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Cardiac Surgical Procedures Flashcards

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1
Q

Difference between Cardioversion and Defibrillation

A

-Both aim to restore normal sinus rhythm/heartbeat & use an EKG monitor.
-Cardioversion is a non-emergency procedure & delivered at a specific point during the cardiac cycle (w/ the R wave)

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2
Q

Defibrillation characteristics

A

-Emergency, for V-Fib/V-Tach, no CO
-200-360 joules
-Pt unconscious

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3
Q

Cardioversion characteristics

A

-Elective procedure
-50-200 joules
-Synchronized w/ QRS
-Requires consent
-Pt aware and frequently sedated throughout procedure

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4
Q

What is a percutaneous procedure and some diff types of cardiac surgeries?

A

-Any procedure where access to inner organs/tissue is done via a needle puncture of the skin rather than an “open” approach
-Percutaneous transluminal angioplasty (PTA) ballooning, stenting, filter delivery, cardiac ablation

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5
Q

What is a cardiac ablation?

A

-tx for Arrhythmias
-Uses ESTIM to locate abnormal electrical activity & tissue causing it. Uses heat or cold via a catheter inserted in the Femoral A to destroy abnormal tissue causing arrhythmia

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6
Q

Cardiac Ablation PT Implications

A

-Hemodynamic Stability
-Bleeding at site of catheter insertion

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7
Q

What is a ballon angioplasty

A

-balloon placed & inflated to widen lumen of vessel to incr. blood flow to the heart.
-Stent is often placed

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8
Q

What is a atherectomy?

A

-Tx blocked arteries that CANNOT be tx with stents
-Catheter w/ sharp blade inserted into the artery to remove plaque from vessel. Lasers may be used also

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9
Q

What is a Coronary A stent?

A

Small, expandable tubes used to open up narrowed arteries (femoral, coronary, carotid). Stents can be drug eluding (block cell production) or bare metal (w/out coating/covering)

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10
Q

Results/Pros to Coronary A stent?

A

-reduce S&S (chest pain)
-incr. blood flow
-keep vessels open to prevent further issues (MI)
-Less invasive & discomfort

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11
Q

Stent Cons

A

-Does not fix underlying cause
-Pts may be place on aspirin or other antiplatelet drugs

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12
Q

2nd and 3rd Gen Stents

A

Covering delivers drug (anti-coagulant to prevent clotting) then stent becomes bare metal. However bare metal stents can lead to scaring of artery, leading to re-stenosis.

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13
Q

Restenosis usually occurs within ____ of placement

A

12 months

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14
Q

Coronary A Stent Procedure

A

1) Peripheral access route (groin, upper arm, wrist)
2) stent collapsed & moved to blockage area via XR w/ dye
3) Pts experience brief angina for 30 mins-2 hrs (1 hr common) when balloon is used to expand stent
4) Pts are d/c the day after PCI

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15
Q

Coronary A Stent Complications

A

-Vessel not big enough for stent
-Bleeding if arterial wall is perforated
-CVA if plaque/blood dislodged by catheter
-Clot formation
-Scar tissue/plaque build up→ restenosis
-Requires lift time anti-coagulation therapy
-arrhythmias
-Kidney damage or allergy from dye

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16
Q

T/F: Restenosis occurs more frequently in pts with DM.

A

True (think about etiology of diabetic heart failure)

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17
Q

Coronary A Stent PT Implications

A

-care with incision
-Consider Cardiac Rehab
-watch for S&S of CVA (BEFAST)

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18
Q

T/F: Stents always work.

A

false

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19
Q

What is CABG (Coronary A Bypass Graft) & what is it used for?

A

Invasive, surgical procedure
-To restore blood flow to obstructed coronary artery
-Relieve angina not ctrled by max dose of anti-HTN meds
-Prevent/relieve LV dysfunction
-Reduce risk of death
-single/double/triple/quad: LAD, RCA, L circumflex A, Post descending A
usually pts have 2 grafts

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20
Q

CABG Procedure/method

A

1) Median Sternotomy
2) Heart stopped & heart/lung machine to circulate blood to body
3) Use vascular graft sites: Saphenous Vein, Internal Mammary As, Radial A
4) New Highways formed creating a bypass to get blood around clogged vessel

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21
Q

How long do CABGs usually last?

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A

15 years, w/ repeat CABGs if pt had one done in 40s-50s

22
Q

Off Pump CABG characteristics

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A

-Performed w/out stopping heart (no need for a machine)
-Limited to 1-2 bypasses
-Pros: reduce risk of post-op complications: inflammation, infection, & arrhythmias, reduced recovery time

23
Q

Minimally Invasive CABG procedures

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A

-Thoraco or subxiphoid incision to L chest cavity
-Internal Mammary A is mobilized from L chest wall & sewn to LAD in front of heart
-No machine used
-Pros: minimal invasive & quicker recovery

24
Q

CABG Complications

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A

1) Postperfusion Syndrome (Pumphead): Transient neurocog impairment that includes reduced ability to follow commands, confusion, & communication difficulty
2) Cardiogenic Shock
3) Nonunion of sternum/infection (common)
4) Acute renal failure d/t embolism/hypoperfusion
5) CVA
6) Pneumothorax/collapsed lung
7) Hemothorax (blood b/w chest wall & lungs)
8) Pericardial tamponade
9) arrthymias

25
Cardiogenic Shock: what is it? meds for it? implications for PT?
-Heart can't pump enough blood/O2 to vital organs -Meds: NE (vasoconstrictor) & Dopamine (incr. cardiac contractility) -PT Implications: monitor vitals and check w/ nursing before session
26
What is a Cardiac Tamponade?
**MEDICAL EMERGENCY** -Reduced cardiac function d/t fluid accumulation in pericardial space reducing EDV/ventricular filling & decr. SV
27
Signs of Cardiac Tamponade
-Beck's Triangle: Hypotension, Muffled heart sounds, Swollen/Bulging Neck Veins -Dyspnea/tachypnea, tachycardia
28
Strict Sternal Precautions can help prevent sternal wound complications. What are some Sternal Wound Complications to look out for?
-Sternal dehiscence -Sternectomy (removal of infected bone) -Pectoralis Flaps (used to cover area of sternal removal) -Donor Sites: rectus abdominus, lats, internal mammary A
29
Sternal Wound/CABG PT Implications
*Less chest wall stability* -Aerobic exercise training (walking, stairs, recumbent stepper), balance, stretch/strength, gait, power/endurance -Family edu -Device/equipment use -Infection ctrl -Sternal Precautions & ROM restrictions
30
CABG Sternal Precautions
"Move Within the Tube" (including BILAT overhead reaching) -*AVOID* for 12 Wks: unilat shld flex/abd >90 degr., full WB thru UE (PWB required for gait), pushing/pulling or lifting >5lbs, no driving or... sitting behind airbag (4wks) -Encourage UE AROM as tolerated for functional mobility
31
CABG Harvest Site PT Considerations
-Protect site, reducing infection/pain/edema -WBAT, no ROM restrictions w/ norm healing -Elevation, compression, & AROM of involved LE while seated & in bed -Monitor for S&S of infection
32
Types of Valve surgeries
1) Annuloplasty: rim (annulus) on mitral or tricuspid valves 2) Valve Repair 3) Valve Replacement: -Mechanical = highly durable, can last a lifetime, requires lifelong anti-coagulation -Tissue/Biologic = human/pig/cow tissue, 10-20 yr durability, no lifelong anti-coagulation required *more useful for elder/frail pts*
33
Valve Replacement PT Implication
Refer to CABG PT implications, may involve median sternotomy
34
Transcatheter Aortic Valve Replacement (TAVR): What is it, what population is it useful for, & PT implications?
-Valve replacement via femoral A, transapical (L ant. thoracotomy to heart apex), & transaortic (upper hemisternotomy or R ant. thoracotomy to get to aorta) -For pts who are high risk or cannot undergo open heart surgery for AVR PT Implications: Minimally invasive, no restrictions/precautions, watch for complications (infection, kidney disease, CVA, etc)
35
Pacemakers (PPM): What is it and the procedures/method for it?
-Creates artificial AP to maintain proper cardiac rhythm/conduction. (Tx for SA/AV node disorder & arrhythmias) -Inserted under skin in L infraclavicular pocket w/ leads inserted into R side of heart via L subclavian vein to superior vena cava. Device will be passive (tined) or active (screw) into myocaridium
36
PPM healing timeline
4-6 wks
37
PPM PT Implications
-Involved UE in sling for 24 -F/B 4-6 Wk Restrictions: no shld flex/abd >90 degr., no lifting >5lbs and... no driving (cardiologist must approve)
38
Implantable Cardioverter Defibrillator (ICD): What is it and what's it used for?
-Battery-powered & capable of cardioversion, defibrillation, & pacing of heart -Detects arrhythmia and corrects it -*Permanent* safeguards against sudden abnormalities
39
ICD PT Implications
-Know if pt has one (duh) -No excessive strain on shld, arm, or torso where ICD is -No sports -Avoid exercises that cause clavicle depression on ICD site (i.e. lifting weight w/ involved UE while standing)
40
A ruptured aortic aneurysm can lead to...
bleeding f/b hypovolemic shock leading to death
41
Clinical Presentation of AA
-Can occur anywhere but usually *abd aorta b/w renal A & aortic bifurcation* -*Common in older males - Asymptomatic until they rupture*, smoker, HTN, CAD -S&S: non-mechanical LBP that doesn't respond to tx, abd fullness/pulsation, palpable pulsatile mass, abdominal bruit (abnormal sound)
42
Surgical Repair of AA is indicated when the aorta is ____ in diameter.
> 4cm
43
Procedure for open surgery repair of AA.
-Tube placed inside AA and sutured into place, blood flows through graft
44
Procedure for Endovascular Stent-Graft Repair
Vessel is cut open at the thigh and graft is inserted & graft is threaded up to bulging area. Tube is NOT sewn into place, blood flows through graft.
45
Intraaortic Balloon Pump (IABP): What is it and Indications for use
-Device that incr. coronary perfusion/incr. O2 availability to heart -Indications: HF, cardiogenic shock, acute MI, ventricular arrhythmias, post cardiac surgery, failure to wean from CP bypass, support during high-risk coronary PTA or stent placement
46
IABP Procedure
1) balloon mounted on catheter inserted into aorta through femoral A (or axillary A) -Balloon Deflates during V systole -Balloon Inflates during V diastole 2) Coronary A perfusion pressure, diastole BP, and SBP are all increased 3) Assists with increasing O2 rich blood output & CO
47
IABP PT Implications
*Pts are hemodynamically unstable & inappropriate for TE* **Protection of catheter's integrity most important** -Avoid hip flex >70 degr. on involved LE -TE to UNINOLVED extremities -Limit extreme joint ROM
48
Left Ventricular Assist Device (LVAD): What is it and Indications for use
**Pump that helps LV pump blood to rest of body, for pts with END-STAGE HF** 1) Bridge to transplantation (main usage) 2) Bridge to candidacy: allows time for pt to become eligible for transplant 3) Destination Therapy: Pt's final intervention for HF 4) Bridge to Recovery: temporary support for pt w/ acute HF
49
T/F: LVAD is temporary needs to be replaced annually.
False - may remain implanted for years
50
LVAD PT Considerations
-Pts typically very sick: multi-organ involved, RV dysfunction, impaired resp., skeletal myopathy, anemia -Devices prevent incr. CO during exercise & may have chronotropic incompetence (EKG abnormality) -Limited data supports exercise is good to pt
51
LVAD PT issues w/ mobility to be concerned about
-Sternal precautions -Line displacement during mobility -Prevent blood flow obstruction: caution w/ supine to sitting, sitting w/ poor posture, transition to standing **Pts are weak and debilitated, slow progressive, & most become NYHA HF class 1 or 2 w/in 6 months**
52
T/F: PT may begin for pts 1 week post-LVAD.
False, PT may being post-op day 1

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