OPEN HEART SURGERY

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OPEN HEART SURGERY

• BY NANCY JENKINS

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Diagnostic Tests

• EKG
• exercise stress test
• CXR
• cardiac cath-http//www.heartcenteronline.com/
• echocardiogram
• thallium scan

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Coronary Arteries

• Left Main
• - widow maker
• LAD-
• supplies LV.
• If occlusion have anterior MI
• RCA-
• if have occlusion have inferior MI

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Echocardiagram
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Transesophageal echocardiogram
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PRE-OP TEACHING
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Intra-op Events

• hypotension
• cardioplegia
• cross clamping aorta
• cardiopulmonary bypass
• heparinized

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CP Bypass
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http//www.nlm.nih.gov/medlineplus/tutorials/openh
eartsurgerywhattoexpect/ct079101.html
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Tubes after open heart
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Open heart surgery
YouTube - Malpractice Medical Coronary Artery
Bypass Graft (CABG) Surgery 3
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Post-op Appearance

• mechanical ventilator-SIMV mode
• hemodynamic monitoring- dec. CO
• cardiac monitoringSVT and Afib common
• mediastinal tube-100cc first hour to 500/24
• multiple IV sites and lines
• pacer wires
• foley-hourly output

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Assessment

• vital signs
• PAP
• PCWP
• CO
• urine output
• bleeding
• fluid balance and neuro

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Complications

• decreased cardiac output
• cardiac tamponade
• hypokalemia
• Hemorrhage-replace cc for cc . 100 first hr. then
  500/24 hours
• neuro changes
• resp insufficiency
• infection and pain-dilaudid, splint incision.
  Offer pain med percoset or vicodin q 4hr.

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Cardiac tamponade
Paradoxical pulse is a pulse that markedly
decreases in amplitude during inspiration. On
inspiration, more blood is pooled in the lungs
and so decreases the return to the left side of
the heart this affects the consequent stroke
volume.
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• Cardiac tamponade (influenced by volume and rate
  of accumulation)
• Beck triad (jugular venous distention,
  hypotension, and muffled heart sounds)
• Pulsus paradoxus is measured by careful
  auscultation with a blood pressure cuff. The
  first sphygmomanometer reading is recorded at the
  point when beats are audible during expiration
  and disappear with inspiration. The second
  reading is taken when each beat is audible during
  the respiratory cycle. A difference of more than
  10 mm Hg defines pulsus paradoxus.
• Cyanosis
• No drainage from mediastinal tube

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Decreased Cardiac Output

• decreased preload-need fluid
• inc. afterload- need to dec. B/P(Nipride)
• dec. contractility- need dobutamine
• Arrhythmias- SVT and Afib common
• (20-40) have A fib and may have increased LOS

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Post-op Care Goals

• Promote CV function, tissue perfusion and
  stablization of VS

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cont.

• Promote respiratory function and sufficient
  oxygenation by promoting chest drainage and use
  of IS

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Goals

• Promote fluid and electrolyte balance
• Promote renal function
• Promote rest, comfort, and relief of pain
• Promote neurological function
• Promote psych adjustment
• Promote early movement and ambulation

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New Advances
CARDICA C-PORT ANASTOMOSIS SYSTEMS For Beating
Heart Surgery
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Robot Assisted CABG
Robot - Assisted Heart Bypass with Cardiac
Catheterization