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26 Cardiac Flashcards

1
Q

congenital heart disease: overview of types, results, examples

A

L to R shunts, cause CHF, ex VSD, ASD, PDA … R to L shunts, cause cyanosis, ex ToF

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2
Q

congenital heart disease: R to L shunts - cause what

A

cyanosis

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3
Q

congenital heart disease: R to L shunts - examples

A

VSD, ASD, PDA

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4
Q

congenital heart disease: R to L shunts - px

A

children squat —> inc SVR —> dec R to L shunt

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5
Q

congenital heart disease: R to L shunts - complications

A

cyanosis leads to polycythemia, strokes, brain abscesses, endocarditis

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6
Q

describe Eisenmenger’s syndrome

A

shift from L to R shunt to R to L shunt …. sign of increasing pulm vascular resistance and pulm HTN … usually IRREV

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7
Q

congenital heart disease: L to R shunts - cause what

A

CHF

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8
Q

congenital heart disease: L to R shunts - ex

A

ToF

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9
Q

congenital heart disease: L to R shunts - px

A

manifests as failure to thrive, inc hR, tachypnea, hepatomegaly, CHF in kids - hepatomegaly is the first sign

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10
Q

describe ductus arteriosus

A

connection between descending aorta and L pulm artery …. blood shunted away from lungs in utero

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11
Q

describe ductus venosum

A

connection between portal vein and IVC …. blood shunted away from liver in utero

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12
Q

ductus arteriosus vs venosum: anatomy

A

arteriosus = descending aorta to L pulm artery - bypass lungs …. venosum = portal vein to IVC - bypass liver

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13
Q

fetal circulation to vs from placenta

A

2 umbilical arteries (2 go to) …. 1 umb vein

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14
Q

MC congenital heart defect - overall vs resulting in cyanosis

A

VSD vs ToF

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15
Q

VSD: stat

A

MC congenital heart defect

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16
Q

VSD: type

A

L to R shunt

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17
Q

VSD: typical course

A

80% close spontaneously, usually by 6 mo old

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18
Q

VSD: px

A

large VSDs usually cause sx after 4-6 weeks of life, as PVR dec and shunt inc …. can get CHF (tachypnea, tachycardia, 1st sign in kids is hepatomegaly) and failure to thrive

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19
Q

VSD: medical tx

A

diuretics and digoxin (same as ASD)

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20
Q

VSD: usual timing of repair

A

large (shunt >2.5), 1yo …. medium (shunt 2-2.5), 5yo …. MC reason for earlier repair is failure to thrive

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21
Q

ASD: type of shunt

A

L to R shunt

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22
Q

ASD: types of ASD

A

ostum secundum - MC (80%), centrally location … ostium primum = AV canal sefects or endocardial cushion defects, can have MV and TV problems, frequent in Down’s syndrome

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23
Q

ASD: px

A

usually sx when shunt >2 —> CHF (SOB, recurrent infections) … can get paradoxical emboli in adulthood

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24
Q

ASD: medical tx

A

diuretics and dig (same as VSD)

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25
ASD: usual timing of repair
1-2 yo ... 3-6 months old if accompanying canal defects
26
MC heart defect that results in cyanosis
ToF
27
ToF: describe
4 parts - (1) VSD, (2) pulmonic stenosis, (3) overriding aorta, (4) RV hypertrophy
28
ToF: type of shunt
R to L
29
ToF: medical tx
Beta blocker
30
ToF: usual timing of repair
3-6 months old
31
ToF: describe repair
remove RV outflow tract (RVOT) obstruction, RVOT enlargement, and VSD repair
32
PDA: type of shunt, medical tx, timing, surgery
(remember ductus arteriosus is connection between descending aorta and L pulm artery, bypasses lung in utero) .... L to R shunt ... idomethacin - causes PDA to close .... rarely successful beyond neonatal period ... surgical repair through L thoracotomy if persists
33
congenital heart defects: VSD, ASD, ToF, PDA - medical tx
diuretics and dig ... same .... beta blocker .... indomethacin (in neonatal period)
34
congenital heart defects: VSD, ASD, ToF, PDA - timing of repair
VSD = large shunt (>2.5) = 1yo vs medium (2-2.5) = 5yo, earlier if failure to thrive .... ASD = 1-2yo, 3-6mo w canal defects .... ToF = 3-6mo ... PDA = medical tx (indomethacin) in neonatal period, rarely works outside that time, surgery if persists
35
MC cause of death in the US
coronary artery disease
36
CAD: risk factors
smoking, HTN, male, fam hx, HL, DM
37
CAD: medical tx
nitrates, smoking cessation, weight loss, statins, ASA
38
CAD: anatomy
Left main coronary artery (LMCA) - blood supply to LV and LA ---> divides into LAD (supplies front of L heart) and circumflex (encircles heart, supplies outer side and back of heart) Right coronary artery (RCA) - blood supply to RV, RA, SA node, AV node ---> branches include R posterior descending artery and acute marginal artery RCA and LAD ---> together supply septum
39
CAD: location of athero lesions
most are proximal
40
CAD: complications of MI - list
VSR (ventricular septal rupture) and papillary muscle rupture .... both occur 3-7 days after MI
41
CAD: complications of MI - VSR px, findings, dx, tx
hypotension, pansystolic murmur, usually 3-7 days after MI ... step up in O2 content between RA and pulm artery (2/2 L to R shunt) ... dx = echo ... tx = IABP to temporize then place patch over septum
42
CAD: complications of MI - papillary muscle rupture px, dx, tx
severe MR with hypotension and pulm edema, usually 3-7 days after MI .... dx = echo .... tx = IABP to temporize, replace valve
43
CAD: drug eluting stent restenosis rate vs saphenous vein graft vs internal mammary CABG
20% at 1 year .... 80% 5-yr patency .... >95% 20 year patency when placed to LAD
44
CAD: best conduit for CABG
internal mammary artery ... >95% 20yr patency when placed to LAD ... collateralizes w superior epigastric artery
45
CAD: controlled cardiac arrest
K and cold solution cardioplegia ---> causes arrest of the heart in diastole ---> keeps heart protected and still while grafts are placed
46
CAD: indications for CABG
>70% stenosis significant for most areas except L main disease .... L main disease, >50% stenosis is significant ... 3-vessel disease - LAD, Cx, R coronary .... 2 vessels disease involving LAD ... lesions not amenable to stenting
47
CAD: high mortality risk factors
pre-op cardiogenic shock = #1 risk factor ... emergent operations ... age .... low EF
48
valve disease: MC valve lesions
aortic stenosis
49
valve disease: bioprosthetic valves - antigcoagulation
no required
50
valve disease: bioprosthetic valves - indications
pts who want pregnancy, have contraindication to anticoagulation, older (>65yo) and unlikely to require another repair in their lives, frequent falls
51
valve disease: bioprosthetic valves - how long do they last?
10-15 years (not as durable as mechanical valves)
52
valve disease: bioprosthetic valves - contraindications
children and young pts 2/2 rapid calcification
53
valve disease: aortic stenosis - stat
MC valve lesion
54
valve disease: aortic stenosis - pathophys
most from degenerative calcification .... calcification ---> stenosis
55
valve disease: aortic stenosis - cardinal sx w mean survival
dyspnea on exertion (5 yrs) ... angina (4 yrs) ... syncope (WORST, 3 yrs)
56
valve disease: aortic stenosis - indications for operation
when symptomatic ... usually have peak gradient >50mmHg and valve area <1.0cm2
57
valve disease: mitral regurg - pathophys
LV dilation
58
valve disease: mitral regurg - complications
v fib and a fib
59
valve disease: mitral regurg - key index of disase progression
v fib
60
valve disease: mitral regurg - describe a fib concerns
common, end-stage disease, pulmonary congestion occurs
61
valve disease: mitral regurg - indications for operation
symptomatic or severe
62
valve disease: mitral stenosis - stats
rare note, most are from rheumatic fever
63
valve disease: mitral stenosis - px
pulmonary edema and dyspnea
64
valve disease: mitral stenosis - indications for operation
symptomatic ....usually have valve area <1cm2
65
valve disease: mitral stenosis - use of balloon commissurotomy
to open valve, often used as first procedure b/c not as invasive
66
endocarditis: px
fevers, chills, sweats
67
endocarditis: MC site for prosthetic vs native valves
aortic = prosthetic .... mitral = native
68
endocarditis: MC organism
staph aureus responsible for 50% of cases .... pseudomonas is MC org for drug abusers
69
endocarditis: location
MC on L except in drug abusers (R side)
70
endocarditis: mgmt
medical therapy first, success rate 75%, sterilizes valve in 50% of people
71
endocarditis: indications for surgery
failure of antimicrobial therapy, severe valve failure, perivalvular abscesses, pericarditis
72
MC tummors of the heart: benign vs malignant vs mets
myxoma (75% in LA) ... angiosarcoma ... lung CA
73
mgmt in this situation: coming off cardiopulm bypass and aortic root vent, blood is dark and aortic perfusion cannula blood is red
vetilate lungs
74
location of lower O2 tension
coronary veins 2/2 high O2 extraction by myocardiu,
75
SVC syndrome: describe
swelling of upper extremities and face
76
SVC syndrome: MC cause
lung CA invading the SVC ... these tumors are unresectable since the tumor has invaded the mediastinum
77
SVC syndrome: tx
emergent XRT
78
mediastinal bleeding postop: when concerned? indications for exploration?
>500cc for 1st hour or >250cc/hr for 4 hours ---> need to re-explore after cardiac surgery
79
mediastinitis: risk factors, tx
risk = obesity, use of b/l internal mammary arteries, DM ... tx = debridement with pectoralis flaps, or can use omentum
80
post-pericardiotomy syndrome: px, EKG, tx
pericardial fraction rub, fever, chest pain, SOB ... EKG = diffuse ST segment elevation in mulitple leads .... tx = NSAIDs, steroids

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