Surgical Procedures - Cardio Interventions

Front 1

Chest Opening

Back 1

-Median sternotomy
-Incision inferior to suprasternal notch to just below xiphoid process
-The sternum is divided along the midline
-Sternal reactor is inserted to and used to keep the incision open
-closer includes the use of stainless steel sutures to bring the sternum back together
-Heart-lung machine

Front 2

Bypass Surgery

Back 2

-Coronary artery bypass graft (CABG)
-Saphenous Vein
-Internal mammory vessel

Front 3

Percutaneous Revascularization Procedures

Back 3

-Catheter is inserted usually in the ffemoral artery
-The catheter is positioned at the site of the sstenotic lesion
-The procedure is successful if the artery remains patent when the catheter is removed, this is checked by an angiogram.
-Angiospasm and wall rupture are possible, negative consequences of procedure

Front 4

Percutaneous Procedures

Back 4

-Percutaneous transluminal coronary angioplasty (PTCA)
-PTCA with endoluminal stents
-Directional coronary arthretomy (DCA) - Suck debris out with catheter - like house plumbing

Front 5

Implantation of devices

Back 5

-Pacemakers - more than one type
-Automatic Internal cardioverter Devices (AICD)
-Left ventricular assist device (LVAD)-external pump
-Artificial Heart

Front 6

Heart Transplant and Valve Replacement

Back 6

-Type of donor
-Rejection
-Animal valve or synthetic valve

Front 7

Unusual Procedures

Back 7

-muscle flap
-removal of ventricular muscle-cut part out and sew back together-began in 1990s
-Ablation-electrical map of heart to pinpoint problem-then lazer spot away (also use radio wave)

Front 8

Diagonostic Stess Testing

Back 8

Why do we stress test?
-To evaluate patients symptoms
-To monitor patency of vessels in patients that have had coronary revascularization precedures
-To evaluate a patient who may be at risk for developing CAD
-Medical clearance for fitness membership
-Insurance policies/job related screenings
-To elevate arrythmias
-To monitor progress of exercise

Front 9

Diagnostic Stress Testing

What do we measure for a GXT?

Back 9

-Blood Pressure
-Heart Rate Response
-EKG Changes
-Patient symptoms
-Gas exchange
-RPE and other scales
-Test determination

Front 10

Contrain dictions to exercise testing

Back 10

Absolute-anything on list-DO NOT test

-Relative-Weigh weather safe to test or not

Front 11

GXT's

Back 11

-Diagnostic Vs. Functional
-Supervision
-Do you have CAD?
-Diagnostic-run test till cant do it anymore
-All diagnostic are functional but, not all functional are diagnostic

-Protocol
-Agressive vs. conservative
-Monitoring Intervals
-Competence to supervise exercise test

Front 12

GXT Interpretation

Back 12

-Responses and significance
-Prognostic application of the GXT
-Duke nomogram

Front 13

Different Types of CV Tests

Back 13

-Graded exercise test (GXT)
-Myocardial perfusion imaging
-Ultrasound Imaging
-DET Scans
-MUGAS
-Radionuleotide angiograms-(Gold standard) (Most compared to others)

Front 14

Diagnostic Accuracy

Back 14

-Evaluating a tests accuracy requires confirmation with a gold standard for CAD, the standard is coronary angiography
-Sensitivity refers to the % of positive results in patients with disease
-Specificity refers to the % of negative results in patients without disease
-High sensitiity and specificity test is good

Front 15

True Positive Test

Back 15

The test is abnormal and patient has CAD

Front 16

True negative test

Back 16

The test is normal and the patient does not have CAD

Front 17

False positive test

Back 17

The test is abnormal, but the patient does not have CAD

Front 18

False Negative test

Back 18

Test is normal, but patient does have CAD

Front 19

Graded Exercise Test (GXT)

Back 19

-Continuous monitoring of 12 lead EKG, hemodynamic response and symptoms during the test (treadmill or bike)
-Generally, used for patients who have normal resting EKG, low rist, atypical symptoms, or arrhythmias
-68% sensitivity and 77% specificity

Front 20

Myocardial perfusion imaging with single photon emission computed tomography (SPECT)

Back 20

-Nuclear tracer injected at rest and stress to assess for any blockages and or heart muscle damage
-SPECT imaging allows us to see traer uptake in the heart muscle (or lack of)
-Nuclear tracers include cardiolite, thallium and myoview
-Performed on patients with a higher ristk or higher probablility of CAD, abnormal resting EKG, abnormal GXT, or previously diagnosed CAD
-Used in patients with typical symptoms
-Used for patients who cannot use treadmill or bike due to orthopedic limitations, severe deconditioning, or previous failure to achieve 85% of APMHR on an exercise test
-Used to rule out false negative and false positive GXTs
-Increased sensitivity of 90% specificity of 93%
-Defines the presence and extent of myocardial ischemia or infarction and differentiates between them
-Determines the locations of lesions
-Assesses myocardial viability
-Establishes diagnosis and prognosis of CAD
-Evaluates results of therapeutic interventions
-Assesses patency of coronary artery bypass grafts
-During

Front 21

Drug Study protocols all vary depending on what drug is used

Back 21

-Adenosine
-Persantine
-Dobutamine

Front 22

Results of myocardial perfusion imaging

Back 22

-A myocardial perfusion defect seen at exercise, but not at rest is typical of ischemia, but a viable myocardium (reffered to as "filling in" defect)
-MPI has become the standard non invasice procedure to assess the functional importance of coronary stenosis

Front 23

Ultrasound/Echocardiogram

Back 23

-Diagnostic test using sound waves to evaluate cardiac wall motion and valve function
-Commonly ordered for patients with heart murmers, congestive heart failure, cardiomyopathy, endocarditus, myocarditis, pericarditis, or any valve problems
-Can be ordered as just a resting echo, but also is used to assss heart function with exercise or dobutamine

Front 24

Stress Echos

Back 24

-Looking for wall motion before exercise, immidiately post exercise and in recovery
-Abnormal wall motion during exercise is indicative of ischemia
-Abnormal wall motion at rest is indicative of infarcted tissue (will be abnormal during stress as well)
-Can also be used to assess valve quality and function with and increased stress
-84% sensitivity, 86% specificity
-Normal response is to increases contractility and wallmotion

Front 25

Akinesis

Back 25

Ventricular wall not moving as would be expected

Front 26

Dyskenisis

Back 26

Left ventricle that expands rather than contracts

Front 27

Hypokinesis

Back 27

Diminished or slow movement in ventricular wall

Front 28

MUGAS/RMAs

Back 28

Multi gated acquisition/radionucleotide angiograms
-Examines the function of the ventricles, primarily the left
-Detects CAD, evaluates unstable angina, monitors cardiotoxicity, predepolarizes heart transplant patients, evaluates ventricular regional wallmotion, quantifies ventricular ejection fraction
-89% sensitivity, 89% specificity

Front 29

PET Scans

Back 29

-Position emission Tomography (PET) imaging
-A reported high sensitivity (92-95%) and a high specificity (95%) of disease detection
-Added valve compared with SPECT for obese individuals and with large breasts where SPECT is less effective
-Typically uses pharmacological stressors to obtain stress images
-Better at evaluating small vessel disease then SPECT imaging