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40 Cards in this Set

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What method for irrregular rhythms?
6 second count
What are non-invasive treatments of dysrhythmias?
Vagal maneuvers - valsalva, coughing, immerce face in cold water (diving reflex), carotid massage (perform by MD)

Medications - antiarrhythmics

electrical therapy - synchronized cardioversion, defibrillations
When do you use defibrillations regarding dysrhythmias?
ventricular fibs

pulseless V-Tach
What do pulseless v-tach indicate?
weak cardiac activity (minimal)
What is echocardiogram?
Provides information about blood flow, structure, and function of heart.

Can also get ejection fraction, valvular stenosis, or incomptence, regurgitation, velocity of blood flow, wall motion, etc.
When do you use synchronized cardioversion regarding dysrhythmias?
"stable" supraventricular dysrhythmias, atrial tachycardia, atrial fibrillation, etc.
What can doppler echocardiography do?
determine VELOCITY and PRESSURE GRADIENT of flow by using doppler shift from red blood cells

estimation fo ejection fraction, JET VELOCITIES (eg stenosis, regurgitation, ASD, VSD, etc)
What are the colors in color flow doppler?
Red is coming towarsd transducer and blue is going away from transducer.

Mosaic of color indicates turbulent flow
How to perform transesophgeal echo?
sedate patient
transducer passed into esophagus
what is tranesophgeal echo useful for?
patients with COPD, ribs close together, or obesity

same information as transthoracic echo
What are stress tests used for?
Determine exercise tolerance, oxygen consumption, ECG

for diagnosis

for pre-discharge assessment
for follow-up assessment
What chemicals are administered in pharmacological stress test?
adenosine, persantine - for vasodilation

dobutamine - accelerate HR and myocardial contractility

do NOT provide information about the patient's functional ability
What is steal syndrome?
in Persantine stress test, sclerotic coronary arteries don't vasodilate

so healthy CA vasodilate and steal blood from areas with plaque

result in reduced blood flow to diseased area
For whom is persantine stress test used?
used in older patients with known CAD for stress test
What is advantage of stress echo?
Yields more info than traditional stress test

can confirm results of stress test

allow eval of wall motion, valvular function, and ventricular function

more functional eval than traditioanl ECG
What does ambulatory monitoring devices do?
Used to assess BP during functional activity 9small device)

can be used by patients on their own, keep diary
What is a holter/event monitor?
Ugly shirt with electrodues, useful to evaluate etiology of dysrhythmias awayf rom the office or assess symptoms that do not have predictable patterns
What is implanted cardioverter defibrillator?
basically little implanted device that detects v-fib (and similar) and shocks the heart in response
What is the gold standard for determining teh degree of coronary artery stenosis?
Angiography (aka cardiac cath)
What is PTCA (percutaneous translumenal coronary angioplasty)

aka PCI (precutaneous coronary intervention)
catheter in baloon advanced to block and inflate baloon to push plaque away/apart/expand out
What are pros of PTCA?
no foreign body
nothing for new clots to form onto
least invasive
What are downsides of PTCA/PCI ?
reoccurence of original clot possible

possibly dislodge part of clot
What is a PTCA stent?
same as regular PTCA but with a wire frame cage about the balloon. Once the balloon leaves the cage stays there and keeps the plaque open/apart.

coated with various drugs to prevent re-stenosis
Why perform CABG?
PTCA did not work as expected

multiple/distal occlusion sites

very symptomatic CAD (MYHA 3 or 4)
+EKG changes with exercise or phamacological stress test
What are the CAB approaches?
sternotomy - sternum split

minimally invasive -1 to 3 intercostal incisions

median sternotomy
why do back hurt after CABG?
opening chest/ribs cause compression pressure alone spine/rib joints
what are sternal precautions for sternotomy?
splinting the incision
log rolling for transfers
elevate height on FWW to avoid UE weight bearing
no driving, lifting, resistance for 6-8 weeks
UE ROM should began after surgery
active or passive ROM for patients with sternotomy?
ACTIVE
What is SVG (saphenous vein graft)?
grafting vein to CA
require donor site, vein has valves, patients will need TED hose, and beware of footdrop... (IL or CL???)
What is minimally invasive direct coronary artery bypass? (MIDCAB?)
require smalll incisions and no heart/lung bypass

appropriate for LAD and RCA bypass
what are pros and cons of MIDCAB?
shroter hospital course but more pain
What is pro of LIMA and RIMA (left/right internal mammary artery graft)
pro: artery acccustomed to pressure
one end already attached to aorta
easy to get to
best for LAD/RIMA artery
longer graft survival vs SVG
What is a downside of mechanical valve implant?
life-long commmitment to anti-coagulation therapy
what approaches work for valve repair/replacement?
sternotomy or minimally invasive technique
What is ventilation perfusion performed for?
detection of pulmonay emboli

assessment of regional lung function
make sure u know the flow volume loops...
:)
what is lung volume reduction for?
performed to improve pulmonary function in patients with obstructive type disease
how can you perform a lung volume reduction?
lateral thoractomy

clam shell thoractomy

thoracoscopic approach
surgical scars vs postural misalignment
TO BE FILLED
Swan-Ganz Cathether stuffs
TO BE FILLED