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MED SURG II EXAM #1
Cardiac Surgical, Medical, and Pharmacological Treatment
| Question | Answer |
|---|---|
| Valvuloplasty | The repair instead of replacement of the cardiac valve. Recommonded treatment. |
| Commissurotomy | Type of valvuloplasty where the repair is made to commissures between the leaflets. |
| Annuloplasty | Type of valvuloplasty where the repair is to the valve annulus, resulting in the narrowing of the valve orifice. Cardiopulmonary bypass is required for most. |
| Annuloplasty Ring | Can be a rigid, semirigid, or flexible ring. Leaflets of the valve are sutured to a ring, creating an annulus of desired size. |
| Balloon Valvuloplasty | A surgical technique involving insertion into a blood vessel of a small balloon that is led via catheter to the narrowed site and then inflated. May also be done to widen a stenotic valve |
| Valve Replacements | Preferred for patients with valves with anatomy which decreases the chance of success with this repair. Replacement can be done with mechanical or biological valves |
| Biological Valves | Are more accepted by the body, but often do not last as long. Also have a higher chance of recurrence of symptoms |
| Mechanical Valves | Higher risk of blood clots and patients often are on long term anticoagulants. However they do last much longer. |
| Nitrates | Standard treatment for angina. Potent vasodilator that improves blood flow to the heart muscle and relieves pain. Dilates primarily the veins, and to a lesser extent, the arteries. Resulting in less blood return to the heart, and filling pressure (preload) is reduced. They also relax the systemic arteriolar bed, lowering BP and decreasing afterload. Can take 3 sublingual tabs every 5 minutes, and if pain is not relieved call 911 |
| Calcium Channel Blockers | Amlodipine and Diltiazem. Decrease sinoatrial node automaticity and AV node conduction, resulting in a slower HR and a decrease in the strength of myocardial contraction (negative intropic effect), decreasing the workload on the heart. Also increase oxygen supply by dilating the smooth muscle wall of the coronary arterioles. Decrease myocardial oxygen demand by reducing systemic arterial pressure and workload on the left ventricle |
| Beta-Blockers | Metoprolol. Reduce myocardial oxygen consumption, reducing stimulation of the heart. Reduction in HR, slowed conduction of impulses through the conduction system, decreased BP, and reduced force of contract. Do not give in those with asthma. Those with diabetes should be instructor to monitor blood glucose levels as this med masks the signs of hypoglycemia |
| Antiplatelets | Aspirin. Prevent platelet aggregation and subsequent thrombosis, which impedes blood flow through the coronary arteries. |
| Anticoagulants | Heparin, Warfarin, Enoxparin. Prevents the formation of new blood clots, and reduces the occurence of MI. |
| Endovascular Therapy | Various procedures that use a puncture or small incision to place catheters inside a blood vessel to repair it or insert a device and have replaced a large proportion of open surgical approaches. |
| Atherectomy | Reduces the plaque buildup within an artery using a cutting device or laser |
| Angioplasty and Stent Placement | Insertions of long, thin catheter into the blocked or narrowed part of the artery. A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area. The balloon is then inflated, compressing the depsits against the artery walls. The stent is then usually left in the artery to hold it open |
| Endarterectomy | Fatty deposits are surgically removed from the walls of a narrowed artery |
| Fibrinolytic or thrombolytic therapy | are clost-dissolving drugs that break the blockage apart |
| Bypass Surgery | A graft bypass using a vessel from another part of the body. Or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery |
| Hardware Monitoring | Used to continuously observe the heart for arrhythmias and conduction disorders |
| Telemetry | Transmission of radio waves from a battery operated transmitter to a central base of monitors |
| System Event Monitor | Used to record and store the ECG during times when the the patient is experiencing symptoms. The patients press a button to activate the system. |
| Holter Monitors | Small, portable recorders, where the patient usually wears at home for 24-48 hours. The patient is asked to keep a diary of the symptoms and activities to match with the ECG |
| Cardiac Implantable | Include pacemakers and ICDs that are used for patients with serious cardiac illnesses. |
| Exercise Stress Test | A patient walks on a treadmill or pedals a stationary bicycle while the ECG is monitored for heart rate, rhythm, and BP, skin temp, perceived exertion, and symptoms are monitored. The test is stopped when the patient reaches their target heart rate. The patient should fast for several hours, avoid tobacco and caffeine, and may be asked to hold beta blockers, calcium channel blockers and digitalis for up to 48 hours |
| Pharmacological Stress Test | Used for those who are cognitively impaired and unable to follow directions. Or are physically disabled and unlikely to achieve their targert heart rate by exercsing. It uses vasodilating agents such as dipyramole, adenosine, regadenosin, and is given by IV infusion to mimic the effects of exercise by maximally dilating normal coronary arteries and identifying stenotic arteries that cannot dilate. |
| Electrocardiogram | Pictorial representation of the heart's electrical conduction. It is a diagnostic tool that measures and records the electrical activity of the heart via electrodes placed on the skin |
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