S2 L2.7: Management of CAD Flashcards by Mind Med

What are the five (5) possible management of CAD?

Identify & treat associated diseases that can precipitate or worsen angina
Reduce coronary risk factors
General and nonpharmacological methods, lifestyle modification
Pharmacological Mx
Revascularization

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Give me the three (3) types or methods for revascularization

Fibrinolysis
Percutaneous coronary intervention
CABG

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REVASCULARIZATION

Done in acute coronary syndrome by melting the
clot

Fibrinolysis

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REVASCULARIZATION

Heart bypass

Percutaneous coronary intervention

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Stent is used to open up the closed arteries so that blood could flow again

CABG

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Is the process of getting arteries from the L
intramammary artery where the great saphenous vein is → then is used as a bypass to be attached distally in the lesion while proximal portion is attached to the aorta

CABG

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CABG is the process of getting arteries from the L
_______ artery where the ______ _______ vein is →
then is used as a bypass to be attached _____ in the lesion while proximal portion is attached to the _____

CABG is the process of getting arteries from the L
INTRAMAMMARY ARTERY where the GREAT SAPHENOUS vein is → then is used as a bypass to be attached DISTALLY in the lesion while proximal portion is attached to the AORTA

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Deployment of stents to open up closed arteries to allow blood flow

PERCUTANEOUS CORONARY INTERVENTION
(PCI)/ANGIOPLASTY

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Done in the cardiac catheterization lab (cath lab)

PERCUTANEOUS CORONARY INTERVENTION
(PCI)/ANGIOPLASTY

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Metallic stent is inserted which stays forever

Stenting

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Commonly done in the present

Stenting

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Absorbable stent may also be used which dissolves over time after opening the obstructed artery

Stenting

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Inflating the inserted balloon material to dilate open the narrowed artery

Balloon Angioplasty

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In the past, it was commonly done
without inserting any stent.

Balloon Angioplasty

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Also known as Percutaneous Coronary Intervention

Coronary Artery Angioplasty (Radial Access)

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Procedure is done on the coronary arteries supplying
the heart muscle with oxygen.

Coronary Artery Angioplasty (Radial Access)

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Goal is to restore blood flow if a substance if plaque
has significantly narrowed the blood vessels

Coronary Artery Angioplasty (Radial Access)

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Arrange the following steps of coronary artery angioplasty (radial access) from 1 to 10:

Needle will be placed through the skin and into the radial artery

Doctor will numb the skin in the wrist

A flexible guidewire will be passed through the needle and into the artery

The guidewire will be advanced to the heart and the catheter will be advanced over the wire to the
coronary artery

Needle will be withdrawn and replaced with a small, flexible tube called the sheath to permit access to the artery. Pressure may be felt when the sheath is inserted but it will not be felt moving inside the artery

If a significant blockage is found, the guidewire will be inserted to the artery

A special dye will be injected to the artery for better viewing. The dye will make any blockage stand out

The doctor will move the tip of the catheter just
inside the coronary artery to be examined

The doctor will remove the guidewire

Progress of the procedure will be checked through an x-ray device called Fluoroscope

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Doctor will numb the skin in the wrist
Needle will be placed through the skin and into the radial artery
A flexible guidewire will be passed through the needle and into the artery
Needle will be withdrawn and replaced with a small, flexible tube called the sheath to permit access to the artery. Pressure may be felt when the sheath is inserted but it will not be felt moving inside the artery
The guidewire will be advanced to the heart and the catheter will be advanced over the wire to the
coronary artery
Progress of the procedure will be checked through an x-ray device called Fluoroscope
The doctor will remove the guidewire
The doctor will move the tip of the catheter just
inside the coronary artery to be examined
A special dye will be injected to the artery for better viewing. The dye will make any blockage stand out
If a significant blockage is found, the guidewire will be inserted to the artery

Arrange the following steps of coronary artery angioplasty (radial access) to balloon angioplasty from 9 to 13:

A special dye will be injected to the artery for better viewing. The dye will make any blockage stand out

If a significant blockage is found, the guidewire will be inserted to the artery

The doctor will then deflate and remove the balloon

A balloon on the tip of the catheter will be movedalong the wire to the blockage

When the balloon inflates, it will expand the arteryand improve the blood flow. Chest discomfort may be felt

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A special dye will be injected to the artery for better viewing. The dye will make any blockage stand out
If a significant blockage is found, the guidewire will be inserted to the artery

BALLOON ANGIOPLASTY:
11. A balloon on the tip of the catheter will be movedalong the wire to the blockage
12. When the balloon inflates, it will expand the arteryand improve the blood flow. Chest discomfort may be felt
13. The doctor will then deflate and remove the balloon

Arrange the following steps of balloon angioplasty to stenting from 12 to 18:

At the end of the procedure the guidewire will be removed

When the balloon is inflated, the stent will expand and lock into place

After the balloon catheter is taken out, the stent will stay in place to hold the artery open

The stent will be moved into the artery over the same guidewire

A wire mesh tube called a stent will be placed to the treated area to help keep the coronary artery opened. The doctor will choose the proper size of the stent which will be compressed over the balloon

The doctor will then deflate and remove the balloon

When the balloon inflates, it will expand the artery and improve the blood flow. Chest discomfort maybe felt

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BALLOON ANGIOPLASTY:
11. A balloon on the tip of the catheter will be moved along the wire to the blockage
12. When the balloon inflates, it will expand the artery and improve the blood flow. Chest discomfort maybe felt
13. The doctor will then deflate and remove the balloon

STENTING
14. A wire mesh tube called a stent will be placed to the treated area to help keep the coronary artery opened. The doctor will choose the proper size of the stent which will be compressed over the balloon
15. The stent will be moved into the artery over the same guidewire
16. When the balloon is inflated, the stent will expand and lock into place
17. After the balloon catheter is taken out, the stent will stay in place to hold the artery open
18. At the end of the procedure the guidewire will be removed

Enumerate the steps discussed in the Coronary Artery Angioplasty (Radial Access) on your own words

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STEPS
1. Doctor will numb the skin in the wrist
2. Needle will be placed through the skin and into the radial artery
3. A flexible guidewire will be passed through the needle and into the artery
4. Needle will be withdrawn and replaced with a small, flexible tube called the sheath to permit access to the artery. Pressure may be felt when the sheath is inserted but it will not be felt moving inside the artery
5. The guidewire will be advanced to the heart and the catheter will be advanced over the wire to the
coronary artery
6. Progress of the procedure will be checked through an x-ray device called Fluoroscope
7. The doctor will remove the guidewire
8. The doctor will move the tip of the catheter just
inside the coronary artery to be examined
9. A special dye will be injected to the artery for better viewing. The dye will make any blockage stand out
10. If a significant blockage is found, the guidewire will be inserted to the artery

Balloon angioplasty
11. A balloon on the tip of the catheter will be moved along the wire to the blockage
12. When the balloon inflates, it will expand the artery and improve the blood flow. Chest discomfort may be felt
13. The doctor will then deflate and remove the balloon

Stenting
14. A wire mesh tube called a stent will be placed to the treated area to help keep the coronary artery opened. The doctor will choose the proper size of the stent which will be compressed over the balloon
15. The stent will be moved into the artery over the same guidewire
16. When the balloon is inflated, the stent will expand and lock into place
17. After the balloon catheter is taken out, the stent will stay in place to hold the artery open
18. At the end of the procedure the guidewire will be removed

Performed to improve circulation to the heart muscle in people with severe coronary artery disease

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Coronary Artery Bypass Graft (CABG)

In this procedure, a healthy artery or vein from
another part of the body is connected or grafted to the blocked coronary artery. The grafted artery or vein bypasses the blocked portion of the coronary artery, carrying oxygen-rich blood to the heart muscle.

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Coronary Artery Bypass Graft (CABG)

T/F

In CABG, one or more coronary arteries may be bypassed during a single operation.

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True

This surgery takes 3 - 6 hrs

Coronary Artery Bypass Graft (CABG)

Arrange the following steps under CABG from 1 to 3: Proximal portion of bypass graft is attached to the aorta Distal portion of bypass graft is attached distal to the lesion Getting arteries from the left intramammary artery or great sacculus vein to use as bypass

1. Getting arteries from the left intramammary artery or great sacculus vein to use as bypass 3. Distal portion of bypass graft is attached distal to the lesion 3. Proximal portion of bypass graft is attached to the aorta

Arrange the following steps of BEFORE THE CABG PROCEDURE in order: CABG procedures are done under general anesthesia which will put the patient to sleep for the duration of the operation. A catheter will be placed in the bladder to drain the urine A breathing tube will be inserted through the mouth and into the throat to help in breathing An IV line will be started and medication may also be given to help the patient relax

1. An IV line will be started and medication may also be given to help the patient relax 2. CABG procedures are done under general anesthesia which will put the patient to sleep for the duration of the operation. 3. A breathing tube will be inserted through the mouth and into the throat to help in breathing 4. A catheter will be placed in the bladder to drain the urine

Arrange the following steps of DURING THE CABG PROCEDURE in order: The surgeon begins by making an incision in the skin over the breastbone or sternum. The sternum will then be cut and move the rib cage in order to get to the heart. One of two blood vessels is typically used for the graft: Internal thoracic artery in the chest or Saphenous vein in the leg Throughout the procedure, the circulatory system will be connected to a pulmonary bypass pump or heart-lung machine. This machine temporarily performs the functions of the heart and lungs during surgery, allowing the heart to be stopped while the surgeon sews the grafts into place. With the graft securely in place, the surgeon will use electrical signals to restore the heartbeat and attach a temporary pacemaker to the heart. A temporary drainage tube will be placed through the skin beneath the incision The surgeon will wire the breastbone back together and suture the skin incision close Once the heart is beating normally, the heart-lung machine will be disconnected

5. The surgeon begins by making an incision in the skin over the breastbone or sternum. 6. The sternum will then be cut and move the rib cage in order to get to the heart. 7. Throughout the procedure, the circulatory system will be connected to a pulmonary bypass pump or heart-lung machine. This machine temporarily performs the functions of the heart and lungs during surgery, allowing the heart to be stopped while the surgeon sews the grafts into place. 8. One of two blood vessels is typically used for the graft: Internal thoracic artery in the chest or Saphenous vein in the leg 9. With the graft securely in place, the surgeon will use electrical signals to restore the heartbeat and attach a temporary pacemaker to the heart. 10. Once the heart is beating normally, the heart-lung machine will be disconnected 11. The surgeon will wire the breastbone back together and suture the skin incision close 12. A temporary drainage tube will be placed through the skin beneath the incision

Arrange the following steps of AFTER THE CABG PROCEDURE in order: In the next 3-4 days, other devices will be gradually removed. The bladder catheter will remain in place The test tube will remain in place to drain excess blood and air from the chest cavity One the patient can breath on his own, the breathing tube will be removed and replaced with an oxygen mask If necessary, the pacing wire will be used to temporarily control the heart rate The activity of the heart will be carefully monitored Patient will be taken to the ICU

13. Patient will be taken to the ICU 14. The activity of the heart will be carefully monitored 15. If necessary, the pacing wire will be used to temporarily control the heart rate 16. The test tube will remain in place to drain excess blood and air from the chest cavity 17. One the patient can breath on his own, the breathing tube will be removed and replaced with an oxygen mask 18. The bladder catheter will remain in place 19. In the next 3-4 days, other devices will be gradually removed.

What are the two (2) other types of CABG surgery?

1. Off-pump bypass surgery 2. Minimally invasive bypass surgery

T/F AFTER THE CABG PROCEDURE: The PTs will intervene to prescribe a therapeutic interventions for post-bypass patients

True

Match the following items: 1. The heart is not stopped 2. Also called beating heart bypass grafting 3. Heart lung machine is not used 4. Performed using specially designed instruments inserted through small incisions or ports in the chest 5. Sometimes require a heart-lung machine 6. Instead, a mechanical device is used to steady the part of the heart where grafting is being done A. Off-pump bypass surgery B. Minimally invasive bypass surgery

1. A 2. A 3. A 4. B 5. B 6. A

Steps in Minimally invasive bypass surgery: 1. Cutting open of ___ & ______, connected the patient to a ____-____ machine because the heart is _____ during the surgery 2. Heart-lung machine handled by a _____ 3. S/P; Tubes are present; Tubes should be removed within ______; PT sessions can now be initiated early

1. Cutting open of skin & sternum, connected the patient to a heart-lung machine because the heart is frozen during the surgery 2. Heart-lung machine handled by a Perfusionist 3. S/P; Tubes are present; Tubes should be removed within 1 week; PT sessions can now be initiated early

Refers to coordinated, multifaceted interventions which involves pt education, designing exercise, risk factor modification and counseling

CARDIAC REHABILITATION

Established as safe and occurrence of cardiovascular events is extremely low

CARDIAC REHABILITATION

What are the three (3) main goals of cardiac rehabilitation?

1. Optimize a cardiac patient’s physical, psychological, and social functioning 2. To stabilize, slow, or even reverse the progression of the underlying atherosclerosis processes 3. Reduce morbidity and mortality - For pts to live longer

GENERAL CONCEPT AND APPROACH TO CARDIAC REHABILITAITON Match the following items: 1. Long term maintenance of physical activity & lifestyle change 2. Intermediate outpatients between (6-12 weeks) 3. For life 4. Starts before the pt gets discharged 5. Immediate post discharge; early post discharge period (4-6 weeks) 6. Hospital care and early rehabilitation (average 10 days) A. Phase I B. Phase II C. Phase III D. Phase IV

1. D 2. C 3. D 4. B 5. B 6. A

Average duration of phase I in cardiac rehab

10 days

Early post discarge period wherein phase II of cardiac rehab happens

4 - 6 weeks

Intermediate outpatients of phase III (of cardiac rehab) happens in what duration?

6 - 12 weeks

How long is pahse IV of cardiac rehab needed?

For life

The following are part of the cardiac rehabilitation team, EXCEPT: A. Cardiologist B. Rehabilitation Team C. Family Doctor D. Rehab Doctor E. PTs F. OTs G. Nutritionists H. SPS I. None of the above

H. The others are part of the cardiac rehab team. Also, to be specific, C to G are under the rehabilitaiton team

Modified T/F MD will do their own assessments & PTs will do their own assessments. Then these professionals try to put all things together in synchrony

What are activities and secondary prevention under cardiac rehab? A. Social welfare, work management B. Decrease to risk factors, education, & information of lifestyle C. Medical Treatment D. Rehabilitative Treatment (PT and SPS) E. Psychological treatment F. Physical activity G. ALL OF THE ABOVE

A, B, C, E, F

S2 L2.7: Management of CAD Flashcards

(44 cards)