Term
| What happens with Coronary Artery Dz (CAD)? |
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Definition
| -Coronary vessels become partially or completely blocked by fatty deposits and/or blood clots |
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Term
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Definition
-Chest Pain
-Indicates muscle spasm, partial blockage, or complete blockage |
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Term
| When was the first human catheterization? |
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Definition
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Term
| What are the Pre-Op precautions taken with a Left Heart Cath? |
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Definition
-NPO for 6 hrs
-Pre-Op Meds
-Pts with renal insufficiency or diabetes should be well hydrated
-Pts on oral anticoagulants should have lower prothrombin times |
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Term
| What artery is accessed with the Judkins Technique? |
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Definition
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Term
| What artery is accessed with the Sones Technique? |
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Definition
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Term
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Definition
-HYPOKINESIS: decreased contractile fxn of the LV
-AKINESIS: basically means motionless
-DYSKINESIS: paradoxical movement (aneurysm) |
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Term
| Coronary Anatomy Review (Left Side) |
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Definition
-Left Main (LM
-Left anterior descending (LAD)
-Diagonal
-Septals
-Left Circumflex (LCX)
-Obtuse marginals (OM)
-Posterior lateral (PL)
-Ramus intermedius |
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Term
| Coronary Anatomy Review (Right Side) |
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Definition
-Right Main
-Acute Marginal (AM)
-Distal Right
-Posterior Descending (PDA)
-Left ventricular branch of RCA (LVB) |
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Term
| How is the degree of stenosis expressed? |
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Definition
| -Expressed as % reduction of lumenal diameter or Cross-Sxnal Area |
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Term
| When does significant obstruction to maximal flow begin? |
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Definition
| -Begins when the lumenal diameter is narrowed by 50% |
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Term
| Pts with what type of stenosis present with the highest risk of morbidity/mortality? |
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Definition
| -Left Main coronary stenosis |
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Term
| When is Angioplasty primarily used? |
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Definition
| -For pts with single or double vessel involvement and discrete coronary stenosis |
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Term
| What type of lesions have the Highest success rate? |
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Definition
-Type A has the high success rate (>85%)
-Type B has moderate success (60-85%)
-Type C has low success (<60%) |
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Term
| What are the complications to PTCA? |
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Definition
-Left main stenosis or equivalent lesions
-Diffuse coronary artery Dz
-Ostial lesions |
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Term
| What is the minimum criteria for a satisfactory PTCA? |
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Definition
| -A 20% change in luminal diameter narrowing such that the residual stenosis is <50% |
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Term
| What are the complications associated with PTCA? |
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Definition
-Dissection
-Spasm
-Thrombosis
-In-Stent Restenosis |
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Term
| What is the Drug-Eluding Stent? |
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Definition
-Sirolimus is the active drug released from the stent and is a naturally occurring substance that reduces the reproduction that makes the bulk of the restenosis.
-BUT --> Because of the physiology, the pt with the drug-eluding stent should remain on Plavix for a much longer time than the bare metal stents |
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Term
| What discovery revolutionized medicine and made way for the Cardiopulmonary Bypass pump? |
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Definition
| -Discovery of Heparin by McClean in 1916 |
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Term
| What is the goal of Bypass? |
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Definition
| -The goal is to provide a wall preserved, motionless, bloodless heart with blood flow diverted to an extracorporeal circuit that can assume the responsibility of the heart and lungs |
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Term
| What are the disadvantages of using a Roller Pump with bypass? |
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Definition
-Hemolysis
-Particulate matter
-Can pump in a lot of air
-More microemboli or microbubbles
-Not sensitive to afterload and tubing can explode |
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Term
| What does the venous reservoir in the pump do? |
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Definition
-Siphons blood by gravity
-Provides storage of excess volume
-Allows escape of any air bubbles returning with the venous blood |
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Term
| What does the oxygenator in the pump do? |
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Definition
-Provides O2 to the blood
-Removes CO2 |
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Term
| What is the optimal Flow Rate on Bypass? |
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Definition
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Term
| What should you do with shed blood? |
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Definition
-Aspirate it with a sxning apparatus, filter it and then return it to the oxygenator
-Cell saving devices may also be utilized before and after bypass |
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Term
| What happens to BP with Bypass? |
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Definition
-Decreases sharply with onset of bypass (vasodilation)
-MAP needs to be =/> 50-60 mm Hg
-After 30 min perfusion pressure usually increases (vasoconstriction) |
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Term
| What does a drop in venous O2 saturation while on pump typically suggest? |
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Definition
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Term
| What type of cardioplegia is most commonly used? |
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Definition
-Blood cardioplegia
-Usually mixed with a colloid in a 3:1 solution |
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Term
| What are the steps to terminate Bypass? |
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Definition
-Systemic rewarming
-Flow-rates are decreased
-Hemodynamic parameters
-Venous line clamping
-Pharmacologic support
-Neutralization of heparin |
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Term
| When does coronary perfusion mainly occur? |
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Definition
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Term
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Definition
| -A mechanical device that is used to decrease myocardial O2 DEMAND while at the same time increasing myocardial O2 SUPPLY |
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Term
| What are the physiologic effects of IABP? |
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Definition
-->Basically it drops pressures and ups flow
-Aortic Systolic: Decreased
-Aortic Diastolic: Increased
-LV Systolic: Decreased
-LVEDP: Decreased
-CO: Increased
-Afterload: Decreased
-Renal/Coronary Blood Flow: Increased |
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Term
| What are the indications for IABP? |
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Definition
-Cardiac failure after a cardiac Sx procedure
-Refractory angina despite maximal medical mgmt
-Perioperative Tx of complications due to MI
-Failed PTCA
-A bridge to cardiac transplantation |
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Term
| What are the contraindications for IABP? |
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Definition
-Severe aortic insufficiency
-Aortic aneurysm
-Severe PVD |
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Term
| Where should the IABP be positioned? |
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Definition
| -The end of he balloon should be just distal to the takeoff of the left subclavian artery |
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Term
| What are complications associated with IABP? |
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Definition
-Limb ischemia
-Bleeding at insertion
-Aortic perforation and/or dissection
-Renal failure and bowel ischemia
-Neuro complications including paraplegia
-HIT
-Infxn |
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Term
| What are the steps to IABP removal? |
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Definition
-D/C heparin six hours prior
-Check platelets and coags
-Deflate balloon
-Apply manual pressure above and below insertion site
-Remove and alternate pressure to expel clots
-Apply constant pressure to insertion site for 30 min
-Check distal pulses |
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Term
| What are the mechanics of IABP counterpulsation? |
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Definition
-Inflation of balloon increases peak diastolic pressure and displaces blood toward the periphery --> Increased MAP and coronary blood flow
-Deflation of balloon reduces end-diastolic pressure which reduces impedance to flow when the aortic valve opens at the beginning of systole --> Decreases ventricular afterload and promotes ventricular stroke output |
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Term
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Definition
| -Coronary artery bypass grafting is done to provide "detours" around the partially or completely blocked arteries. With a new open "bypass system", the heart can now receive its much needed blood supply |
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Term
| What are the indications for CABG? |
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Definition
-Angina - Pre-infarctal, unstable
-Failure of medicine
-AMI
-Failed angioplasty or stenting (or re-stenosis)
-Emergencies
-->Done for both quality and quantity of life |
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Term
| What are the contraindications for CABG? |
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Definition
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Term
| -What are the risk factors for CABG? |
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Definition
-Advance age
-Female
-Cardiogenic shock
-Recent MI
-IABP/Inotropes
-Reoperation
-CHF
-Coronary Dz
-Low EF
-Dysrrhythmia
-LV aneurysm
-Obesity
-Anemia
-Diabetes
-Renal Dysfxn
-COPD
-Cerebrovascular Dz
-Tobacco use |
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Term
| What are the steps to CABG Sx? |
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Definition
-Opening
-Cannulation
-Cross-Clamping
-Administration of Cardioplegia
-Distal Anastomosis
-Proximal Anastomosis
-Weaning from CPB
-Closure |
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Term
| What are the types of conduits? |
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Definition
-Saphenous vein (greater and/or lesser)
-IMA
-GEA
-Radial Artery
-Cadaver veins
-PTFE |
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Term
| What are some problems association with the Saphenous vein? |
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Definition
-Variations in size
-Multiple branches
-Lesser saphenous veins have slightly lower patency rates |
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Term
| What is the best conduit to revascularize any organ? |
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Definition
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Term
| What are some problems with the IMA? |
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Definition
-Limited in length
-Can't use with diabetics or breast cancer pts
-Can be difficult to work with |
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Term
| What are the three techniques used to remove the saphenous vein? |
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Definition
-Slicing from ankle to groin
-Bridging technique
-Endoscopic vein harvesting |
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Term
| When harvesting the IMA, how should it be removed? |
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Definition
-With the fascial bed left around it
-Do not grasp the IMA directly with your instruments |
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Term
| When should you femorally cannulate a pt? |
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Definition
-Emergent
-Redo
-Eggshell aorta |
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Term
| What are the two types of cardioplegia cannulation? |
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Definition
-Antegrade: Aorta
-Retrograde: Coronary sinus via the RA |
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Term
| What is the purpose of LV venting? |
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Definition
-Prevention of ventricular distension
-Bloodless field during distal anastomosis
-Many methods described and employed
-Prevents rewarming of the myocardium |
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Term
| What is myocardial quiescence? |
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Definition
-The effect of cold cardioplegia is closely related to the level of myocardial hypothermia
-Reinfuse every 20-30 min, when the temp increases 20* C, or the electrical activity resumes |
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Term
| What should you always do prior to coming off pump? |
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Definition
| -De-Air the aorta and heart chambers |
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Term
| What are the parameters for adequate LV Fxn? |
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Definition
-SBP >90, DBP >75
-MAP >70
-Wedge <20
-Sinus Rhythm with HR <110 |
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Term
| What are the post-op complications with CABG? |
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Definition
-Bleeding
-Tamponade
-Respiratory failure
-Shock
-Infxn
-Hypothermia
-Aortic dissection
-Fever
-Arrhythmias
-Stroke
-GI complications
-Renal Failure
-PTX |
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Term
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Definition
-ET tube: 4-6 hrs (depending)
-Swan Ganz: 24 hrs
-Art Line: 24 hrs
-Foley: 1-2 days
-Chest tube: 24 hrs (depending)
-IVs: @ D/C home
-O2: PRN |
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Term
| What are the most common heard complaints after CABG Sx? |
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Definition
-Bowel
-Appetite
-Soreness
-Sleep problems |
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Term
| When did the ear of modern cardiac valve replacement begin? |
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Definition
| -Harken and Starr in 1960 |
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Term
| What are the types of valves? |
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Definition
-Mechanical
-Biprosthetic
-Biologic/Allograft |
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Term
| What characteristics should the ideal valve have? |
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Definition
-Hemodynamically efficient with laminar flow patterns
-Competent with unobstructed moving parts
-Maintain normal cardiac fxn
-Be 100% viable with ability for self-repair & resistant to infxn
-Fxnally inert with respect to interaction
-Durable enough to outlive the pt
-Convenient in availability and ease of implantation |
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Term
| What must you do if you give a pt a mechanical valve? |
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Definition
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Term
| What type of valve would you give to a young pt? |
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Definition
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Term
| Describe the surgical anatomy of the Mitral Valve |
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Definition
-Two leaflets: Anterior and Posterior
-Anterior leaflet inserts on about 1/3 of the annulus
-Posterior leaflet inserts on the other 2/3
-Both leaflets are approximately the shape of a trapezoid |
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Term
| What are the causes of Mitral Stenosis? |
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Definition
-RF is the #1 cause
-Congenital MS
-Idiopathic calcification (elderly) |
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Term
| What are the S&S of Mitral Stenosis? |
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Definition
-Dyspnea! (especially exertional)
-Washed-out and sallow mitral facies
-Increased JVP, increased WOB, and diastolic murmur with an opening snap |
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Term
| What are the causes of Mitral Valve Regurgitation? |
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Definition
-Myxomatous Degeneration
-Mitral Valve prolapse
-Infective endocarditis
-Ischemic mitral regurg |
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Term
| What is the natural Hx of Mitral Regurgitation? |
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Definition
-Gradual progression of MR results in enlarged LA & LV
-Enlarged LA often results in A-Fib
-Moderate to severe MR results in LV dysfxn, CHF, pulmonary HTN |
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Term
| What are the indications for Mitral Sx with Mitral Regurg? |
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Definition
-Acute MR with CHF or cardiogenic shock
-Acute SBE
-Class III/IV symptoms
-Systemic Emboli |
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Term
| What is the surgical anatomy of the aortic valve? |
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Definition
-Has three size leaflets attached to the aortic wall, forming three aortic sinuses
-Thee is a left, right and noncoronary cusp |
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Term
| What are the S&S of Aortic Valve Stenosis? |
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Definition
-Classic Triad: Angina Pectoris, Syncope, CHF
-Pulse pressure narrowed
-Harsh midsystolic murmur radiating to carotids |
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Term
| What are the indications for Aortic valve Sx? |
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Definition
| -Circulation affected when the valve area is reduced by ~75% |
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Term
| What are the causes of Aortic Regurgitation? |
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Definition
-Caused by abnormal coaptation of the valve leaflets
-Endocarditis
-Acute aortic dissection
-Trauma
-Atherosclerosis |
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Term
| -What are the S&S of Aortic regurg? |
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Definition
-Usually present with severe CHF and pulmonary edema
-Pulse pressure is narrowed
-Diastolic pressure is low (Corrigna's pulse)
-Blowing high pitched diastolic murmur |
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