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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
Q

ASD: usual timing of repair

A

1-2 yo … 3-6 months old if accompanying canal defects

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26
Q

MC heart defect that results in cyanosis

A

ToF

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27
Q

ToF: describe

A

4 parts - (1) VSD, (2) pulmonic stenosis, (3) overriding aorta, (4) RV hypertrophy

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28
Q

ToF: type of shunt

A

R to L

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29
Q

ToF: medical tx

A

Beta blocker

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30
Q

ToF: usual timing of repair

A

3-6 months old

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31
Q

ToF: describe repair

A

remove RV outflow tract (RVOT) obstruction, RVOT enlargement, and VSD repair

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32
Q

PDA: type of shunt, medical tx, timing, surgery

A

(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

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33
Q

congenital heart defects: VSD, ASD, ToF, PDA - medical tx

A

diuretics and dig … same …. beta blocker …. indomethacin (in neonatal period)

34
Q

congenital heart defects: VSD, ASD, ToF, PDA - timing of repair

A

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
Q

MC cause of death in the US

A

coronary artery disease

36
Q

CAD: risk factors

A

smoking, HTN, male, fam hx, HL, DM

37
Q

CAD: medical tx

A

nitrates, smoking cessation, weight loss, statins, ASA

38
Q

CAD: anatomy

A

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
Q

CAD: location of athero lesions

A

most are proximal

40
Q

CAD: complications of MI - list

A

VSR (ventricular septal rupture) and papillary muscle rupture …. both occur 3-7 days after MI

41
Q

CAD: complications of MI - VSR px, findings, dx, tx

A

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
Q

CAD: complications of MI - papillary muscle rupture px, dx, tx

A

severe MR with hypotension and pulm edema, usually 3-7 days after MI …. dx = echo …. tx = IABP to temporize, replace valve

43
Q

CAD: drug eluting stent restenosis rate vs saphenous vein graft vs internal mammary CABG

A

20% at 1 year …. 80% 5-yr patency …. >95% 20 year patency when placed to LAD

44
Q

CAD: best conduit for CABG

A

internal mammary artery … >95% 20yr patency when placed to LAD … collateralizes w superior epigastric artery

45
Q

CAD: controlled cardiac arrest

A

K and cold solution cardioplegia —> causes arrest of the heart in diastole —> keeps heart protected and still while grafts are placed

46
Q

CAD: indications for CABG

A

> 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
Q

CAD: high mortality risk factors

A

pre-op cardiogenic shock = #1 risk factor … emergent operations … age …. low EF

48
Q

valve disease: MC valve lesions

A

aortic stenosis

49
Q

valve disease: bioprosthetic valves - antigcoagulation

A

no required

50
Q

valve disease: bioprosthetic valves - indications

A

pts who want pregnancy, have contraindication to anticoagulation, older (>65yo) and unlikely to require another repair in their lives, frequent falls

51
Q

valve disease: bioprosthetic valves - how long do they last?

A

10-15 years (not as durable as mechanical valves)

52
Q

valve disease: bioprosthetic valves - contraindications

A

children and young pts 2/2 rapid calcification

53
Q

valve disease: aortic stenosis - stat

A

MC valve lesion

54
Q

valve disease: aortic stenosis - pathophys

A

most from degenerative calcification …. calcification —> stenosis

55
Q

valve disease: aortic stenosis - cardinal sx w mean survival

A

dyspnea on exertion (5 yrs) … angina (4 yrs) … syncope (WORST, 3 yrs)

56
Q

valve disease: aortic stenosis - indications for operation

A

when symptomatic … usually have peak gradient >50mmHg and valve area <1.0cm2

57
Q

valve disease: mitral regurg - pathophys

A

LV dilation

58
Q

valve disease: mitral regurg - complications

A

v fib and a fib

59
Q

valve disease: mitral regurg - key index of disase progression

60
Q

valve disease: mitral regurg - describe a fib concerns

A

common, end-stage disease, pulmonary congestion occurs

61
Q

valve disease: mitral regurg - indications for operation

A

symptomatic or severe

62
Q

valve disease: mitral stenosis - stats

A

rare note, most are from rheumatic fever

63
Q

valve disease: mitral stenosis - px

A

pulmonary edema and dyspnea

64
Q

valve disease: mitral stenosis - indications for operation

A

symptomatic ….usually have valve area <1cm2

65
Q

valve disease: mitral stenosis - use of balloon commissurotomy

A

to open valve, often used as first procedure b/c not as invasive

66
Q

endocarditis: px

A

fevers, chills, sweats

67
Q

endocarditis: MC site for prosthetic vs native valves

A

aortic = prosthetic …. mitral = native

68
Q

endocarditis: MC organism

A

staph aureus responsible for 50% of cases …. pseudomonas is MC org for drug abusers

69
Q

endocarditis: location

A

MC on L except in drug abusers (R side)

70
Q

endocarditis: mgmt

A

medical therapy first, success rate 75%, sterilizes valve in 50% of people

71
Q

endocarditis: indications for surgery

A

failure of antimicrobial therapy, severe valve failure, perivalvular abscesses, pericarditis

72
Q

MC tummors of the heart: benign vs malignant vs mets

A

myxoma (75% in LA) … angiosarcoma … lung CA

73
Q

mgmt in this situation: coming off cardiopulm bypass and aortic root vent, blood is dark and aortic perfusion cannula blood is red

A

vetilate lungs

74
Q

location of lower O2 tension

A

coronary veins 2/2 high O2 extraction by myocardiu,

75
Q

SVC syndrome: describe

A

swelling of upper extremities and face

76
Q

SVC syndrome: MC cause

A

lung CA invading the SVC … these tumors are unresectable since the tumor has invaded the mediastinum

77
Q

SVC syndrome: tx

A

emergent XRT

78
Q

mediastinal bleeding postop: when concerned? indications for exploration?

A

> 500cc for 1st hour or >250cc/hr for 4 hours —> need to re-explore after cardiac surgery

79
Q

mediastinitis: risk factors, tx

A

risk = obesity, use of b/l internal mammary arteries, DM … tx = debridement with pectoralis flaps, or can use omentum

80
Q

post-pericardiotomy syndrome: px, EKG, tx

A

pericardial fraction rub, fever, chest pain, SOB … EKG = diffuse ST segment elevation in mulitple leads …. tx = NSAIDs, steroids

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