Heart failure treatment - Devices and surgery | NCLEX-RN | Khan Academy
Aug 26, 2023
Heart failure treatment - Devices and surgery | NCLEX-RN | Khan Academy
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Content
4.312 -> - So let's say a patient's
Heart Failure gets to this point
6.855 -> where medications and
lifestyle changes help
9.292 -> but really, they just aren't enough.
10.98 -> And the patient's symptomatic
almost all the time.
14.018 -> Well, that's when we start to think about
15.201 -> medical device implants or surgery.
18.394 -> So there are actually a few
types of medical devices
20.128 -> that can be used.
21.603 -> And the first one we call
the ventricular assist device
24.842 -> or sometimes just the VAD, V-A-D.
28.36 -> This device assists or it
helps the patient's ventricle
31.517 -> or ventricles.
33.282 -> Since with Heart Failure
one or both ventricles
34.896 -> aren't pumping very well,
36.637 -> these devices actually help out with that
38.589 -> and essentially take over the
pumping for the ventricle.
42.163 -> And so how they typically work
43.162 -> is that there's this small tube
45.124 -> that attaches to the
ventricle that needs help.
47.83 -> And we'll say that in this case
48.757 -> the left ventricle needs help.
50.615 -> And so it's coming from the
bottom of the ventricle, here.
53.738 -> So at this point the blood,
55.259 -> instead of exiting out the artery
56.838 -> as you'd normally expect it
to, it sort of rerouted, here.
63.385 -> And so it goes through this
tube to this separate pump.
67.202 -> The VAD then pumps it out
through this next tube
69.422 -> which connects up with the
artery and then leaves the heart.
73.602 -> So we're sort of bypassing this whole area
75.948 -> and letting the VAD shoulder
all the pumping work.
79.353 -> These VADs are usually connected
to a small control unit
82.151 -> that's actually outside the body.
84.101 -> So a cable goes from the
inside, connected to the VAD,
87.073 -> through a small hole in the abdomen,
89.061 -> to a control unit that's outside,
91.007 -> and it's also connected to some batteries.
93.412 -> Both of which are usually kind of worn
95.095 -> with straps over the body.
98.81 -> So I drew it for the left ventricle
100.04 -> and so usually we call
that a left VAD or an LVAD.
104.035 -> But you can certainly have one
for the right ventricle too.
107.192 -> And we call that an RVAD or a right VAD.
110.791 -> Those usually connect
up to the right atrium,
113.015 -> take blood to the pump,
114.487 -> and then give it back to the
artery on the right side,
116.807 -> which heads off to the lungs.
119.615 -> You can even have a BiVAD,
120.857 -> meaning that there's a
pump for each ventricle.
124.757 -> And depending on the VAD it may pump blood
126.754 -> just like your heart does,
kind of rhythmically.
129.854 -> But it could also be a
continuous flow of blood.
132.88 -> So in that case, there's no pumping.
135.31 -> And you might not have a normal pulse
136.913 -> but your body's still getting
the blood that it needs.
140.453 -> Implantable VADs are usually
reserved for people who are
143.019 -> either waiting for a heart transplant
144.888 -> or as a long term solution
146.653 -> for those that actually
can't have heart transplants.
153.618 -> So the other type of
medical device implant
155.475 -> is something called Cardiac
Resynchronization therapy.
158.75 -> This could be a pacemaker only
160.543 -> or it could be a special dual
pacemaker and defibrillator.
164.694 -> For the pacemaker you
have this small device
166.888 -> that's implanted in the chest.
168.815 -> And then these electrical wires are,
170.255 -> sometimes we call them leads,
that go from the device
172.867 -> to both the left and the right ventricles.
176.094 -> One thing to notice though,
177.011 -> is that to actually get
to the left ventricle
180.169 -> they have to go in through
your coronary veins
182.316 -> and then kind of go around the heart
184.526 -> to the outside of the left ventricle.
187.494 -> And that's why I kind
of drew it dotted as it,
189.19 -> as soon as it's going, sort
of around the backside.
192.173 -> With Heart Failure we
know that both the right
193.787 -> and the left ventricles can be
affected differently, right?
196.818 -> And so what can happen is that
they beat at different times.
199.854 -> And this makes the heart
a way less efficient pump.
203.168 -> The pacemaker sends signals
down these wires or these leads
206.476 -> at the same time to tell both ventricles
208.554 -> to pump at the same time,
210.551 -> leading to a much more normal
and efficient pumping action.
214.951 -> Now this device might also come with
216.255 -> what's called a defibrillator.
218.446 -> If the patient's Heart Failure
219.472 -> leads to life threatening
rapid heart rates,
221.642 -> and then it's going sort
of uncontrollably fast,
224.741 -> the device can deliver a shock
226.41 -> that sort of resets the
heart to a normal rhythm.
231.03 -> But besides medical device implants
233.212 -> a patient can also have
a surgical intervention.
236.688 -> And so they might be given
stents to help with blood flow
239.493 -> for coronary artery disease.
242.187 -> These are placed over
areas in the arteries
244.091 -> that have plaque buildup
245.867 -> which help to widen the
arteries and make it easier
248.363 -> for blood to flow through them.
250.186 -> And so then it's easier for
the heart to pump through them.
254.342 -> Another surgery is called
a coronary artery bypass.
258.091 -> This surgical technique bypasses
260.344 -> or sort of reroutes the blood supply
262.526 -> around a blocked artery instead.
265.101 -> Again, just like a stent
it makes it a lot easier
267.276 -> to pump through this artery
268.911 -> that's not blocked anymore, right?
271.025 -> Usually the doctor connects
or sometimes we say grafts
274.229 -> a healthy artery from
somewhere else in the body
275.912 -> where its absence isn't
as much of a big deal.
280.544 -> Finally, what's considered
281.485 -> the ultimate surgical intervention
283.563 -> is a complete heart transplantation.
286.258 -> This is where the patient's
entire heart is removed
288.847 -> and replaced with a healthy donor heart.
291.521 -> And this procedure is
really limited to patients
294.142 -> that are considered at
end stage Heart Failure
296.791 -> or where other medical treatments
in surgery have failed.
Source: https://www.youtube.com/watch?v=1q06qHX1K-I
