Coronary Artery Disease Management Quiz

Patient Positioning for Assessments

• Sit in a new part of the room next to someone you do not normally sit with

Ischemic Conditions and Med/Surg Management

Medical 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.

Surgical Interventions for CAD & MI

• PTCA (Percutaneous Transluminal Coronary Angioplasty): Balloon angioplasty using a balloon-tipped catheter to compress plaque in an occluded coronary artery, restoring blood flow.
• Stent: Used in conjunction with PTCA to prevent re-stenosis. Blood thinners are also used.

Surgical Interventions - CABG

• CABG (Coronary Artery Bypass Graft): A surgical procedure that uses a harvested blood vessel (saphenous vein, internal mammary/internal thoracic artery, or brachial vein) to bypass an occluded coronary artery, restoring blood flow.

Surgical Treatments: Coronary Artery Bypass Graft (CABG)

• Harvest a vessel from the body (saphenous vein, ulnar artery).
• Connect vessel from aorta to 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 vein was harvested, and anything unusual in the perioperative or operative period.

PT Examination

• Cardio-vascular screen: Heart auscultation, observation of color/perfusion.
• Sternal stability and precautions teaching.
• Tests for cardiorespiratory fitness, education about risk factor reduction.
• Referral to cardiac rehabilitation.
• Vital sign or cardiorespiratory response to activity.
• ECG/telemetry.

Examination Continued: Special Tests CV

• Special Test: Heart Auscultation
• Special Test: Capillary Refill
• Special Test: Peripheral pulse strength
• Special Test: Lung Auscultation
• Special Test: Blood Pressure (orthostatic hypotension)
• Special Test: Sternal stability

Examination - Sternal Incision

• Wound evaluation (color, odor, discharge—more to come in fall P2).
• Sternal Stability.
• Risk factors for dehiscence: older age, smoking, diabetes, overweight or obese, poor nutritional status.

Sternotomy

• Different types (median, mid-lateral, anterior, lateral, interior) CAB.

Sternal Instability

• Palpate between sternal halves, noting motion, bony gap, and tenderness.
• Further challenging the sternum with alternate shoulder movements, and recording the grade of motion.
• 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

• No pushing, pulling, lifting, or carrying > 5-10 pounds for 8 weeks.
• No bilateral shoulder elevation past 90 degrees for 8 weeks.
• Unilateral unweighted shoulder elevation past 90 degrees is allowed within pain limits.
• No reaching behind back, splinted coughing.
• No driving x 8 weeks.

Modified Sternal Precautions "Move in the Tube"

• Alternative to traditional precautions in several institutions.
• Patients to keep their moves within the "tube" or green area.
• Allowed to move out of the green area for open chain activities such as ADLs.

Sternal Precautions – Move in the Tube

General Instructions

• Bilateral arm movements in the horizontal plane, backwards, or over the shoulder level.
• Only within pain-free limits for the first 10 days after sternotomy.
• Loaded movements of the arms should only be done at a pain-free level.
• Keep upper arms close to body for 6-8 weeks.
• Patients with BMI ≥35 need a supportive vest to protect sternum for 6-8 weeks.
• Splinted coughing is needed (a pillow over incision).
• Sternal vest for patients who cough frequently.
• Supportive bra for patients with large breasts.

Functional Measures

• 1. Determining functional status.
• 2. Determining impact of medications and/or surgery on function
• 3. Risk stratification for mortality, re-admissions, falls.
• 4. Baseline data for home exercise program.

Aerobic Capacity

• Six Minute Walk Test (25 m MCID, time to move)
• Two Minute Marching/Step Test.
• Functional Activities: 5 times sit to stand, 30 second sit to stand

Ready, Set, Go!

• Stand up straight next to wall, mark on wall midway between patella and iliac crest.
• March for two minutes lifting knees to designated height/90 degrees.
• Resting allowed, subjects may hold onto wall or chair.
• Count the number of times right knee hits the mark.

Men's and Women's Results

• Average scores for senior fitness test protocol

2 Minute Step Test

• Pros: Alternative to 6MWT, no equipment needed.
• Cons: Low correlation to VO2, insufficient data for reliability and responsiveness.

Documenting Level of Assist

• Independent (I)
• Supervision (S)
• Contact Guard Assist (CGA)
• Minimal Assist (Min A)
• Moderate Assist (Mod A)
• Maximum Assist (Max A)
• Dependent (D)

QOL

• SF-36: Physical functioning, Role physical, Bodily pain, General health, Vitality, Social functioning, Role emotional, Mental health
• Seattle Angina Questionnaire

Test your knowledge on the medical interventions related to Coronary Artery Disease (CAD) and Myocardial Infarction (MI). This quiz covers various aspects of treatments, surgical procedures, and key concepts in cardiac health management. Perfect for healthcare professionals and students alike.