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From Flashcardlet > CABG > Flashcards

CABG Flashcards

1
Q

What do you look at first when considering someone for a CABG?

A

Cardiac Cath Report

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2
Q

What is the first thing you look at on a cardiac cath report?

A

Percent and Location of lesion

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3
Q

What percent blockage is there when you begin to see symptoms and it will be treated?

A

70%

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4
Q

If the left main artery is diseased when will you have surgery?

A

Almost immediately

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5
Q

Do cardiologists stent the left main artery?

A

Not usually because if they damage it then the whole left side of the heart is gone.

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6
Q

How many arteries will they usually stent?

A

2-3

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7
Q

If you have more than 3 involved vessels what will they do?

A

Surgery

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8
Q

Which coronary artery is the easiest to stent?

A

LAD

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9
Q

What are areas that are hard to stent?

A

Where the arteries twist

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10
Q

What are the areas that should never be stented?

A

Where other vessels branch off

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11
Q

What is collateral blood flow?

A

When other arteries bridge and compensate for the impeded blood flow

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12
Q

How does ejection fraction effect surgery risk?

A

The worse the ejection fraction the higher the risk

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13
Q

What are the three types of irregular ventricular movement?

A
  • Hypokinesis
  • Akinesis
  • Dyskinesis
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14
Q

What is hypokinesis?

A

Decreased ventricular movement

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15
Q

What is akinesis?

A

No ventricular movement

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16
Q

What is dyskinesis?

A

Paradoxical movement of the ventricle (part of it balloons out when everything else is contracting)

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17
Q

How do they look at age when looking at considerations for surgery?

A
  • Look more at quality of life

- Over 75 has higher risk

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18
Q

What do we consider when a person has COPD and needs heart surgery?

A

They are hard to get off a ventilator

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19
Q

What do we consider when a person has diabetes and needs heart surgery?

A

-Diabetes causes vascular changes (arteries are harder to stent, angioplast, and bypass)

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20
Q

What are the two cases that will guarantee that you will have surgery?

A
  • Left Main Disease

- Recurring Stenosis

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21
Q

Why is it important to know pre-op information?

A

So you know how to treat them after

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22
Q

What is a single graft?

A

One conduit around a blockage

23
Q

How can a single graft be done?

A
  • Place vein from aorta to below blockage

- Mammary artery to below blockage

24
Q

What is a sequential graft?

A

When one graft goes to more than one place (go from below one blockage to below another)

25
Q

What is a Y graft?

A

A piece of vessel that has a natural “Y” in it to graft one end to artery and the other two ends to different blockages

26
Q

Which mammary artery do we use more?

A

Left

27
Q

What is different about surgery using the mammary artery?

A
  • Takes longer
  • Hurts more
  • Last longer than veins
28
Q

Where is the saphenous vein taken from?

A

Medial aspect of leg

29
Q

How much of the saphenous vein is taken?

A

6-8 inches

30
Q

Why do we turn the vein upside down?

A

So the valves don’t prevent blood flow

31
Q

What are other harvest options for a graft?

A
  • Cephalic
  • Radial
  • Right Gastroepiploic
  • Inferior epigastric artery
32
Q

What is a problem that the radial artery may have?

A

It is prone to spasms

33
Q

What is given to treat the spasms with the radial artery graft?

A

CCB

34
Q

What do they prime the heart lung machine with to perform hemodilution?

A

2-4 L of crystalloid (can use combination of crystalloid, colloid, and blood)

35
Q

What is the purpose of hemodilution?

A

Get hematocrit down 20-25% (decrease amount of blood given in surgery)

36
Q

How does hemodilution support decrease renal insufficiency?

A

Increases urinary output

37
Q

What are the negative aspects of hemodilution?

A
  • Decreases insulin

- Decreases colloid osmotic pressure

38
Q

What does decreasing colloid osmotic pressure do?

A

Increases edema

39
Q

As your body temperature decreases what happens to oxygen demand?

A

Goes down

40
Q

For every 10 degrees C lower you body temperature is how much less oxygen do you use?

A

50%

41
Q

What does hypothermia also reduce besides oxygen consumption?

A

Insulin

42
Q

What do we heparinize patients to?

A

Over 400 seconds

43
Q

What do we maintain heparinization between?

A

400-600 seconds

44
Q

What do they reverse heparinization with?

A

Protamine or another reversing agent

45
Q

Why do we heparinize?

A

To keep the blood thin during surgery (after surgery we thicken it to reduce bleeding)

46
Q

What is cardioplegia?

A

Stopping of the heart

47
Q

What does the cardioplegia solution contain?

A
  • Potassium
  • Glucose
  • Buffer
  • Calcium
48
Q

What temperture is the cardioplegia solution and why?

A

4 degrees C (to assist with hypothermia)

49
Q

What is potassium for in the cardioplegia solution?

A

This electrolyte actually stops the heart

50
Q

What is the glucose for in the cardioplegia solution?

A

For energy

51
Q

What is the buffer for in the cardioplegia solution?

A

Membrane stabilization

52
Q

What is the calcium for in the cardioplegia solution?

A

To help maintain things during this period of low flow

53
Q

What does the exact mixture of cardioplegia solution vary based on?

A

Surgeon’s preference

From Flashcardlet (107 decks)

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