Cardiology, Cardiac Procedures, and Cardiothoracic Surgery: Overview and Clinical Implica<ons for the Medical SLP Andrea Hayes, M.S.

Transcription

1 Cardiology, Cardiac Procedures, and Cardiothoracic Surgery: Overview and Clinical Implica<ons for the Medical SLP Andrea Hayes, M.S., CCC- SLP, BCS- S January 10, 2016

2 Learner Objec<ves 1) Accurately iden<fy the cardiac structures and their anatomic rela<on to relevant peripheral nerves of swallowing and voice. 2) Define known risk factors for dysphagia following cardiothoracic surgery. 3) Describe common motor speech, voice, and cogni<ve- communica<on impairments seen post- opera<vely.

3 I. Anatomy and Physiology

4 Facts Greek: /kardia/ heart /- logy/ to speak Weighs about 9-12 ounces About the size of your fist Pumps approximately four quarts of blood per minute at rest and quarts per minute during exercise Dona<ng blood is only one pint every three months RED- CROSS or

5 Embryology

6 Heart lies beneath and to the le_ of the sternum Manubrium Sternum Xiphoid process Ribs Covered by the pericardium Protec<on

7 Chambers and Valves Four chambers Le_ ventricle Right ventricle Le_ atrium Right atrium Four valves Tricuspid Pulmonic/pulmonary Mitral/bicuspid Aor<c

8 Aorta

9 Arterial System Two coronary arteries Right Le_ Le_ anterior descending artery (LAD) Circumflex artery

10 Neural Innerva<on Heart is innervated by the Vagus nerve and mediated by the autonomic nervous system Heart rate Blood pressure

11 Nodes and Heart Rate Sinoatrial node (SA) Natural pacemaker Atrioventricular node (AV) beats per minute (bpm) at rest Infants bpm

12 I ve Got Rhythm. Normal sinus rhythm Irregular heartbeat Premature ventricular contrac<on Supraventricular tachycardia Atrial fibrilla<on Atrial fluier and tachycardia Paroxsysmal supraventricular tachycardia Ventricular tachycardia Bradycardia

13 Blood Pressure 90/60 mm Hg to 130/80 mm Hg Hypertension Hypotension

14 II. Cardiac Tes<ng

15 Testy testy Electrocardiogram (EKG/ECG) Cardiac enzymes Holter monitor Exercise Stress Test Echocardiogram Myocardial perfusion imaging Transesophageal echocardiogram (TEE) Magne<c Resonance Imaging (MRI) Computed Tomography(CT) Tilt table test Electrophysiology study

16 III. Cardiac Diseases

17 Coronary Artery Disease and Myocardial Infarc<on

18 Conges<ve Heart Failure

19 Cardiomyopathy Dilated Hypertrophic Restric<ve

20 Pericardial Effusion/ Cardiac Tamponade

21 Aneurysms and Aor<c Dissec<ons Type A Type B

22 Valve Disease Stenosis Regurgita<on

23 Congenital Heart Defects Atrial septal defect Ventricular septal defect Coarcta<on of the aorta Transposi<on of the great arteries Truncus arteriosis Kawasaki disease William s syndrome Marfan syndrome Tetralogy of Fallot Another subject for another day

24 Op<ons Medica<ons and lifestyle changes Radiofrequency abla<on and cardioversion Pacemakers/AICD Angioplasty/PCI Stent Coronary Artery Bypass Gra_ing (CABG) LVAD/RVAD/BiVAD AVR, MVR, TVR Aneurysm repairs and replacement of parts of aorta Aor<c root replacement Heart Transplanta<on

25 IV. Cardiac Surgery

26 Historical Perspec<ves 1895: le_ thoracotomy for stab wound to coronary artery 1920s: valve surgery 1950s: open heart surgery/heart- lung machine 1985: first successful heart transplant 2000s: robot assisted/minimally invasive surgery

27 Gelng to the Heart of the Maier Catheteriza<on Tradi<onal median sternotomy Mini- sternotomy Thoracotomy Port- access incisions Transcatheter valve replacement

28 Cardiopulmonary Bypass

29 CABG x1, 2, 3, 4, 5!

30 Valve Replacement AVR MVR TVR

31 LVAD/RVAD/BiVAD

32 Aneurysm Repairs

33 Cardiac Transplanta<on

34 Apparatuses! Chest tube(s) Femoral Line Arterial Line Intra- aor<c balloon pump External pacemaker Automa<c Internal Central Defibrillator/Pacer ECMO LVAD, RVAD, BiVAD

35

36 V. SLP: We work from the head to the heart

37 Neurologic Effects Cerebral hypoperfusion Anoxia Cerebral emboli Encephalopathy Post- perfusion syndrome

38 Dysphagia and Dysphonia

39 What Nerve You Have!

40 What happens in VAGUS Sensory from pharynx and larynx Motor to pharynx and larynx Superior laryngeal nerves Recurrent laryngeal nerves Visceral to mul<ple organs

41 Some thoughts. ETT and TEE Post- perfusion syndrome Medica<ons Intra- opera<ve nerve retrac<on Disuse atrophy

42

43 Thank you!!