Week 4- Cardiac Interventions Flashcards
PART 1: NON-INVASIVE TREATMENTS
PART 1: NON-INVASIVE TREATMENTS
List of “Non-Invasive” Cardiac Treatments. (4)
- Cardioversion
- Coronary Artery Stents
- Balloon Angioplasty
- Atherectomy
What is the difference between cardioversion and defibrillation?
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.
Electric Cardioversion:
- What is it?
- Done either ________ or ___________.
- Withhold care for ___ or until pt can tolerate activity.
- Procedure aimed at restoring normal sinus rhythm.
- electrically or pharmacologically
- 24hrs
Coronary Artery Stents:
- What is it?
- What are some results of this? (3)
- What are the 2 types of stents?
- 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
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?
- light sedation
- angina
- 30m-2h
- 1 day
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.
- bleeding
- CVA
- clot formation
- restenosis
- anti-coagulation therapy
- arrhythmias
- kidney damage
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?
- 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.
Balloon Angioplasty:
- What is it?
- ______ often placed during the procedure.
- Tiny balloon deflated and guided through artery to blockage to widen opening and increase blood flow to heart.
- stents
Atherectomy:
- What is it?
- What is an obvious risk of this?
- What are the benefits?
- 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
PART 2: SURGICAL TREATMENTS
PART 2: SURGICAL TREATMENTS
What is a CABG?
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.
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?
- 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.
What are the 2 ways to perform CABG?
- On pump
- Off pump
Off Pump CABG:
- Allows procedure to be done on ________ heart.
- Limited to __-__ lesion bypasses.
- What are some pros of an off-pump CABG?
- beating heart
- 1-2 lesions
- Decreased post-op complications and recovery times
What are the pros of performing a minimally invasive CABG?
-Incision site is much smaller and less invasive procedure.
CABG Complications. (9)
- Postperfusion Syndrome
- Cardiogenic Shock
- Nonunion of sternum/infection
- Acute renal failure due to embolism/hypoperfusion
- Stroke
- Pneumothorax
- Hemothorax
- Pericardial temponade
- Arrhythmias
Postperfusion Syndrome:
- What is it?
- What increases incidence of postperfusion syndrome?
- Cognitive deficits from coming off lung/heart machine.
- The longer the bypass time, the higher the incidence.
Cardiogenic Shock:
- What is it?
- SBP
- Heart cannot pump enough blood and O2 to vital organs.
- SBP <80mmHg
- 50%
- Norepinephrine (Levophed) or Dopamine
Cardiac Tamponade:
- What is it?
- What is Beck’s Triad for Dx of cardiac tamponade? (3)
-Reduced cardiac function secondary to fluid accumulation in pericardial cavity.
- ) HYPOTENSION
- ) MUFFLED HEART SOUNDS
- ) BULGING NECK VEINS (JVD)
Sternal Wound Complications:
- What is sternal dehiscence?
- What is sternectomy?
- What are pectoralis flaps?
- 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.
CABG Post-op Complications:
- Often have LE edema, extravasation, inflammation, and ecchymosis. How do we treat this?
- _______
- Mortality ___%
- Treat with thigh length compression stocking, elevation of limb, and early/frequent slow walking
- clotting
- Mortality 1.7%
What are Sternal Precautions? (4)
- ) No pushing/pulling
- ) No lifting >5lbs
- ) No lifting one arm above head (can lift both at same time)
- ) No reaching behind back
“Keep your move in the tube”
How long should you follow sternal precautions?
8-12 weeks
What are some harvest site treatments for PT? (4)
- 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.
- What is a Pericardial Window procedure?
- Do they have precautions?
- Surgical procedure creating a “window” on sac around the heart to drain pericardial effusions.
- No restrictions/precautions
PART 3: VALVE REPLACEMENT/REPAIR
PART 3: VALVE REPLACEMENT/REPAIR
What are (3) types of valve surgeries?
- Annuloplasty
- Valve repair
- Valve replacement
What is Annuloplasty?
Tightening or replacement of rim of mitral/tricuspid valves.
What are the (2) types of valve replacements? Give the pros and cons of each.
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
What surgical procedure is usually performed for valve replacements/repairs?
Median sternotomy
- What is TAVR?
- Why would it be used?
- Do they have restrictions?
Transcatheter Aortic Valve Replacement
- Minimally invasive procedure that is useful for patients at high risk or cannot undergo open heart surgery.
- No restrictions/precautions.
PART 4: PACEMAKERS
PART 4: PACEMAKERS
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.
- Creates artificial AP to maintain appropriate cardiac conduction/rhythm.
- subclavian
- 4-6 weeks
Pacemakers are most often used for ____/____ disorders resulting in _________.
-SA/AV node disorders resulting in bradycardia
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.
- 24 hours
- 4-6 weeks
- 4-6 weeks
- 4-6 weeks
What is an ICD?
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.
ICD Implications for PT:
- Can they perform physical activity?
- What activities/exercises must they avoid?
- 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
PART 5: CARDIAC ABLATION
PART 5: CARDIAC ABLATION
What is a cardiac ablation used to treat?
Used to treat conduction defects/heart rhythm problems.
What is the procedure for cardiac ablation?
- 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.
PART 6: AORTIC ANEURYSM REPAIR
PART 6: AORTIC ANEURYSM REPAIR
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.
- Localized blood-filled bulge in wall of blood vessel.
- Can occur in any blood vessel and in the heart.
- rupture
- clot formation
What is the clinical presentation of an Aortic Aneurysm? (4)
- ) Older males, often asymptomatic until rupture.
- ) Present with abdominal fullness/pulsation.
- ) Palpable pulsatile mass present.
- ) Abnormal bruit
- ) LBP
What aorta size indicates surgery?
> 4cm
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
- (CV risk factors)
- LBP
- palpation/auscultation
- males >65
What are 2 ways to repair AAA?
Open Repair
-Large abdominal incision in the abdomen to expose aorta.
Endovascular Aneurysm repair
-Minimally invasive small groin incisions.
PART 7: INTRAAORTIC BALLOON PUMP
PART 7: INTRAAORTIC BALLOON PUMP
- Describe what a Intraaortic Balloon Pump (IABP) is?
- Are they permanent?
- 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”,
Intraaortic Balloon Pump MOA:
- The balloon deflates during ventricular ________.
- The balloon inflates during ventricular ________.
- deflates during ventricular systole
- inflates during ventricular diastole
With Intraaortic Balloon pumps the balloon inflates during diastole for what reason?
To push blood back to the coronary arteries, while also pushing blood downstream into circulation.
IABP Implications for PT:
- Protection of _________ integrity is most important.
- Therex to ___________ extremities.
- Avoid hip flexion >___ degrees.
- Minimize extreme joint ROM.
- catheter
- uninvolved
- > 70 degrees
PART 8: LEFT VENTRICULAR ASSIST DEVICE (LVAD)
PART 8: LEFT VENTRICULAR ASSIST DEVICE (LVAD)
- LVADs were previously used for what?
- Now what can they be used for?
- Used to bridge patient between heart that was failing to getting a transplant.
- Now can be used as permanent replacement for the heart.
What is the purpose of an LVAD?
Takes blood from LV and assists in moving it into and through systemic circulation.
What are the (4) indications for LVAD?
- ) Bridge to transplantation.
- ) Bridge to candidacy.
- ) Destination therapy.
- ) Bridge to recovery.
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.
- multi-organ involvement
- CO
- RV dysfunction
