Ischaemic Heart Disease - Coronary Re-vascularisation Flashcards Preview

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Flashcards in Ischaemic Heart Disease - Coronary Re-vascularisation Deck (15)
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1
Q

what happens in coronary artery bypass?

A
  • enters through median sternotomy
  • long saphenous vein
  • internal mammary artery
  • cardio-pulmonary bypass
  • cardioplegia

= risk of Graft disease 8-10 years later

2
Q

what are the complications of coronary artery bypass graft (CABG)?

A
  • death
  • stroke
  • MI
  • atrial fibrillation
  • infection
  • cognitive impairment
  • sternal malunion
  • renal failure
  • failure to recover
3
Q

what is Percutaneous coronary intervention, PCI?

A

non-surgical procedure used to treat narrowing (stenosis) of the coronary arteries
= a balloon catheter is inserted into the obstructed artery and inflated to relieve the narrowing; stents can be used to keep the blood vessel open

4
Q

what are complications of PCI?

A
  • death
  • stroke
  • MI
  • renal failure
  • bleeding
  • vascular complications
  • stent thrombosis
  • stent restenosis
5
Q

what happens in the PCI tehcnique?

A
  • Vascular access
  • Anti-platelet drugs, anticoagulation
  • Catheter to ostium of coronary
  • Guidewire down vessel
  • Balloons threaded over wire
  • Stent(s) implanted
  • Balloon, catheter, wires removed
6
Q

who is suitable for re-vascularisation?

A

1) multi-vessel disease, diffuse or focal
2) left main disease
3) diabetes
4) co-morbidities

7
Q

what could go wrong with the Stent insertion in PCI?

A
  • stroke
  • contrast
  • nephropathy
  • bleeding
  • failure of stent to;
    = deliver
    = expand
    = to expand without perforation
    = to remain patient
  • to treat all atherosclerosis, and prevent future events
8
Q

what are 2 specific issues with PCI?

A

1) dual anti-platelet therapy

2) vascular access

9
Q

what is radial artery access?

A

dual supply to hand, superficial and compressible

10
Q

is radial artery access superficial or deep?

A

superficial

11
Q

what are 3 problems that could arise from radial artery access?

A

1) smaller
2) prone to spasm
3) occlusion (asymptomatic)

12
Q

wha is the biggest risk of using femoral artery?

A

haematoma = life threatening

13
Q

how would you treat STEMI?

A

= primary PCI

14
Q

how would you treat coronary syndrome?

A

= angiography with a view to re-vascularisation

15
Q

how would you treat sable angina?

A

= re-vascularisation for severe symptoms or high risk