Surgical Interventions

Question 1

This is an atherosclerotic disease process that narrows the lumina of coronary arteries resulting in ischemia to the myocardium.

Answer 1

CAD

Main Clinical Symptoms:

• Angina
• MI
• Congestive Heart Failure

Question 2

This procedure is performed when the stenotic lesion is not too large, inflation of the balloon compresses fatty tissue making opening larger

Answer 2

Percutaneous Transluminal Coronary Angioplasty

Question 3

A patient had an angioplasty procedure done but still has symptoms of angina. What is another option?

Answer 3

Transmyocardial Revascularization
*Procedure used to improve chronic angina not amenable to angioplasty or stenting. Laser creates a channel allow blood to flow through it to the heart.

Question 4

This procedure takes a healthy aa or vv from the body and is grafted to the blocked coronary artery to bypass the blocked portion and create a new path for blood to flow to myocardium

Answer 4

Coronary Artery Bypass Graft (CABG)

*Saphenous vein is the most commonly used vein but the internal mammary artery would be easied to use but not long enough

Question 5

Your patient had a traditional median sternotomy. What are the precautions you should tell him.

Answer 5

• No lifting more then 5-10 lbs for 8 weeks
• Shoulder ROM less than 90 degrees
• Avoid reaching behind you

Question 6

A person has a thoracoabdominal incision done, what should your concern be?

Answer 6

Possible nerve compression/damage. Need to do a full sensory exam

Question 7

What are some conditions that warrant a pacemaker?

Answer 7

Chronic Arrhythmias

• SA and AV node disorders
• Tachyarrhythmias

Question 8

This type of pacemaker is used as an emergency tx in symptomatic or hemodynamically compromising bradycaridas, after MI or CABG, or when a arrhythmia is believed to be reversible

Answer 8

Temporary Pacemaker

Question 9

This type of pacemaker mode sense the inherent rhythm of the heart and doesn’t discharge if heart initiates impulses

Answer 9

Demand (inhibited)

• Asynchronous (fixed-rate) mode= fire continuously without regard to patient’s own rhythm
• Dual chamber= capable of sensing both the atria and vents, preserve the normal sequence of cardiac events

Question 10

Used for patients who have or are at high risk for developing life threatening rapid heart racing attacks such a v-tach or v-fib

Answer 10

Implantable cardioverter defibrillator (ICD)

*Shocks the heart back into rhythm, higher voltage then a pacemaker

Question 11

What is the goal of a ventricular assist device (VAD)

Answer 11

Reduce stress on heart before complications lead to end organ dysfunction (Pulmonary HTN, renal or liver failure)
*Used as a bridge to transplant

Question 12

What are some thing people that can help bridge to candidacy of heart transplant

Answer 12

• Reduce BMI
• Cancer free period
• Financial or family

Question 13

What is the criteria for a cardiac transplant?

Answer 13

• End stage MI disease
• LVEF < 20%
• Prognosis for survival 6-12 mo
• Underlying disease process: idiopathic, viral, valvular, cardiomyopathy, ischemic heart disease
• Lots more…..

Question 14

When a person has abnormally high levels of pulmonary vascular resistance, the heart transplant is performed without removal of the native heart….what type of transplant is this?

Answer 14

Heterotopic Heart Transplant

Question 15

What are symptoms patients will have if they are rejecting donor heart?

Answer 15

-Malaise, reduced ex tol, low grade fever, vent dysrhythmias, hyptotension w/activity

Question 16

What are you focusing on post-heart transplant 12-24 hours

Answer 16

-Focus on impaired gas exchange, airway clearance, pain, mobility restrictions
GOALS:
-Optimizing pulmonary hygiene and chest wall mechanics
-Improve strength and ROM and ex tol through ADL’s (Met 1-4)