WEEK 7 Cardiothoracic Surgery Flashcards by Clay Williams

Which 3 procedures are considered percutaneous revascularization?

Angioplasty, arthrectomy, stenting

How well did you know this?

Not at all

Perfectly

Why would percutaneous revascularization procedures be done?

To revascularize myocardium because of obstruction from plaque that occludes coronary artery flow

How well did you know this?

Not at all

Perfectly

Which arteries can the balloon tip catheter in angioplasty be inserted through?

Femoral artery or radial artery

How well did you know this?

Not at all

Perfectly

After the balloon is inflated to push plaque against lumen, what occurs?

Blood flow checked via angiogram; stent placed

How well did you know this?

Not at all

Perfectly

What movement restrictions are associated with angioplasty?

Not much except no vigorous exercise for 5-7 days because prone to bleeding

How well did you know this?

Not at all

Perfectly

How long does the 10 lb sandbag stay over the femoral artery to help it heal?

6 hours

How well did you know this?

Not at all

Perfectly

What’s the difference between angioplasty and arthrectomy?

Similar but arthrectomy is used for coronary artery stenosis due to larger plaque build up

How well did you know this?

Not at all

Perfectly

What is the function of the balloon and cutter in arthrectomy?

Balloon inflates and cutter excises atheroma

How well did you know this?

Not at all

Perfectly

What are some sources of grafts for CABG?

Internal mammary arteries, radial arteries, saphenous veins (from calf or thigh)

How well did you know this?

Not at all

Perfectly

What are some cardiac complications that can occur after CABG, especially in high risk patients?

MI (2-4%), myocardial stunning, arrhythmias (tachy or irregular)

How well did you know this?

Not at all

Perfectly

What is myocardial stunning and why does it lead to low CO?

Heart not going to function normally again after blood circulation

How well did you know this?

Not at all

Perfectly

True or False: Myocardial stunning is temporary/reversible and can be helped by inotropic meds, balloon pump, & LVAD

True

How well did you know this?

Not at all

Perfectly

What neurologic complications are associated with CABG?

CVA, delirium

How well did you know this?

Not at all

Perfectly

Where are the surgical sites of CABG that can become infected located?

Sternal and leg

How well did you know this?

Not at all

Perfectly

True or False: Renal failure (permanent) occurs in 5-10% of patients after CABG

False (temporary decrease)

How well did you know this?

Not at all

Perfectly

Pleural effusions occur in up to ___% of patients after CABG.

How well did you know this?

Not at all

Perfectly

If median sternotomy is involved, how long are the precautions for movement and lifting?

6-8 weeks

How well did you know this?

Not at all

Perfectly

What are the sternal precautions?

No push or pull; no lift more than 5 lbs; no lift 1 arm above head; no reach behind back

How well did you know this?

Not at all

Perfectly

Which conditions would intra-aortic balloon pump be used to temporarily restore cardiac output by 40%?

Severe heart failure, post-op cardiac surgery, cardiogenic shock

How well did you know this?

Not at all

Perfectly

Where can IABP be inserted? What should you consider for each of these sites?

Femoral artery (bedrest, no walking); axillary (can walk but avoid using arms a lot with ADs but check with physician)

How well did you know this?

Not at all

Perfectly

IABP is inserted through the _________ aorta.

Descending

How well did you know this?

Not at all

Perfectly

When does the balloon in IABP inflate and deflate?

Inflate during diastole; deflate during systole (to help pump blood out)

How well did you know this?

Not at all

Perfectly

Out of these ratios of inflation for IABP, which one is full assistance? 1:1, 1:2, 1:4, 1:8

1:1

How well did you know this?

Not at all

Perfectly

What are some risks of IABP?

Damage from lack of blood flow to limb (ischemia), injury to artery, rupture of balloon, incorrect position of balloon –> injure kidneys, low platelet count, infection, stroke

How well did you know this?

Not at all

Perfectly

What are these indications of? Aortic insufficiency, aortic stenosis, congenital heart valve disease, mitral regurg, mitral stenosis, mitral valve prolapse, pulm valve stenosis, tricusp regurg, tricusp valve stenosis

Valve repair or replacement

Which valve is the most common valve to be replaced?

Aortic

What is done in the Ross procedure?

Pulmonary valve replaces aortic valve & donor valve replaces pulmonary valve

Why can't the aortic valve be repaired?

Because left side pressure too high

Which 2 valves rarely need repair or replacement?

Tricuspid, pulmonary

How are valve replacements done?

General anesthesia & open heart surgery

What are some complications of a mechanical valve?

Increased stroke risk, need to be on life-long blood thinners to prevent thrombus

How long do mechanical valves last?

20-30 years

What happens in a mitral repair with annuloplasty?

Flexible ring placed around mitral valve for reconstruction & reinforcement of annulus (also prevents future annular dilation)

How are valve repairs done?

Minimally invasive techniques & percutaneous

For valve repair, where is catheter inserted?

Femoral vein

Why are repairs preferred over replacement?

More durability (with mitral); does not need long-term anti-coagulation therapy

What is the name of the procedure that destroys ectopic cells in myocardium responsible for initiating arrhythmias?

Cardiac ablation

How are cardiac ablation procedures done?

Radiofrequency energy (microwave), cryo

Cardiac ablation procedures are done after _________ testing for mapping.

Electrophysiologic

What are the movement precautions after cardiac ablation?

Refrain from heavy exercise until 4-7 days

What does a pacemaker do?

Maintains regular rate especially if rate drops below certain bpm or if atria go too fast

What are the 3 indications of pacemaker implantation?

SA node disorders (bradyarrhythmias), AV node disorders (heart block), tachyarrhythmia (SVTs)

Before working with a patient with a pacemaker, what should you know?

Why they have it; on which side; the settings (on demand or continuous, when does it deploy, if it can modulate during exercise); is it also a defibrillator

Which type of pacemaker has 1 electrode (one at myocardium - & second within pacemaker box +)?

Unipolar

Which type of pacemaker has 3 leads (1 at RA & 2 at ventricles)?

Bipolar (biventricular)

What are bipolar pacemakers used for?

Ventricular pacing, helps sync especially with heart failure

What is the name of the device that prevents life threatening arrhythmias by correcting bradyarrhythmias (pacemaker function) & tachyarrhythmias?

Implantable cardioverter defibrillator (ICD)

How is pacemaker or ICD placed endocardially?

Inside RA & ventricle via access through large vein (subclavian, internal jugular, cephalic); incision at pectoralis minor & upper pectoralis major on the left

When would pacemaker or ICD be placed epicardially?

In children; in patients undergoing heart surgery at the same time; temporary

How many bpm below the HR that will cause deployment should patient stay below to prevent shock from ICD?

10-20

What precautions does a patient have after pacemaker/ICD placement?

No shoulder elevation > 90 degrees for 4 weeks; no shoulder extension or horizontal abduction past plane of trunk; no lifting > 10 lbs for 4 weeks

If ECG change is seen before P wave, where is the pacemaker working? How about before QRS?

P: atria; QRS: ventricles

Which 4 arteries have tendencies for blockages?

Carotid, femoral, popliteal, tibial

What 2 ways can peripheral vascular interventions be done?

Surgery or transluminal angioplasty

When would angioplasty be preferred for peripheral vascular intervention?

Stenotic lesions moderate & short; mild disease at proximal or distal segments of artery

True or False: Peripheral vascular procedures increase risk for myocardial stunning.

False

Which patients are carotid endarterectomy indicated for?

Symptomatic with > 50% stenosis; asymptomatic with > 60%

What happens in a carotid endarterectomy?

Anterior SCM cut; common & external carotid occluded; bypass shunt inserted; plaque removed

How will a patient present after carotid endarterectomy?

Neck pain & limited mobility for 6-8 weeks

What are some thoracic aortic aneurysm risk factors?

Hypertension, hypercholesterolemia, prior tobacco, family history, collagen vascular disease (Marfan's)

Thoracic AA tends to have little to no symptoms, but what type of pain can be present?

Sudden & sharp (pulsating or throbbing) abdominal & thoracic pain

What motions should patient avoid after abdominal AA repair for 4-6 weeks?

Extension, rotation, sidebending

Abdominal AA repairs are indicated for aneurysms > ___ cms, with rapid enlargement, or sudden change in pain characteristics.

What happens in abdominal AA repair?

Midline incision at xiphoid process to pubis; aorta cross clamped below renal arteries & above aneurysm & 2 clamps at iliac arteries

Why are abdominal AA repair patients at high risk for pulmonary complications?

Incisional pain limits inspiration

True or False: Abdominal AA repair patients should be discouraged from coughing & huffing & encouraged with bronchial hygiene techniques instead.

True

What are some examples of thoracic procedures?

Bronchoscopy, thoracentesis, thoracotomy, lung resection

Which thoracic procedure is performed with endoscope to inspect upper airway of lungs?

Bronchoscopy

What does bronchoscopy do diagnostically?

Determine cause of obstruction; perform biopsies of lung tissue; obtain mucus/sputum samples

What does bronchoscopy do therapeutically?

Remove sources of obstruction; remove tumor that blocks airway; control bleeding; introduce radioactive to treat cancer

What are the 3 types of lung resections?

Wedge, lobectomy, pneumonectomy

Where is incision for lung resection?

Lateral chest wall

What things should be considered with patient post lung resection?

Could be on ventilator; IV pain meds & fluids; O2 therapy at home; risk of bleeding, infection, allergic reaction

Which procedure is done to drain excess fluid from pleural space, diagnose cause of pleural infection, & temporarily restore lung expansion due to reduced pleural pressure?

Thoracentesis

What are the risks of thoracentesis?

Pneumothorax, pain, infection, bleeding

What are the PT goals involved with thoracentesis?

Prevent microatelectasis (due to pain), breathing exercises, chest wall expansion exercises

What happens in thoracotomy approach?

Incision through intercostals (posterolateral, anterolateral, lateral)

What is the advantage of thoracotomy?

Full visualization

What are the complications of thoracotomy?

Pain, infection, bleeding/clots, pneumonia, empyema, breathing affected because cutting through ribs

True or False: Posterolateral thoracotomy is from T4 & scapula to 5/6 IC space & serratus anterior & long thoracic nerve divided.

False (nerve preserved)

Which type of thoracotomy is from 4/5 IC space midaxillary to midclavicular, pectoralis major is incised, & serratus anterior separated?

Anterolateral

Which type of thoracotomy is near nipple line extending toward scapula, latissimus dorsi retracted, serratus & intercostals incised?

Lateral

__________ incision is at 8/9 IC space at posterior axillary line to midline abdomen & transects latissimus dorsi, serratus anterior, external obliques, & rectus abdomen.

Thoracoabdominal

What activities are difficult for patient after thoracoabdominal incision?

Coughing, deep breathing, thoracic extension

What are some thoracic surgery complications?

Respiratory failure, cardiac arrhythmias, cardiac ischemia, shoulder pain (80% ipsilateral, referred from phrenic mostly)

Which type of arrhythmia is most common after thoracic surgery?

Atrial fibrillation