Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Cardio > TPCH Prep > Flashcards

TPCH Prep Flashcards

(44 cards)

Start Studying
1
Q

What is a CABG

A

For critical stenosis due to coronary artery disease
Arteries or veins harvested and grafted to aorta and
coronary arteries
 Does not remove blockage – bypasses it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Valve repair overview

A

 Indicated for severe stenosis or regurgitation
 Aortic and mitral valve most common
 Prosthetic valves are either mechanical or tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mechanical vs tissue valves

A

 Mechanical valves:
 Titanium, carbon or metal
 Longer lasting
 Anti - coagulation for life
 Biological valves:
 Human (allograft/ autograft) or animal (xenograft) tissue
 Bioprosthesis deteriorate after 8-15 years, but only require anticoagulation for 3 months
 Mainly used in elderly patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CABG donor site

A

Best is the internal thoracic artery

 LITA / LIMA (left internal thoracic (mammary) artery)

 Greater saphenous vein (60-70% patency after 10 years)

 Radial artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

LIMA graft complications

A

 Higher pulmonary complication rates
 Reduction in lung function
 Increased risk of pleural effusion
 Increased risk of phrenic nerve injury affecting diaphragmatic function
 Bilateral: potential for poorer sternal healing
 Affect circulation breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Saphenous vein complications

A

Few restrictions to activity
 Decreased venous return, some problems with venous pooling
 No special precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Radial artery grafts complications

A

Risk of gapping of incision site
 Paraesthesia
 Decreased circulation
 Consider exercises to facilitate circulation, return of ROM and muscle power

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cardiovascular complications

A

 Rhythm disturbances are common
 Atrial fibrillation
 Supra-ventricular tachycardia
 Ventricular tachycardia
 Bigeminy
 Complete heart block
 Temporary pacing
 Hypertension and hypotension
 Orthostatic hypotension common, secondary to immobility and some medications (e.g. GTN)
 Fluid Overload
 Pulmonary oedema
 Pleural effusions
 Cardiac failure
 Poor haemodynamic function may require IABP support
 Tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

AF as a complication

A

Atrial fibrillation occurs in one-third after CABG and one-half after valve
surgery1,3
 Irregularly, irregular pulse
 When uncontrolled results in deterioration of exercise capacity
 Management depends on ventricular rate:
 < 90, treat as per normal
 90-120, care with mobility, will be symptomatic
 >120, circulation & breathing exercises only, or as per medical advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is IABP (Intra Aortic Balloon Pump)

A

 Increases coronary perfusion and reduces afterload during systole
 Balloon placed in descending aorta via femoral artery, deflates rapidly at
start of systole and inflates in diastolic phase
 Triggered by either pressure changes or ECG
 Hip flexion only to 15° while IABP in-situ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Effects of IABP

A

Provide circulatory support, reducing ventricular workload and
oxygen demand of heart
 Maintaining coronary and systemic circulation
 Allowing heart time to relax and heal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sternal precautions

A

Minimise pressure through upper limbs when possible/practical
 Bilateral rather than unilateral upper limb activity
 Avoid reaching backwards when possible
 No weights for 1 month / limited weight with elbows by side and
pain free
 Pain used as a guide – appropriate level pain relief
 No heavy lifting or work for 3 months
 No driving for 6 weeks

 Sternal support when coughing
 Hug folded towel across sternum
 Self hugging

 Education on moving in bed, transfers, posture, ADL, healing of
sternum
 Ladies wear bra esp. if bigger cup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pre op cardiac surgery physio and why

A

Helps to decrease risk of PPCs
- Incentive spirometry
- ACBT
- Med/bed to identify risks
- Op order/special orders
- S/ normal but ask any missing information from chart
- O/ normal and mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Atelectasis risk factors

A

Surgical Incision (abdo / thoracic / cardiac)
* Previous respiratory condition
* Smoking history
* Obesity
* Age
* Impaired cognitive function
* Monotonus pattern of mechanical
ventilation
* Body position (supine, slouched)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Types of PPCs

A
  • CXR report atelectasis/consolidation
  • Temp >38
  • Raised WCC (white cell count) or prescription of ABs specific for lung infection
  • SpO2 <90
  • NEW production of yellow/green sputum
  • Positive signs of infection on sputum
  • Diagnosis of pneumonia/chest infection
  • Readmission to or prolonged stay in ICY with resp problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

General post surgery complications

A

↓ Lung volumes ↓ VC ↓ FRC
 Atelectasis (surfactant impairment, anaesthesia)
 V/Q mismatch
 Hypoxaemia
− Supplemental O2 routinely given post-op
* ↓ Mucociliary function (FiO2, atelectasis, decrease cough and mucosa)
* ↓ Diaphragm excursion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Wedged resection

A
  • Wedged resection → small part of lobe, typically done to remove a contained lung cancer. Should have little effect on lung function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lobectomy

Study These Flashcards
A
  • Lobectomy → whole lobe is removed but should still have little effect on lung function.
19
Q

Pneumonectomy

Study These Flashcards
A
  • Pneumonectomy → one whole lung is removed. Fluid will often accumulate in the space previously filled by the lung. The remaining lung will also often hyperinflate. The heart and other organs will also often migrate into the empty pleural space. Has a big effect on pulmonary function (Dyspnoea, decreased physical function)
20
Q

What is an ICC (inter costal catheter)

Study These Flashcards
A

Is used after lung surgery
to drain air, fluid and
blood out of your chest
cavity
* Helps promote reexpansion of lung

Proper function of Inter Costal Catheter (ICC)
* Swinging - eg rises with inspiration
* Bubbling – if continuous/ rapid  large air leak
* Draining – observed in collection part/bottle

21
Q

Pre op physio for thoracic

Study These Flashcards
A
  • Obtain medical history including smoking history,
    previous surgical & medical history
  • Assess patient’s chest
  • Basal expansion, auscultation & cough
  • Assess patient mobility & any limitations in limb
    movement
  • Frailty considerations
  • Educate patient on physio’s role post-op
  • Teach breathing exercise techniques
22
Q

What is lung volume reduction surgery

Study These Flashcards
A

Lung tissue resected in pts with sever emphysema or sometimes COPD

Can improve lung elastic recoil and diaphragmatic function

Incision: Mini-thoractomy

23
Q

Lung Transplant

Study These Flashcards
A

For patients with:
- Chronic, end-stage lung disease
- Who are failing optimal maximal medical therapy, interventional and surgical treatment
- Poor quality of life, potentially with intractable symptoms and repeated hospital admissions.

24
Q

Complications post lung transplant

Study These Flashcards
A

Denervated
* Impaired mucociliary escalator
* Poor cough reflex
* Impaired lymphatic drainage* Location - exposure to inhaled material
* Higher immunosuppression
* Chronic Lung Allograft Dysfunction (e.g. common phenotype is O

25
Pleurodesis
Preformed either as a: * Medical procedure through the chest drain * Surgical procedure via a mini-thoracotomy * Used to “stick” open a lung following a persistent or recurrent pneumothorax or pleural effusion (egmalignancy)
26
What is a TAVI
Transcatheter aortic valve implantation Insciosion, transfemoral, hemi sternotomy, transapical. Does not require open heart surgery Used to treat aortic stenosis
27
4 valves of the heart
Tricuspid valve. Located between the right atrium and the right ventricle. Pulmonary valve. Located between the right ventricle and the pulmonary artery. Mitral valve. Located between the left atrium and the left ventricle. Aortic valve. Located between the left ventricle and the aorta.
28
Valve disease
Stenosis: valve doesn't work properly because the valve flaps are thick or stiff. This can reduce blood flow straining heart. Regurgitation (or insufficiency): valve flaps are ‘leaky’ and don't close properly. This lets blood leak back through the valve and makes the heart work harder to circulate blood around your body. Eg:
29
Normal pH ABGs
(aci) 7.35-7.45 (alk)
30
Normal PaCo2 ABGs
(alk) 35-45 (aci)
31
Normal HCO ABGs
(aci) 22-28 (alk)
32
Normal PaO2 ABGs
80-100
33
Nasal prongs
Flow rate of 1-4 and FiO2 depends on the flow rate (0.24-0.36)
34
Face mask
Needs a flow rate >5L to prevent rebreathing of exhaled gas. FiO2 0.4-0.6
35
Partial and non rebreather
Very high flow rate so increased risk of drying or secretions. Also risk of retaining CO2). A non rebreather has a valve between the bag and mask so cant rebreath Co2. Partial = 6-10 L, FiO2 <9.6. Non rebreather 10-15 L FiO2 0.8-0.9
36
Hypoxic drive to breath
Normally, hypercapnia and hypoxaemia stimulate ventilation, but in people with COPD chronic hypercapnia may lead to tolerance to subtle changes so that hypercapnia no longer is the stimulus to breathe. * Patients instead rely on their “hypoxic drive” (low O2 levels) to maintain ventilation. * *If an individual with COPD is administered a high dose of oxygen, the stimulus to breathe may be removed altogether. * Therefore, oxygen administration to treat hypoxaemia is always carefully titrated, wit
37
FRC
This is the volume of gas left in the lung after normal expiration. Differs to residual capacity as this is the amount of air left in the lungs after forced expiation. FRC changes with position due to the effects of gravity
38
Hypoxemic pulmonary vasoconstriction
This is a protective response causing constriction of pulmonary vessel in a state of V/Q mismatch (Decrease PaO2). This will divert blood to areas with greater ventilation (increase perfusion to areas with increase ventilation) which will increase PaO2
39
Effects of atelectasis
- V/Q mismatch which can cause hypoxemia or sometimes hypercapnia - Decreased FRC - Decreased compliance → difficult to reinflate (balloon analogy), increase WOB, increased O2 consumption
40
Atelectasis risk factors
- Surgery - Shallow breathing - Supine or slumped - Increased Secretion - Decreased Surfactant - Senior - Supplemental oxygen - Smoking history - Size (obesity)
41
Atelectasis on auscultation
Fine end inspiratory crackles
42
Time constants and why they're important
impaired lung the time constants are differed meaning different rates and pressure will inflate different alveoli - Units with increased resistance take longer - Alveoli with increased compliance take longer - Alveoli with decreased compliance take a greater inspiratory effort to fill Net result is increased time to fill alveoli with fresh air and empty alveoli of stale air. This is why inspiratory holds are used, to allow for different time constants.
43
Ventilation techniques
Pain relief Aiming to optimist inspiratory volume which can be pain inhibited - Support and positioning - Timing physio with medication Positioning High sitting, standing are best to increase FRC Breathing exercises Slow laminar flow - Avoid more than 5 consecutive to avoid hyperventilation Demand ventilation - mobilisation UL and LL movements to increase muscle activity which will increases ventilation and therefore cardiac output leading to O2 extraction at tissues Facilitation techniques These are useful when the patient is drowsy or unconscious - Quick stretch of intercostals at end of expiration leading to larger inspiration - Neurophysiological facilitation → pressure on top lip top increase ventilation Incentive spirometry Positive expiratory pressure devices
44
PEP precautions
- Active haemoptysis, lung surgery, pneumothorax, increased WOB - Facial fractures, middle ear infection, sinusitis

Cardio (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions