25-50%

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13
Q

T/F: According to one study there was a significant difference 4 years after between pts who had an angioplasty after an MI vs. a patient who just had meds

A

False; study found that there was not a difference

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14
Q

What can increase the long term patency of a PTCA?

A

A stint

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15
Q

What is the criteria for a PTCA? Give the mortality rate after.

A

Criteria: Single vessel disease
Mortality: ~1% acute complications; ~6-7% after 2-3 years.

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16
Q

Give some post-op complications for a PTCA.

A

Acute occlusion of CA, MI, CA dissection, bleeding, compromise to circulation

17
Q

Which has better vascularization: PTCA or CABG? Which requires a longer stay and has more complications?

A

CABG for both

18
Q

What are the criteria for a heart transplant?

A
  1. 2nd stage myocardial disease
  2. Ejection Fraction <20%
  3. Medical rx not effective
  4. Survival prognosis 6-12 months
  5. Cardiomyopathy; Ischemic disease
  6. Upper age: 60-65 yrs old
19
Q

What is the mortality for a heart transplant? What is the cause of this mortality?

A

1 yr: 10-15%
3 yrs: 25%
Cause: rejection and infection

20
Q

If a patient has a successful heart transplant what might you see when you exercise them?

A

Heart is denervated so HR will decrease with exercise or it won’t go up with exercise

21
Q

Who decides which patients get a heart transplant?

A

United Network of Organ Sharing

22
Q

Give the difference between an orthotropic heart transplant and a heterotrophic heart transplant

A

Orthotropic: Patients heart is removed and donor heart inserted
Heterotrophic: Patients heart is left in and the donor heart is attached to it.

23
Q

What are the 4 types of pacemakers?

A
  1. Fixed Rate: hardly used anymore (older pts may have these)
  2. Demand: Most commonly used (only works when pt needs it to)
  3. Atrium Trigger: senses atria and paces it
  4. Ventricular Trigger: senses ventricles and paces it
24
Q

Give the 3 other modes for pacemakers and state what they are used for.

A
  1. Rate Modulation: changes rate depending on demand, stimulated by motion/activity or minute ventilation
  2. Antitachyarrhythmia Function: not used b/c defib more successful, slows racing heart
  3. Defibrillators: shocks heart to restart dangerous rhythm to normal rhythm, know limits and contraindications for pt
25
Q

What are some complications associated with pacemakers?

A
  1. Local Infection
  2. Ventricular arrhythmias
  3. Loss of capture (doesn’t pick it up)
  4. Perforation of chamber
26
Q

The two types of valves used for valve repairs or replacements are?

A
  1. Mechanical: Last longer but high chance for clots

2. Biological Prosthesis: 10-15 years; use bovine or porcine

27
Q

Complications of valve repairs/replacements include?

A

Normal sx risks unless arthroscopic

Mechanical- emboli

28
Q

Describe the function of a ventricular assistive device.

A

Takes over work of L ventricle
Worn outside body
Won’t have heart beat that is heard
Jarvik and Debacci most common

29
Q

Give the basic goals of surgery for heart patients.

A
  1. Complete return to full participation in life
  2. Avoid recurrence of medical reason for sx
  3. Reduce need for doctor/hospital care
  4. Lifelong health
30
Q

During preoperative care name the three things you should start with the patient.

A

1) Begin education and nutrition: what pt can foresee after sx and start eating heart healthy
2) Begin exercise program: submax exercise they can handle and establish routine, look at post sx options for community activities
3) Note current issues affected by anesthesia and depressed breathing (cyanotic, memory deficits, SOB, recumbent too long)

31
Q

A patient is in recovery until what?

A
  1. Vitals stabilize
  2. No apparent internal bleeding
  3. Can respond to their own name
32
Q

When a patient is in the ICU what are some of the main things they need to be doing?

A

REST (need to rest, but stay moving)

Low level ADLS

33
Q

What are some ways to prevent complications in an ICU patient?

A

Pain: TENS, binders, MFR
Difficulty Breathing: in nose and out mouth
Watch arousal levels

34
Q

What is the purpose of a PT in ICU?

A

Reduces effect of restricted mobility
Reduce risk of MS deformity (contractures)
Reduce risk of decubitus ulcers
Teach breathing and coughing techniques

35
Q

What are the three main things a PT is working on in early post-op PT?

A
  • Breathing: up and moving, position, huffing/expiratory spirometry
  • Emboli Prevention: get moving, exercises
  • Return to function: community & home needs for pt

Cardiopulmonary Lecture Test 2- Lauryl (2 decks)

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