7.0 Treatment and management
Management of coronary artery disease includes a variety of treatment methods mainly through the use of invasive interventional procedures which aim to correct the cardiac defect. The following procedures will be explored, coronary bypass surgery, angioplasty and stents.
7.1 Coronary bypass surgery
Coronary bypass sugery involes the repair of congenital heart disease and atrial or ventricular defects which bypasses a blocked coronary artery by using another artery or vain with the use of a heart-lung cardiopulmonary bypass machine used to stop the heart to complete the surgery (DeSilva, 2013). Similarly, the surgery can also be completed without the heart-lung cardiopulmonary machine called an off-pump coronary bypass surgery which is associated with fewer grafts and reduction in complications due to the heart continueing to beat (Diegeler et al., 2013). Coronary bypass surgery is performed on patients suffering from multiple areas of coronary blockages or severe narrowing. Patients who have received coronary bypass surgery will have variables which will shorten or prolong their admission stay as 33.3 per cent of patients discharged from intensive care within 48 hours while the remaining 66.7 per cent remained in intensive care for longer periods
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Once the balloon is inflated the artery expands and the stent is placed inside the artery, which acts a support preventing the artery from blocking and restoring blood flow ("How Are Stents Placed?", 2013). Furthermore, 95 per cent of patients who received angioplasty surgery were discharged within 24 hours from hospital and associated with reduced amounts of readmission and death (Rao et al.,
The purpose for the stent was to hold the coronary artery open to allow the blood to flow more freely.
ECMO is an external cardiopulmonary bypass circuit that serves to temporarily replace the functions of the heart and lungs. This necessitates the surgical placement of a catheter into a central vein located near the heart and a second catheter that can be placed in either a different central vein (VV ECMO), which is used for respiratory support, or placed into artery (VA ECMO), used when the patient requires cardiac and respiratory support. These catheters are connected to the ECMO machine where the blood is pumped through an oxygenator where carbon dioxide is removed and oxygen instilled (http://nyp.org/services/carf/what-is-ecmo.html).
There are four different categories of treatment: lifestyle changes, surgical procedures, non-surgical procedures, and medications. Lifestyle changes include having a healthy diet; increasing physical activity; eliminating cigarettes, alcoholic beverages, and illicit drugs; and getting enough rest and sleep; losing excess weight. These lifestyle changes are to lower the patient’s blood pressure, cholesterol, and reducing any other future medical conditions. There are also surgical options to help cure, prevent, or control cardiomyopathy. Surgical method include a septal myectomy, surgically implanted devices, and a heart transplant. A septal myectomy is used to specifically treat hypertrophy cardiomyopathy which is where the heart muscle cells enlarge and cause the walls of the ventricles to thicken. The thickening of the walls may not affect the size of the ventricles but instead may affect the blood flow out of the ventricle. Usually along with the ventricles swelling, the septum in between the ventricles can become enlarged and block the blood flow causing a heart attack. When medication is not working well to treat hypertrophic cardiomyopathy, a surgeon will open the chest cavity and remove part of the septum that is blocking blood flow. Surgically implanted devices include a pacemaker, a cardiac resynchronization therapy device, a left ventricular assist device, and an implantable
After review of the clinical information provided by North Central Bronx Hospital, the Medical Director has denied your admission to North Central Bronx Hospital. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. You are a 56 year old female with complaints of worsening pressure-like chest pain on the left sided that radiated to your left arm and neck. The symptoms began when you were at rest and woke you from your sleep. Based on the Interqual guideline (a decision based program to determine medical need) criteria to for acute coronary syndrome the clinical guidelines were not met because troponins were negative, there was no diagnostic testing such as a stress test, or documentation of ischemia in the clinical information that was submitted.
Endovascular stent graft repair is designed to help reinforce a weakened aorta. Endovascular surgery is performed inside the aorta using thin, long tubes called catheters to place a stent surrounded with a fabric liner. Endovascular stent grafting uses an endovascular stent graft to reinforce the wall of the aorta and to help keep the damaged area from rupturing and developing into a potentially serious health problem that can be fatal and cause massive internal bleeding.
There are various treatments for acute coronary syndrome to prevent the occurrence of an acute myocardial infarction. The purpose of this essay is to discuss the current research of the pharmacological treatments of this condition and to evaluate the relevance of this research in relation to the practise of paramedics.
When the heart valve has been replaced and the surgery is completed. The heart will be beating on its own and all incisions will be sewn or stapled closed (Surgery: What to Expect – Heart Valve Replacement. n.d.).
...lood Vessel Stents.” 1-3). Bypass surgery is another option; a blood vessel from somewhere in the body is used to go around the blocked artery. This completely bypasses the blocked artery, so it no longer becomes an issue. Thrombolytic therapy is a method that involves injecting a medication into the artery that will dissolve the clot and allow blood to pass freely through the artery (“Peripheral Artery Disease.” 3).
Coronary artery disease (CAD) is the most common type of multifactorial chronic heart disease. It is a consequence of plaque buildup in coronary arteries. The arterial blood vessels, which begin out smooth and elastic become narrow and rigid, curtailing blood flow resulting in deprived of oxygen and nutrients to the heart [1].
This assignment is a case study that aims to explore the biospychosocial impacts of a myocardial infarction on a service user. It will focus on the interventions used by healthcare professionals throughout the patient’s journey to recovery. To abide by the NMC’s code of conduct (2015) which states that all nurses owe a duty of confidentiality to all those who are receiving care, the service user used in this case study will be referred to as Julie. Julie is a 67 year old lady who was rushed to her local accident and emergency following an episode of acute chest pain and was suspected to have suffered from a myocardial infarction. Julie who lives alone reported she had been experiencing shortness of breath and
...gs causing high pressure in the arteries; leading to an irreversible pulmonary hypertension. Other complications include, “aortic insufficiency, leaking of the valve that separates the left ventricle from the aorta; damage to the electrical conduction system of the heart during surgery causing an irregular heart rhythm; delayed growth and development; heart failure; stroke; infective endocarditis, a bacterial infection of the heart.”
The primary concern for Mr. Miller would be preventing further ischemia and necrosis of the myocardial tissues, preventing serious complications such as cardiac dysrhythmias and heart failure, as well as relieving his chest pain that radiates to his left arm. Preventing further ischemia and necrosis of the myocardial tissue will help prevent the development of heart failure due to myocardial infarction, whereas relieving his pain will help reduce his episodes of shortness of breath, and will also help to reduce any anxiety and restlessness he may be having from being in pain and short of breath.
Equipment needed following open heart surgery Initially the patient will be recovered in the post anesthesia area. They are orally intubated for a few hours or more. Blood pressure will be measured via an arterial line to their radial, brachial or femoral artery, depending on their vascular issues. An invasive line called a Swan Ganz catheter measures “pressures inside your heart and in the artery to
Coronary Angiography helps the doctor to plan a treatment. The area where catheter will be inserted is
Myocardial infarction occurs when the coronary arteries are blocked by a blood clot. It is commonly known as “heart attack”. The heart needs its own constant supply of oxygen and nutrients to work properly. Two coronary arteries delivery oxygenated blood to the heart, and if one of these two arteries fail or become blocked, then a portion of the heart will not acquire the necessary oxygen. This clot could be because of CAD (coronary artery disease), which happens when the inner walls of the coronary arteries thicken because of build up of cholesterol, fatty deposit, calcium among other elements that are carried in the blood (Boston Scientific, 2009).