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Clin MED > Week 4 Cardiothoracic & Vascular Surgeries > Flashcards

Week 4 Cardiothoracic & Vascular Surgeries Flashcards

1
Q

What is the most common approach for cardiac surgeries?

A

Median sternotomy

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2
Q

What is the suture for median sternotomy?

A

from suprasternal notch to xiphoid process

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3
Q

How are median sternotomy closed?

A

wired or sutured

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4
Q

Posterolateral Thoracotomy muscles

A

serratus anterior, lats, lower trap are split/resected; risk of intercostal nerve injury

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5
Q

Anterolateral Thoracotomy Muscles

A

cut into pec major and serratus anterior

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6
Q

Lateral thoracotomy muscles

A

lats are spared

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7
Q

Axillary Thoracotomy muscles

A

Serratus and pec major are splits but lats are spared

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8
Q

Median sternotomy

A

mainly for open heart surgery
sternum is cracked open and chest is opened

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9
Q

Median sternotomy indications

A

valve surgery, congenital cardiac defect correction, CBG

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10
Q

Pacemaker scar

A

Usually on left side of chest but can be on right

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11
Q

Pacemaker Scar indications

A

pacemaker/ICD/loop recorder insertion

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12
Q

Anterolateral thoracotomy

A

Under breast

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13
Q

What is left anterolateral thoracotomy

A

Used for open chest massage

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14
Q

What is the most common thoracotomy?

A

Posterolateral Thoracotomy

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15
Q

What position is the posterolateral position performed in?

A

Decubitus position

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16
Q

Where is the posterolateral thoracotomy?

A

Cut through intercostal space beginning inferomedially to tip of scapula

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17
Q

Posterolateral Thoracotomy indications

A

pulmonary resections and oesophageal surgery

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18
Q

Why do a axillary thoracotomy?

A

muscle sparing

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19
Q

Axillary thoracotomy indications

A

pneumothorax, pleurectomy, pulmonary restrictions

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20
Q

Mini-thoracotomy/mini-sternotomy

A

Aortic valve accessed via right anterior mini-thoracotomy (2nd intercostal space) or mini-sternotomy
Mitral valve assessed via right lateral mini-thoracotomy (below nipple or in breast crease)

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21
Q

Mini-Thoracotomy/Mini-sternotomy indications

A

minimally invasive valve replacement/repair

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22
Q

Surgery Complications

A

Pain
Respiratory compliance
Impaired cognition/delirium
Acute blood loss/anemia

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23
Q

What are the types of revascularization procedures?

A

Percutaneous coronary intervention (PCI)

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24
Q

ACS widow time

A

<90 min

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25
Q

Coronary artery bypass graft (CABG)

A

Grafts taken from saphenous vein vein, internal mammary arteries, or radial arteries and used as a bypass around lesions in coronary artery
(on pump or off pump)

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25
Q

Most common PCI

A

drug-eluting stents

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26
Q

Which CBAG has a longer duration patency?

A

internal mammary arteries is longer compared to saphenous arteries

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27
Q

CABG indications

A

multivessel disease, too significant of a lesion for PCI

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28
Q

CABG contraindications

A

lack of target for bypass

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29
Q

What does the literature show about CABG?

A

CABG is superior to PCI with regards to mortality, MI occurence

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30
Q

Indications for valve repair/replacement

A

valve insufficiency, stenosis, prolapse, regurgitation

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31
Q

What side is a valve repair/replacement performed on?

A

more common on left side of heart due to elevated pressures

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32
Q

Valve repair/replacement risk factors

A

RA, IVDA, smoking, obesity, congenital heart defects, family hx, autoimmune disorders, age

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33
Q

Types of valve repair/replacement

A

Tricuspid (TVR)
Bicuspid/mitral (MVR)
Aortic Valve (AVR)
Valvuloplasty

34
Q

How is a valve repair/replacement performed?

A

ministernotomy

35
Q

What is an LVAD?

A

a battery-powered device for patients with end-stage HF that helps left ventricle work more efficiently

36
Q

Components of LVAD

A

Pump
tubing
drive line
controller
external power

37
Q

How is an LVAD implanted?

A

Surgically (via sternotomy or thoracotomy) into L ventricle after extensive pre-operative workup

38
Q

LVAD battery information

A

LVAD is connected to external power source, but switched to batteries for mobility/community living (typical power supply is 10-17 hours)

39
Q

Who is your LVAD tea?

A

Patient + family/caregiver
Cardiothoracic surgeon
Heart failure physician
PT, OT, ST
Respiratory therapist
Cases management
Nurse navigator
Licensed clinical social worker

40
Q

LVAD POC pre-implication

A

Medical optimization
6MWT
MOCA
Meeting with HF team, social worker
Power bill
Family meeting

41
Q

LVAD post-implantation

A

Medical optimization
Training in VAD management
Nutrition
Pain management
Pulm function
Rehab services
Addressing social/psych needs

42
Q

PPM

A

single chamber, dual chamber, or biventricular

43
Q

How does a PPM function?

A

by creating an action potential

44
Q

Indications for PPM

A

bradycardia, complete heart block, Type II AV block, tachyarrhythmias; arrhythmia with symptoms such as lightheadedness or syncope

45
Q

After getting PPM, how long does it take to get discharged

A

Many patients d/c within 24 hours

46
Q

When does PPM get replaced

A

every 10 years

47
Q

PPM considerations

A

proximity to mobile phones, magnets, MRI

48
Q

What does the PPM do

A

function at fixed rate, demand/inhibited mode, or in conjunction with patient’s typical rhythm

49
Q

How is PPM implanted

A

Implanted via incision – typically in L lateral chest pocket (below skin but above pectorals) with leads inserted transvenously (typically through cephalic vein) to the R atrium, R ventricle, or L ventricle

50
Q

PPM components

A

generator, leads

51
Q

PPM complications

A

bleed, failure to capture, blood clot, bruising, infection, device/lead migration

52
Q

A =

A

atrium

53
Q

V =

A

ventricle

54
Q

D =

A

dual

55
Q

I =

A

inhibited

56
Q

O =

A

none

57
Q

EKG difference with PPM

A

Arterial Pacing Spike
Ventricular Pacing spike

58
Q

Micra leadless pacemaker

A

inserted through femoral vein with catheter and sheath directly into right ventricle

59
Q

Indications for temporary Pacemaker

A

complete heart block, post cardiac surgery, post-MI, bridge to PPM

60
Q

Where is temporary Pacemaker placed

A

subclavian or femoral vein with sheath

61
Q

Rate

A

at which pacer is firing

62
Q

Output

A

MA going to each lead

63
Q

Mode

A

which leads are paced and where

64
Q

Sensitivity

A

level of current in mA that allows for detection of action potential

65
Q

Can a pt have a ICD and PPM

A

yes

66
Q

AICD

A

is also a defibrillator

67
Q

MAZE procedure

A

uses cryo or radiofrequency ablation to create a “maze” of scar tissue for passage of electrical signals through the atria in patients with a fib

68
Q

LLA Ligation

A

L atrial appendage is an area where blood often pools/collects or clots in patients with a fib; can decrease risk of CVA by 30%

69
Q

Ablation

A

cryoablation or electrocautery to create scar tissue that does not conduct electrical impulses; for a fib, VT/VF

70
Q

Aneurysm

A

ballooning, swelling, or weak spot in vascular wall/blood vessel to >50% more than its normal width

71
Q

Abdominal Aorta

A

supplies major abdominal organ and LE

72
Q

AAA Rupture + repair most commonly occurs

A

btw near renal arteries intro retroperitoneal space

73
Q

AAA Rupture risk factors

A

HTN
smoking
DM
HLD

74
Q

AAA Rupture symptoms

A

acute abdominal pain
pulsating mass in abdomen
lumbar pain
nausea
decrease appetite

75
Q

Classic triad of AAA rupture

A

flank/back pain, pulsatile
abdominal mass
hypotension

76
Q

Indications for AAA surgery

A

> 5.0-5.5cm
rupture
+symptoms
large growth
risk of dissection

77
Q

EVAR sx for AAA rupture

A

access through femoral artery

78
Q

Open sx for AAA

A

large incision from xiphoid to umbilical region

79
Q

What are the peripheral vascular sx

A

surgical bypass
angioplasty and stenting
atherectomy

80
Q

Surgical Bypasses

A

aorto(bi)femoral, femoral-popliteal, femoral-tibial

81
Q

Angioplasty & stenting

A

percutaneous transluminal angioplasty

82
Q

Atherectomy

A

removal of plaque(s) from blood vessels

Clin MED (10 decks)

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