Cardiac Surgery - 1

Front 1

what is myocardial revascularization?

Back 1

2 or 3 CABG- coming from aorta/ being used to bypass blockage

Front 2

what is a coronary artery bypass graft -CABG used for?

Back 2

-saphenous veing (SV)
-internal mammary artery (IMA)
-gastric ateries
-radial arteries

Front 3

MID-CABG (minimally invasive direct coronary artery bypass graft) is used for who?

Back 3

only for pts w/ LAD or RCA single vessel disease- usually a younger population

Front 4

procedure of MID- CABG?

Back 4

thoracotomy approach w/ a thorascope
no cardioplegia or extracorporeal support needed
still has chest tub, wires, incision

Front 5

pros of using a mid-cabg?

Back 5

less time on the ventilator, no ICU, can walk by the evening, shorter LOS, dec risk of infection, dec. atelectasis/pneumonia, no pain

Front 6

how does a transmyocardial laser revascularization work? (TMLR)

Back 6

use laser to create up to 40 holes in the myocardium to help create more blood vessels and to incrase O2 to the heart

Front 7

possible complications of a TMLR- transmyocardial laser revascularization

Back 7

can damage mitral valve
can cause murmurs- assess heart sounds
arrhythmias
low CO
angina may continue
remain on anti-anginals

Front 8

valvular repair or replacement

Back 8

usually sicker b/c mitral valve regurgitation backs up into L atrium and gets boggy, turns into Afib, potential for clots with afib, dec. CO

check for mental status b/c of dec. blood flow and bp, check HR, chest pain, SOB

Front 9

ventricular septal defect=congeintal

Back 9

involves suturing or patching the defect, occasionally occurs as a result of M
Ican develop holes in the ventricles

Front 10

ventricular aneurysmectomy

Back 10

aneurysm is excised and ventricle closed

Front 11

septal myotomy/myectomy

Back 11

for hypertrophic cardiomyopathy- a portion of the septum is removed

Front 12

cardiomyoplasty

Back 12

for augmenting cardiac function

Front 13

valvulotomy

Back 13

dilation of valve- choice for mitral stensosis

Front 14

valvuloplasty

Back 14

repair of the valve by suturing torn leaflets, chordae tendinae or papillary muscle (mitral and triscuspid regurgitation)

Front 15

annuloplasty

Back 15

valve surgery, reconstruction of annulus with or without carpenter rings: put another ring around valve to support it

Front 16

valve replacement

Back 16

mitral, tricuspid, aortic, and occasionally pulmonic valves

Front 17

mitral valve repair

Back 17

try to stuture to make the vlave tighter, may not know this until they actually go into surgery

Front 18

aortic valve surgery

Back 18

have replace with mechanical vavles which are much stronger, last longer, better for younger pts. -- anticoagulation therapy for the rest of your life
pig valves: don't last as long, but don't need anticoagulation therapy- elderly

Front 19

at the start of anticoagulation check for

Back 19

change in mental status, headache. can be caused by head bleeds and cause an increase in readmission

Front 20

most common need for a heart transplant

Back 20

dilate cariomyopathy

Front 21

cardiac transplants

Back 21

immunosuppressive therapy is started before surgery, to dec. a chance of rejection(which will start during the surgery)
-strict isolation, heavy screening before (psych--> b/c compliance w/ meds)
good recovery rate in first yr
88% live 5 yrs longer

Front 22

cadiopulmonary bypass (CPB)

Back 22

pump is primed w/ fluid, heparin give, venous cannulas placed, anterial cannulas are placed, roller pump is adjusted to maintain flow >2L/min

Front 23

what does CPB do?

Back 23

keeps blood out of the heart by pumping left ventricle and pulmonaryarteries are vented

Front 24

goal for CPB?

Back 24

on pump less than 3 hours

Front 25

after CPB it is common for what to happen to pt?

Back 25

hypokalemia, dysrhythmias (esp vtach) vfib, freq pvcs

Front 26

taking a patient off cbp

Back 26

heart is defibrillated- jump start, pacing wires placed, mediatinal CT placed
protamine given to neutralize the heparin

Front 27

roller pump damage r/t effects of cpb

Back 27

damged RBCs, hemolysis contributes to renal failure
dec. fxn WBC
destroys immunoglobulins
dec. album: edema
lipoproteins: fat emboli

Front 28

what is hemodilution?
effects of cpb

Back 28

decreased hbg/hct
decreaed serum albumin- causes edema
dec. electrolytes: potassium

Front 29

blood exposure due to cpb can lead to?

Back 29

microthrombi formation: clots, cva
consumption of clotting factors
dec. microcirculatory blood flow- legs
organ ischemia/injury: organ that suffers the most is the kidney

Front 30

baroreceptor stimulation r/t effects of cpb

Back 30

red cell aggregation:mini clots
catecholamine stimulation
activation of renin/angiotensin
inc. ADH inc. aldosterone: inc. BP- BAD

Front 31

hypothermia- r/t effects of cpb

Back 31

intense vasoconstriction: harder for the heart to pump effectively
myocardial depression
shivering causes inc. O2 consumption/demand

Front 32

what is IABP- intra aortic balloon pump

Back 32

is used to dec. cardiac work and improve organ perfusion. inflate during diastole (when coronary arteries are perfused) and displaces blood sothat when its deflated there is not as much blood
used for 1-2 days up to one week

Front 33

IABP indications

Back 33

unstable angina
acute mi
peri operate for surg
a bridge to transplant

Front 34

contraindication to IABP

Back 34

terminal/untreatable disease
irreversible brain damage
ruptured or dissecting aortic/thoracic aneurysm
gnerealized pvd
incompetent aortic valve

Front 35

complications to IABP

Back 35

pneumonia, secondary to immoblitiy
infection
arterial trauma
thromboembolism r/t potential clots
hematological complicats
hemorrhage at insertion site

Front 36

Ventricul assist devices: VAD used ?

Back 36

-the left vent require support while recovering from acute injury
-hrt require surg repair but the pt must be stabilized and preps must be made before procedure
-the pt is in end stage heart falure and awaits transplant

Front 37

VAD indicated when?

Back 37

allows for long-term support and more stability
-failure to wean from cpb
- to support ventricular failure w/ acute mi, pt awaiting transplant

Front 38

VAD exclusion criteria

Back 38

significant aortic valve insufficiency
major cva
bsa <1.5m
sepsis
life-limiting comorbidities
renal or liver failure

Front 39

Intra-operative MI

Back 39

incidence can be as high as 25% despite best efforts
prevention: hypothermia
Monitor ECG, cardiac output, abgs, and serial enzymes

Front 40

what is low cardiac output syndrom

Back 40

pats are in a controlled state of shock due to hypovolema( cvp, lap, pap will be dec, called pre-load) and varying degress of vascular tone, or poor left ventricular function

Front 41

I flove CO is due to hypovolemia?

Back 41

the cvp, lap and pawp will be low
low bp, urine output, cool extremeties

Front 42

treatment for low CO due to hypovolemia

Back 42

intravascular volume replacement (blood, colloid, LR) calcium administration, close monitioring for blood loss

Front 43

low CO due to poor left vent function

Back 43

high LAP, low bp, low urine, but high CVP and PAWP

Front 44

treatment for low CO due to poor left vent fxn

Back 44

medication: diuretics, inotropes, vasopressors

Front 45

cardiac tamponade

Back 45

pressure on the heart due to accumulation of fluid in the pericardium

Front 46

s/s cardiac tamponade

Back 46

low CO
dec. in chest tube drainage
dec. pulsation of precordium
muffled heart sounds
PAWP, LAP, and CVP are incrased

Front 47

treatment of cardiac tamponade

Back 47

clean out the chest tube with sterile cath
remove tube, break up clot
return to Or
open up chest at beside

Front 48

casues of arrhythmias after cardiac surgery

Back 48

electrolyte imabalance, myocardial irritability, ischemia, re-infarct, low O2 status, stunned SA or AV node

Front 49

pulm emoblism most commonly occurs when?

Back 49

3rd day post op

Front 50

anterial embolis post op

Back 50

may occur after AVR, MVR pts are frequently placed on anticoag therapy

Front 51

cause of fever post op

Back 51

atelectaisis, uti, pneumonia, thrombophlebitis, drug reactions, transfusion reactions, wound infection

Front 52

when to transfer to step down unit

Back 52

1-3 days after surgery
most lines /tubes removed at day 3