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S7- Cardiopulmonary > Week 4- Cardiac Interventions > Flashcards

Week 4- Cardiac Interventions Flashcards

1
Q

PART 1: NON-INVASIVE TREATMENTS

A

PART 1: NON-INVASIVE TREATMENTS

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2
Q

List of “Non-Invasive” Cardiac Treatments. (4)

A
  • Cardioversion
  • Coronary Artery Stents
  • Balloon Angioplasty
  • Atherectomy
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3
Q

What is the difference between cardioversion and defibrillation?

A

Cardioversion
-An elective procedure synchronized with “QRS” where the client is awake and frequently sedated.

Defibrillation
-An emergency procedure where there is no CO or v.tach/v.fib and the client is unconscious.

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4
Q

Electric Cardioversion:

  • What is it?
  • Done either ________ or ___________.
  • Withhold care for ___ or until pt can tolerate activity.
A
  • Procedure aimed at restoring normal sinus rhythm.
  • electrically or pharmacologically
  • 24hrs
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5
Q

Coronary Artery Stents:

  • What is it?
  • What are some results of this? (3)
  • What are the 2 types of stents?
A
  • Small expandable tubes used to open narrowed arteries.
  • Reduce symptoms (chest pain), increase blood flow, help prevent subsequent problems
  • drug-eluting stent, bare metal stent
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6
Q

Coronary Artery Stents Procedure:

  • Occur under _____ sedation.
  • Patients experience brief period of _____ when balloon used to expand stent is inflated.
  • Lasts ___-___.
  • How long until discharge?
A
  • light sedation
  • angina
  • 30m-2h
  • 1 day
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7
Q

Coronary Artery Stent Risks/Complications. (7)

  • _______ if arterial wall perforated.
  • _____ if plaque or blood clot gets dislodged by catheter.
  • ______ formation.
  • _______ = Scar tissue/plaque can form in area of stent.
  • Require ____-_________ therapy.
  • __________
  • _______ damage from dye.
A
  • bleeding
  • CVA
  • clot formation
  • restenosis
  • anti-coagulation therapy
  • arrhythmias
  • kidney damage
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8
Q

Stents Facts:

  • Are they safe with MRI?
  • What is the issue with using stents as a treatment method of a disease?
  • Do they usually require restenting?
  • (T/F) PCI (Stenting) was better at relieving angina symptoms than OMT (optimal medical treatment).
  • Are they eligible for cardiac rehab?
A
  • Most are safe with MRI.
  • Stents only treat one area of narrowed artery, DON’T TREAT UNDERLYING CONDITION.
  • Yes, 60% require restenting.
  • False, stenting was no better at relieving symptoms than OMT.
  • Only 25% go to cardiac rehab.
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9
Q

Balloon Angioplasty:

  • What is it?
  • ______ often placed during the procedure.
A
  • Tiny balloon deflated and guided through artery to blockage to widen opening and increase blood flow to heart.
  • stents
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10
Q

Atherectomy:

  • What is it?
  • What is an obvious risk of this?
  • What are the benefits?
A
  • Catheter with sharp blade inserted into artery to treat those not easily treated with stents.
  • embolism
  • minimally invasive, short recovery time, small incision, less pain/scarring, and reduced blood loss
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11
Q

PART 2: SURGICAL TREATMENTS

A

PART 2: SURGICAL TREATMENTS

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12
Q

What is a CABG?

A

Coronary Artery Bypass Graft

  • Surgical procedure used to restore normal blood flow to an obstructed coronary artery, creating a alternate route past clogged vessels.
  • Prevent/relieve LV dysfunction.
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13
Q

CABG

  • How are CAGBs characterized?
  • What are the donor sites?
  • 50% that come off heart/lung machine have cognitive deficits for ___m.
  • Do grafts need to be replaced?
A
  • Characterized by the number of grafts done (single, double, triple, quadruple)
  • saphenous vein, internal mammary arteries, radial artery
  • 12m
  • Yes, grafts typically last 10 years.
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14
Q

What are the 2 ways to perform CABG?

A
  • On pump

- Off pump

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15
Q

Off Pump CABG:

  • Allows procedure to be done on ________ heart.
  • Limited to __-__ lesion bypasses.
  • What are some pros of an off-pump CABG?
A
  • beating heart
  • 1-2 lesions
  • Decreased post-op complications and recovery times
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16
Q

What are the pros of performing a minimally invasive CABG?

A

-Incision site is much smaller and less invasive procedure.

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17
Q

CABG Complications. (9)

A
  • Postperfusion Syndrome
  • Cardiogenic Shock
  • Nonunion of sternum/infection
  • Acute renal failure due to embolism/hypoperfusion
  • Stroke
  • Pneumothorax
  • Hemothorax
  • Pericardial temponade
  • Arrhythmias
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18
Q

Postperfusion Syndrome:

  • What is it?
  • What increases incidence of postperfusion syndrome?
A
  • Cognitive deficits from coming off lung/heart machine.

- The longer the bypass time, the higher the incidence.

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19
Q

Cardiogenic Shock:

  • What is it?
  • SBP
A
  • Heart cannot pump enough blood and O2 to vital organs.
  • SBP <80mmHg
  • 50%
  • Norepinephrine (Levophed) or Dopamine
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20
Q

Cardiac Tamponade:

  • What is it?
  • What is Beck’s Triad for Dx of cardiac tamponade? (3)
A

-Reduced cardiac function secondary to fluid accumulation in pericardial cavity.

  1. ) HYPOTENSION
  2. ) MUFFLED HEART SOUNDS
  3. ) BULGING NECK VEINS (JVD)
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21
Q

Sternal Wound Complications:

  • What is sternal dehiscence?
  • What is sternectomy?
  • What are pectoralis flaps?
A
  • Sternal dehiscence = Separation of the bony sternum.
  • Sternectomy = Partial or total debridement of sternum to remove infected bone.
  • Pectoralis flaps = Pectoralis major muscle used to cover area where sternum removed.
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22
Q

CABG Post-op Complications:

  • Often have LE edema, extravasation, inflammation, and ecchymosis. How do we treat this?
  • _______
  • Mortality ___%
A
  • Treat with thigh length compression stocking, elevation of limb, and early/frequent slow walking
  • clotting
  • Mortality 1.7%
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23
Q

What are Sternal Precautions? (4)

A
  1. ) No pushing/pulling
  2. ) No lifting >5lbs
  3. ) No lifting one arm above head (can lift both at same time)
  4. ) No reaching behind back

“Keep your move in the tube”

24
Q

How long should you follow sternal precautions?

A

8-12 weeks

25
Q

What are some harvest site treatments for PT? (4)

A
  • Thigh-high compression garments
  • Elevation of involved LE while seated and in bed.
  • Active ROM to promote edema reduction.
  • Monitor for S/Sx of infection.
26
Q
  • What is a Pericardial Window procedure?

- Do they have precautions?

A
  • Surgical procedure creating a “window” on sac around the heart to drain pericardial effusions.
  • No restrictions/precautions
27
Q

PART 3: VALVE REPLACEMENT/REPAIR

A

PART 3: VALVE REPLACEMENT/REPAIR

28
Q

What are (3) types of valve surgeries?

A
  • Annuloplasty
  • Valve repair
  • Valve replacement
29
Q

What is Annuloplasty?

A

Tightening or replacement of rim of mitral/tricuspid valves.

30
Q

What are the (2) types of valve replacements? Give the pros and cons of each.

A

Mechanical (metallic/synthetic)

  • Pros = highly durable and can last a lifetime
  • Cons = require lifelong anticoagulation to decrease risk for thromboembolism

Tissue (human/pig/cow)

  • Pros = no lifelong anticoagulation required
  • Cons = durability only 10-20 years
31
Q

What surgical procedure is usually performed for valve replacements/repairs?

A

Median sternotomy

32
Q
  • What is TAVR?
  • Why would it be used?
  • Do they have restrictions?
A

Transcatheter Aortic Valve Replacement

  • Minimally invasive procedure that is useful for patients at high risk or cannot undergo open heart surgery.
  • No restrictions/precautions.
33
Q

PART 4: PACEMAKERS

A

PART 4: PACEMAKERS

34
Q

Pacemaker:

  • What is the purpose?
  • Usually inserted under the skin in left infraclavicular pocket, with leads inserted into the R side of the heart via L ________ vein to SVC.
  • ___-___ weeks needed to allow incision healing and firm adhesion of pacemaker leads.
A
  • Creates artificial AP to maintain appropriate cardiac conduction/rhythm.
  • subclavian
  • 4-6 weeks
35
Q

Pacemakers are most often used for ____/____ disorders resulting in _________.

A

-SA/AV node disorders resulting in bradycardia

36
Q

Pacemaker Implications for PT:

  • Keep involved UE in sling for _____
  • No therex to involved shoulder for __-__ weeks.
  • Involved UE limited to 90 degrees shoulder flexion/abduction for __-__ weeks.
  • No lifting greater than 5lbs with involved UE for __-__ weeks.
  • No driving until follow up.
A
  • 24 hours
  • 4-6 weeks
  • 4-6 weeks
  • 4-6 weeks
37
Q

What is an ICD?

A

Implantable Cardioverter Defibrillator

  • Small electrical impulse generator capable of cardioversion, defibrillation, and pacing of the heart.
  • Programmed to detect cardiac arrhythmia and correct through jolt of electricity.
38
Q

ICD Implications for PT:

  • Can they perform physical activity?
  • What activities/exercises must they avoid?
A
  • Yes, all forms of physical activity can be performed with an ICD.
  • No sports which might damage device, no excessive strain on shoulder/arm/torso, exercises that cause clavicle to be pulled down towards ribs
39
Q

PART 5: CARDIAC ABLATION

A

PART 5: CARDIAC ABLATION

40
Q

What is a cardiac ablation used to treat?

A

Used to treat conduction defects/heart rhythm problems.

41
Q

What is the procedure for cardiac ablation?

A
  • Catheter inserted into cardiac chamber.
  • Electrodes at tip of catheter gather data for mapping of heart.
  • Data pinpoints location of faulty electrical site.
  • Site destroyed via heat/cold.
42
Q

PART 6: AORTIC ANEURYSM REPAIR

A

PART 6: AORTIC ANEURYSM REPAIR

43
Q

Aortic Aneurysm:

  • What is it?
  • Where can it occur?
  • As an aneurysm increases in size, risk of _______ increases which can lead to hypovolemic shock/death.
  • Site for ______ formation.
A
  • Localized blood-filled bulge in wall of blood vessel.
  • Can occur in any blood vessel and in the heart.
  • rupture
  • clot formation
44
Q

What is the clinical presentation of an Aortic Aneurysm? (4)

A
  1. ) Older males, often asymptomatic until rupture.
  2. ) Present with abdominal fullness/pulsation.
  3. ) Palpable pulsatile mass present.
  4. ) Abnormal bruit
  5. ) LBP
45
Q

What aorta size indicates surgery?

A

> 4cm

46
Q

Aortic Aneurysm Screening:

  • Understand pt Hx (__________)
  • Non-mechanical pattern/not responding to treatment of _____.
  • Abdominal ________/_________.
  • Most common in _____ > ___yo.
  • Cigarette smoker
  • Hx of CAD/HTN
A
  • (CV risk factors)
  • LBP
  • palpation/auscultation
  • males >65
47
Q

What are 2 ways to repair AAA?

A

Open Repair
-Large abdominal incision in the abdomen to expose aorta.

Endovascular Aneurysm repair
-Minimally invasive small groin incisions.

48
Q

PART 7: INTRAAORTIC BALLOON PUMP

A

PART 7: INTRAAORTIC BALLOON PUMP

49
Q
  • Describe what a Intraaortic Balloon Pump (IABP) is?

- Are they permanent?

A
  • Balloon mounted on catheter inserted into aorta through femoral artery to increase coronary perfusion.
  • No, designed to be used temporarily after surgery in case heart doesn’t “kick in”,
50
Q

Intraaortic Balloon Pump MOA:

  • The balloon deflates during ventricular ________.
  • The balloon inflates during ventricular ________.
A
  • deflates during ventricular systole

- inflates during ventricular diastole

51
Q

With Intraaortic Balloon pumps the balloon inflates during diastole for what reason?

A

To push blood back to the coronary arteries, while also pushing blood downstream into circulation.

52
Q

IABP Implications for PT:

  • Protection of _________ integrity is most important.
  • Therex to ___________ extremities.
  • Avoid hip flexion >___ degrees.
  • Minimize extreme joint ROM.
A
  • catheter
  • uninvolved
  • > 70 degrees
53
Q

PART 8: LEFT VENTRICULAR ASSIST DEVICE (LVAD)

A

PART 8: LEFT VENTRICULAR ASSIST DEVICE (LVAD)

54
Q
  • LVADs were previously used for what?

- Now what can they be used for?

A
  • Used to bridge patient between heart that was failing to getting a transplant.
  • Now can be used as permanent replacement for the heart.
55
Q

What is the purpose of an LVAD?

A

Takes blood from LV and assists in moving it into and through systemic circulation.

56
Q

What are the (4) indications for LVAD?

A
  1. ) Bridge to transplantation.
  2. ) Bridge to candidacy.
  3. ) Destination therapy.
  4. ) Bridge to recovery.
57
Q

LVAD PT Considerations:

  • Often have _____-______ involvement.
  • Devices prevent patients from increasing _____.
  • Often also have _____ dysfunction.
  • May have chronotropic incompetence.
  • May have impaired pulmonary function.
  • May have skeletal myopathy, endothelial dysfunction and anemia.
  • At rest the device provides most of the CO, whereas during exercise the contribution is variable.
A
  • multi-organ involvement
  • CO
  • RV dysfunction

S7- Cardiopulmonary (24 decks)

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