what is it?
Altered
Perfusion
Altered perfusion
describes the lack of
oxygenated blood flow
to areas of the body.
Proper perfusion is
detrimental to the
function of organs and
body systems as organs
and tissues that are not
perfusing will die.
What
for?
Chronic DVT and Blood vessel
occlusion.
Is it
important?
Chronic DVT and other forms of
occlusion can result in swelling,
skin changes, venous ulcers and
impaired perfusion to other body
parts.
Recanalization
The process of restoring flow to or reuniting
an interrupted channel of a bodily tube
(such as a blood vessel).
Procedure
How is it done?
uses ultrasound
to access the
target vein
Wires, catheters
and other
devices are used
The level of
anesthesia is
usually conscious
sedation
Follow-up
Risks
Bleeding is the main risk, along with
pulmonary embolism and infection.
Postproce
dure
discharge home
can usually
occur several
hours later
Doppler
ultrasound
and clinic visit
is typically
performed
several weeks
Palliative
Care
specialized
medical care
for people
living with a
serious illness
Palliative care
for Heart Failure
Eligibility for Palliative Care
The care team, patient/family needs help with
complex decision-making and determination of
goals of care.
New diagnosis of life-limiting illness
Declining function with decreased ability to
complete activities of daily living
Patient requires constant care and monitoring
Patient is at the end stage of heart disease
often recommended
because heart failure
patients not only suffer
from dyspnea and fatigue
as a result of their
disease process, but also
have a high burden of
somatic complaints,
including pain, nausea,
anxiety, and depression,
leading to significant
psychosocial distress for
both patients and their
caregivers.
Common Heart
Failure symptoms
and palliative care
treatment options
Edema
a
significant
cause of
discomfort
in patients
Pain
common
and often
undertrea
ted in
end-stage
heart
failure
Depression
occurs in
21% to
36% of
patients
with heart
failure
Fatigue
Dyspnea
The foundation for
treatment of
fatigue is
the identification
and treatment of
secondary causes
Patients with endstage heart
failure may
develop increasing
levels of diuretic
resistance
Goal of
Palliative
Care
Percutaneous
Transluminal
Angioplasty
improve quality of
a minimally
life for both the invasive procedure
patient and the
used to open a
family
blocked artery
How
is it
done?
(procedure)
What is
STEN
TING
Atherec
tomy
the process of
de-bulking —
removing some
of the plaque
from a blockage
Rotational Atherectomy
Directional Atherectomy
Laser Atherectomy
pace
maker
electronic devices
that stimulate the
heart with
electrical impulses
to maintain or
restore a normal
heartbeat
Conduction
System of the
Heart
The conduction
system of the heart
starts when the
sinoatrial (SA) node or
the natural
pacemaker of the
heart creates an
excitation signal.
Types of
Pacemaker
Parts of pacemaker
Single
chamber
pacemaker.
Dual chamber
pacemaker.
Biventricular
pacemaker.
Possible complications of a pacemaker device or its
surgery may include:
Infection near the site in the heart where the device is
placed.
Swelling, bruising or bleeding, especially if you take blood
thinners.
Blood clots near where the device is placed.
Damage to blood vessels or nerves.
Collapsed lung.
Blood in the space between the lung and the chest wall.
Moving or shifting of the device or leads, which could
cause a hole in the heart.
Before the
procedure
Surgery is needed to place a
pacemaker in the body which is called
Epicardial Implantation.
During the
procedure
a doctor inserts one or more wires into
a major vein under or near the
collarbone. The doctor uses X-ray
images to guide the wires to the heart.
Special
precautions
there are safety tips to follow when
a patient has a pacemaker
Mobile Phones
Medical Equipment
a medical procedure
that uses quick, lowenergy shocks or
medications to
restore a regular
heart rhythm.
Cardio
version
Types:
Electric
cardioversion
Chemical
(pharmacological)
CHEMICAL
CARDIOVERSION
Chemical cardioversion
is the use of medicines
to change the heart
rhythm from an
abnormal one to a
normal one
Chemical cardioversion drugs:
Adenosine (Adenocard® or Adenoscan®).
Quinidine.
Ibutilide.
Diltiazem (Cardizem® or Tiazac®) or another calcium channel blocker.
Flecainide.
Metoprolol (Lopressor® or Toprol®XL) or another beta-blocker.
Digoxin
CHEMICAL
CARDIOVERSION
What are the risks?
Dislodged blood clots.
Irregular heart rhythms (arrhythmia).
ABLATION
Indications
recommended for patients with
arrhythmias that can’t be
controlled by medication or with
certain types of arrhythmia
from the heart’s upper
chambers, called the atria.
also known as a
cardiac ablation or
radiofrequency
ablation
importance
The main reason for
ablation is to control
symptoms. It is not
intended to eliminate
the need for blood
thinners for stroke
prevention.
Procedure
Done in an
electrophysiology lab.
A doctor puts catheters
(thin hollow tubes) into a
blood vessel in the groin
and threads it up to the
heart giving access to
the inside of the heart.
Before
Patients prepare for an
ablation in the same way
they prepare for an EPS
(electrophysiology study)
procedure.
Instruct patients to not
eat or drink anything for
eight hours prior to the
procedure.
During
During the
electrophysiology
procedure, the
healthcare team will
reproduce the fast
heart rhythm and
attempt to identify the
specific area of the
heart that is initiating it.
After
The healthcare
team will remove
the catheters and
take the patient to
a monitored unit
for observation.
What are the risks?
Bleeding, infection, and pain from the catheter
insertion
Damage to the blood vessels from the catheter
Puncture to the heart
Damage to the heart, which might require a permanent
pacemaker
Blood clots, which might lead to a stroke
Narrowing of the pulmonary veins (veins that transport
blood from the lungs to the heart)
Radiation exposure
CABG
Indications
procedure
used to treat
coronary
artery disease
done to restore blood flow around a
blocked heart artery.
risks:
importance
Coronary artery bypass surgery
creates a new path for blood to
flow around a blocked or partially
blocked artery in the heart.
Bleeding during or after
the surgery
Blood clots that can
cause heart attack,
stroke, or lung problems
Death
Pneumonia
Breathing problems
Pancreatitis
Kidney failure
Abnormal heart
rhythms
Failure of the graft
Infection at the
incision site
During the procedure
Coronary artery bypass graft
surgery-on-pump procedure
Coronary artery bypass
surgery-off-pump procedure
Procedure completion, both methods
Your doctor will sew the sternum together with small
wires
He or she will insert tubes into your chest to drain
blood and other fluids from around the heart.
Your doctor will sew the skin over the sternum back
together.
Your doctor will put a tube through your mouth or
nose into your stomach to drain stomach fluids.
He or she will then apply a sterile bandage or dressing.
(IABP) is a device that
controls blood flow
from the heart.
An intra-aortic balloon
pump usually only stays
in place for a few days.
Indications
intra-aortic
balloon pump
Acute congestive
heart failure.
Arrhythmias.
Heart attacks.
Myocarditis.
Coronary artery
disease.
during
before
numbing medicine (local anesthesia)
to reduce the chance of pain during
the procedure.
Inserts a hollow tube called a catheter
into an artery in your leg.
Threads the balloon through the catheter.
Uses X-ray imaging to guide the balloon
and catheter up to your aorta.
Attaches the intra-aortic balloon pump to
a machine that tells the balloon when to
inflate and deflate.
risk
after the
procedure
Balloon rupture, which could lead to blood clots.
Excessive bleeding.
Incorrect balloon positioning, which could lead
to a kidney injury or other problems.
Infection.
Injury to an artery.
HEART
TRANS
PLANT Indications
Surgery to remove the diseased
heart from a person and
replace it with a healthy one
from an organ donor
End-stage heart failure is a
disease in which the heart muscle
is failing severely in its attempt
to pump blood through the body.
WHAT ARE THE RISKS?
Infection
Bleeding during or after the surgery
Blood clots that causes heart attack, stroke, & lung
problems
Breathing problems
Kidney failure
Coronary allograft vasculopathy (CAV).
Failure of the donor heart
Death
During the procedure
After the procedure
Pharmacologic
Management;
Complementary &
Alternative Therapy
Fish Oil/Omega
3 Fatty Acids
a type of
unsaturated fatty
acid. They may
lower inflammation
in the body.
Currently, the three
most clinically relevant
omega-3
polyunsaturated fatty
acids (PUFAs) are
α-linolenic acid (ALA),
eicosapentaenoic acid
(EPA), and
docosahexaenoic acid
(DHA).
Omega-3s and
other nutrients in
fish may improve
heart health. They
also may lower the
risk of dying of
heart disease
Omega-3 fatty acids may:
Keep the heart
healthy by slightly
lowering blood
pressure.
Lower levels of fats
called triglycerides in
the blood.
Lower the risk of
irregular heartbeats.
Thought to lower
triglycerides by
suppressing lipogenic
gene expression,
increasing betaoxidation of fatty acids,
increasing the
expression of lipoprotein-lipase (LPL), and
influencing total body
lipid accretion.
Good omega-3-rich
fish options include:
Salmon.
Sardine.
Atlantic mackerel.
Cod.
Herring.
Lake trout.
Canned, light tuna.
Hawthorn
a common thorny
shrub in the rose family
that grows up to 5 feet
tall on hillsides and in
sunny wooded areas
throughout the world.
Its flowers bloom in
May
used to help protect
against heart disease
and help control high
blood pressure and
high cholesterol.
potentially help combat
cardiovascular disease
such as heart failure,
chest pain (angina), and
high blood pressure.
contraindications
1. Herbs may contain
components that may trigger
side effects and interact
Digoxin
Beta-blockers
Calcium-channel blockers
Phenylephrine
Medications for male sexual
dysfunction
(Phosphodiesterase-5
inhibitors)
Nitrates
2. Pregnant or
breastfeeding.
3. People who
experience more pain,
more angina attacks,
or more exhaustion
while walking or
exercising when taking
this herbal supplement.
Ginkgo
Biloba
contain flavonoids
and terpenoids,
which are both
antioxidants.
Antioxidants like those
found in ginkgo fight off
free radicals, and stop
them from damaging
DNA and other cells.
Ginkgo has a long
history of use in
treating blood
disorders and memory
issues.
improves blood circulation by
opening up blood vessels and
making blood less sticky.
Overall, it further helps improve
vein and eye health.
Two components are believed
to act as medicine: flavonoids
and terpenoids.
Potential interactions
with medications
1 to 2 weeks before surgery
or dental procedures due to
the risk of bleeding.
People who have epilepsy
should not take ginkgo,
because it might cause
seizures.
Pregnant and breastfeeding
women.
People who have diabetes.
DO NOT eat Ginkgo biloba
fruit or seed.
Medications broken down by
the liver
Seizure medications
(anticonvulsants)
Antidepressants
Medications for high blood
pressure
Blood-thinning medications
Alprazolam (Xanax)
Ibuprofen (Advil, Motrin)
Medications to lower blood
sugar
Cyclosporine
Thiazide diuretics (water pills)
Ginseng
Ginseng is a plant with
different varieties of
ginseng root that have
been used as
treatments in Asia and
North America for
centuries.
have the following benefits:
Increased energy.
Sharper cognitive
function.
Anti-inflammatory
effects.
Treatment of erectile
dysfunction.
Flu prevention.
Lowering blood sugar.
Safety considerations:
Never take ginseng and heart medications at
the same time without first consulting a doctor.
The herb can also increase the risk of bleeding
when taken with blood thinners, such as
warfarin or aspirin.
People may experience a moderate interaction
when using ginseng with a class of
antidepressants called monoamine oxidase
inhibitors (MAOIs).
Garlic
Benefits to heart health
(Prevents cell damage,
regulating cholesterol and
It is native to Central lowering blood pressure)
Asia and has been a
staple ingredient in
various cuisines and
traditional medicine
practices for
thousands of years.
Helps boost your immune
system and protect cells
Helps lower blood
pressure
Helps combat
atherosclerosis
(hardening of the arteries)