Cardiovascular Procedures and Management Quiz

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Questions and Answers

What is the primary purpose of PTCA in managing CAD?

To compress plaque and restore blood flow (correct)

To introduce medications that lower cholesterol

To insert a stent to maximize blood flow

To increase the heart's contractility

Which of the following factors is not typically optimized for medical management of CAD?

Increased carbon dioxide production (correct)

Blood pressure through medication

Heart's contractility

Myocardial oxygen demand

What type of vessel is typically harvested for a CABG procedure?

Saphenous vein (correct)

Femoral vein

Brachial artery

Jugular vein

When managing ischemic conditions, which medication strategy is important for reducing myocardial oxygen demand?

Lowering heart rate or contractility Signup and view all the answers

What is a common complication that stents aim to address after PTCA?

Re-stenosis Signup and view all the answers

What is one of the primary indications for performing a MID-CAB procedure?

Patient has a high risk for bypass surgery Signup and view all the answers

Which of the following is NOT a benefit of MID-CAB surgery?

Longer recovery time Signup and view all the answers

During a physical therapy examination post-surgery, which aspect is specifically required?

Cardiovascular screen Signup and view all the answers

Which special test is NOT included in the cardiovascular examination?

Neurological reflexes Signup and view all the answers

What is a risk factor that could increase the likelihood of sternal dehiscence after surgery?

Smoking Signup and view all the answers

What is the recommended duration for patients to keep their upper arms close to their body after surgery?

6-8 weeks Signup and view all the answers

Which group of patients is advised to wear a supportive vest for sternum protection?

Patients with a BMI of 35 or higher Signup and view all the answers

What should patients do when coughing or sneezing to protect the surgical incision?

Hug a pillow over the incision Signup and view all the answers

Which type of bra should patients with large breasts utilize after surgery?

A supportive bra that fastens at the front Signup and view all the answers

What is a key consideration for patients regarding sternal precautions?

Patients should adhere to either traditional precautions or move in the tube, but not both. Signup and view all the answers

What is the maximum weight that patients should avoid lifting during the first 8 weeks post-surgery?

5-10 pounds Signup and view all the answers

Which movement is NOT allowed during the standard sternal precautions?

Bilateral shoulder elevation past 90 degrees Signup and view all the answers

During which activity should the sternum NOT be palpated?

Driving Signup and view all the answers

How is a 'Moderately separated sternum' classified on the sternal instability scale?

Moderate increase in motion upon testing Signup and view all the answers

What is the primary focus of the modified sternal precautions program titled 'Move in the Tube'?

Allowing movements within a designated area Signup and view all the answers

What precaution should be taken when a patient is coughing post-surgery?

Coughing while splinted Signup and view all the answers

Which of the following is allowed during the initial 10 days following sternotomy?

Horizontal arm movements within pain-free limits Signup and view all the answers

Which special testing result indicates a clinically stable sternum?

Normal detectable motion Signup and view all the answers

What does the term 'Independent (I)' in the level of assist indicate?

Patient can transfer independently and safely. Signup and view all the answers

Which level of assist indicates the patient performs 50% of the movement with the clinician providing the remaining 50%?

Moderate Assist (Mod A) Signup and view all the answers

What is not a function of Functional Measures?

Assessing the psychological well-being of patients Signup and view all the answers

What does CGA stand for in the context of levels of assist?

Contact Guard Assist Signup and view all the answers

How much effort does a patient performing at the Maximum Assist (Max A) level provide?

25% of the movement Signup and view all the answers

What is the primary purpose of the Six Minute Walk Test?

To determine aerobic capacity in patients Signup and view all the answers

How long should the 30 seconds sit to stand test be performed?

For a minimum of 30 seconds Signup and view all the answers

What is a use of determining baseline data from Functional Measures?

To tailor a home exercise program Signup and view all the answers

What is a major advantage of the 2-minute step test compared to the 6-minute walk test (6MWT)?

It requires only basic items like tape and a timer. Signup and view all the answers

Which age group of women has the highest threshold for being classified as above average in the 2-minute step test?

80-84 Signup and view all the answers

What is a noted limitation of the 2-minute step test?

There is insufficient data on its reliability. Signup and view all the answers

Which of the following best describes the response options in the senior fitness test protocol for men aged 90-94?

< 52 Signup and view all the answers

What aspect of quality of life does the SF-36 questionnaire NOT directly assess?

Chest pain frequency Signup and view all the answers

In the context of the 2-minute step test, what is the average threshold for women aged 70-74?

68 to 101 Signup and view all the answers

What is the primary role of the function assessment tool mentioned in the text?

Determining therapy effectiveness Signup and view all the answers

Study Notes

Patient Positioning for Evaluation

Sit in a new part of the room next to someone you normally don't sit with.

Ischemic Conditions and Med/Surg Management

Patients with CAD and/or MI may be managed medically:
- Optimize blood pressure through medications, weight loss, and exercise.
- Optimize myocardial oxygen demand through medications that lower heart rate and/or lower contractility.
- Optimize coronary blood flow through medications that thin blood.
- Manage cholesterol.
- Optimize physical activity.
Additional pharmacology lecture is planned.

Surgical Interventions for CAD & MI

Percutaneous transluminal coronary angioplasty (PTCA):
- Balloon-tipped catheter fed into occluded coronary artery.
- Balloon compresses plaque, restoring blood flow.
Stent:
- Used in conjunction with PTCA.
- Used to prevent re-stenosis (restenosis).
- Blood thinners used with stents.

Surgical Interventions - CABG

Coronary artery bypass graft (CABG):
- Uses saphenous vein, internal mammary/internal thoracic artery, or brachial vein.
- Bypasses occlusion to restore blood flow.

Surgical Treatments: Coronary Artery Bypass Graft (CABG)

Harvest a blood vessel (saphenous vein, ulnar artery) from the body.
Connect the harvested vessel from the aorta to the distal area of occlusion.

Mid-CAB: Indications and Contraindications

Indications:
- 1-2 blocked arteries on the anterior surface of the heart.
- High risk for bypass surgery.
Benefits:
- No sternotomy (less functional impairment).
- Shorter length of stay.
- Lower risk than with heart-lung machine.

Chart Review: Surgery

Look for:
- Type of surgery.
- Method of surgery.
- Where the vein was harvested.
- Anything unusual in the perioperative or operative period.

PT Examination

Cardiorespiratory screen/heart auscultation
Observation of color/perfusion.
Sternal stability and precautions.
Cardiac rehabilitation and education.
Vital signs/cardiorespiratory response to activity.
ECG/telemetry.

Examination Continued: Special Tests CV

Special tests:
- Heart auscultation.
- Capillary refill.
- Peripheral pulse strength.
- Lung auscultation.
- Blood pressure (orthostatic hypotension)
- Sternal stability.

Examination - Sternal Incision

Wound evaluation (color, odor, discharge; more detail in future).
Sternal stability.
Risk factors for dehiscence (older age, smoking, diabetes, overweight/obese, poor nutritional status).

Sternal Instability

Method for testing:
- Palpate between sternal halves using the 2nd, 3rd, and 4th digits.
- Consider shoulder flexion/rotation, coughing, and deep breathing.
- An optional further challenge is contrary shoulder movement.
- Record grade of motion, gap, and tenderness.
Sternal Instability Scale:
- 0: Clinically stable sternum (no detectable motion).
- 1: Minimally separated sternum (slight increase in motion).
- 2: Moderately separated sternum (moderate increase in motion).
- 3: Completely separated sternum (marked increase in motion).

Sternal Precautions

Limit pushing, pulling, lifting, or carrying > 5-10 lbs for 8 weeks.
Limit bilateral shoulder elevation past 90 degrees for 8 weeks (Unilateral unweighted shoulder elevation is allowed within pain limits).
Limit reaching behind back.
Splinted coughing.
No driving (for 8 weeks).

Modified Sternal Precautions ("Move in the Tube")

Alternative to standard sternal precautions.
Patients keep moves within a defined "tube" or green area.
Allowed to move out of the green area for open-chain activities (e.g., ADLs).
- Detailed guidelines for arm movements, loading, positioning, and specific precautions concerning patients with BMI≥35, coughing, and large breast size are included.

Functional Measures

Determining functional status.
Determining impact of medications and/or surgery on function.
Risk stratification for mortality, readmissions, and falls.
Baseline data for a home exercise program.

Aerobic Capacity

Six-minute walk test.
Two-minute marching/step test.
Functional activities (e.g., 5 times sit-to-stand, 30-second sit-to-stand).

Ready, Set, Go!

Testing procedure for functional activities:
- Stand upright next to a wall, marking a point midway between patella and iliac crest.
- March for 2 minutes, lifting knees to 90 degrees.
- Allow rest and use of support (wall/chair).
- Count knee hits against the mark.

Men's and Women's Results (Fitness Protocol):

Provides average, above average, and below average data for various age ranges

2 Minute Step Test

An alternative to 6-minute walk test.
Lightweight (no equipment except tape and timer).
Low correlation to VO2.
Insufficient data determining reliability and responsiveness.

Documentation of Level of Assistance

Independent (I), Supervision (S), CGA, Minimal Assist (Min A), Moderate Assist (Mod A), Maximum Assist (Max A), Dependent (D).
Description of each level.

QOL - SF-36

Physical functioning, Role physical, Bodily pain, General health.
Vitality, Social functioning, Role emotional, Mental health.

Seattle Angina Questionnaire

Detailed questions about limiting factors due to chest pain over the past 4 weeks; frequency, symptoms, and impact on daily life and ability.

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Description

Test your knowledge on cardiovascular procedures like PTCA and CABG, as well as the associated management strategies in coronary artery disease. This quiz covers indications, complications, and rehabilitation aspects related to these procedures.