Medical and Pharmacological Mgmt of CVD Flashcards
Defibrillation occurs with what two heart problems? Is the heart beating before a person needs to be defibrillated?
Ventricular Tachycardia and Ventricular Fibrillation; no the heart is not beating before defibrillation
Contrast thrombolytic vs anti-thrombolytic therapies.
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!
What are the other meds associated with emergency management?
- Cholesterol/Lipid Mgmt: Statins
- Anti-Coagulants: Plavix and Coumadin
- Diuretics: Lasix, pulls extra fluid from CHF
- ACE Inhibitors: Decrease BP
- Beta Blocker: block epin. and keep slow HR
- Ca Channel Blocker: decrease vasospasm
- Cardiac Glycosides: Increase force of contraction (Digoxin)
- Ant-arrhythmias
- Nitrates: Decrease angina
Name the 5 classes of anti-arrhythmias, what they effect, and drugs include in each class.
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
CABGs include what two kinds of grafts?
- Saphenous vein: 81% patency at 10 yrs, longer with 2 veins to supply from, 10 yrs post= 44% have atherosclerosis
- Internal mammary artery: 96% patency at 10 years, atherosclerosis rare, short and only 1 to supply from
What method does the surgeon use for a CABG?
Anastomose to aortic root and create direct revascularization
– IMA to site distal to lesion
Give the 3 criteria needed for selection of patients for CABG. How many of these are needed to be considered?
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
What are some of the post-op complications from a CABG?
Bleeding, Altered BP, cardiac arrhythmias, renal dysfucntion, infection, fluid & electrolyte imbalance, hemodynamic instability, pulmonary dysfunction, neurological events, blood clots
Is there a direct relationship between age and mortality after a CABG?
Yes, the older a patient is the higher their likelihood of death post CABG
What is a common complication of a bypass with older patients?
Stroke
Give the name of the surgical procedure that inflates a balloon in a stenotic area for 1-3 minutes at 60-80 psi.
Percutaneous Transluminal Coronary Angioplasty (PTCA)
How often does restenosis occur within patients who have a PTCA?
25-50%
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
False; study found that there was not a difference
What can increase the long term patency of a PTCA?
A stint
What is the criteria for a PTCA? Give the mortality rate after.
Criteria: Single vessel disease
Mortality: ~1% acute complications; ~6-7% after 2-3 years.
Give some post-op complications for a PTCA.
Acute occlusion of CA, MI, CA dissection, bleeding, compromise to circulation
Which has better vascularization: PTCA or CABG? Which requires a longer stay and has more complications?
CABG for both
What are the criteria for a heart transplant?
- 2nd stage myocardial disease
- Ejection Fraction <20%
- Medical rx not effective
- Survival prognosis 6-12 months
- Cardiomyopathy; Ischemic disease
- Upper age: 60-65 yrs old
What is the mortality for a heart transplant? What is the cause of this mortality?
1 yr: 10-15%
3 yrs: 25%
Cause: rejection and infection
If a patient has a successful heart transplant what might you see when you exercise them?
Heart is denervated so HR will decrease with exercise or it won’t go up with exercise
Who decides which patients get a heart transplant?
United Network of Organ Sharing
Give the difference between an orthotropic heart transplant and a heterotrophic heart transplant
Orthotropic: Patients heart is removed and donor heart inserted
Heterotrophic: Patients heart is left in and the donor heart is attached to it.
What are the 4 types of pacemakers?
- Fixed Rate: hardly used anymore (older pts may have these)
- Demand: Most commonly used (only works when pt needs it to)
- Atrium Trigger: senses atria and paces it
- Ventricular Trigger: senses ventricles and paces it
Give the 3 other modes for pacemakers and state what they are used for.
- Rate Modulation: changes rate depending on demand, stimulated by motion/activity or minute ventilation
- Antitachyarrhythmia Function: not used b/c defib more successful, slows racing heart
- Defibrillators: shocks heart to restart dangerous rhythm to normal rhythm, know limits and contraindications for pt
