Adult Cardiac Flashcards
OPCAB
Similar rates of periop stroke, MI, renal failure, cost
Lower blood transfusion rate
Cutoff for doing concominant aortic surgery (root or ascending) in bicuspid aortic valve
4.5cm
Blood cardioplegia
Blood mixed with cardioplegia increases O2 delivery to hyopthermic cadiac myocytes. O2 dissociation curve shifted left to there is less release to tissues so HIGH O2 content is necessary for tissue extraction
Anomalous right coronary artery
Rare (more common japanese)
courses between Aorta and PA
Risk of arrythmia, MI, sudden death
Treat with unroofing
Conduit patency rates
Mammary - 90% 10 year
BIMA skeletonized does not increase rate of wound infection in trials
SVG - 50% 15 year
Radial - 92.5% 7 year (patency decline if lesion less than 70%)
GE - more susceptible to steal and higher closure than other radial
Low EF, borderline AS severity on echo
Low flow/low gradient AS
Dobutamine stress echo to elucidate
Paget schroeder- TOS
Compression of SC vein by clavicle/first rib/scalene muscle
First AC and catheter lysis
Then early first rib resection
No role for stenting and high rate of failure for long term AC without surgery
Must debrideme subclavius tendon at angle between clavicle and rib
Restrictive cardiomyopathy vs constructive pericarditis
Both caused by prior radiation. Present with diastolic HF
Constrictive - equalization of LV and rV end diastolic pressure. Very sensitive to respiratory variation
Restrictive - LV>RV EDP. Less respiratory variation
CTEPH diagnosis
V/Q scan needed to dx. Pulmonary angiogram and CT with contrast may miss distal disease and can’t differentiate acute/chronic
PA pressure> 25 with wedge <15 in presence of multiple organized clot
Indication for ICD
EF<35% and NYHA 2/3, 90 days post revascularization. Benefits should be seen by 90 days
EF<30% with any NYHA class if patient expected to live a year
LVAD outcome
50% 5 year mortality
OHT survival
75% 5 year
50% 10 year
Screening for aortopathy
First degree relatives of patient with dissection/aneurysm should get ECHO screening. No CTA unless echo suggests
Screen for Marfans if >1 family has aortic disease or if presence of associated signs
LA mass
Usually myxoma treated with simple excision
Sarcoma less likely but also in LA. Complete resection is key and may need to remove whole septum and patch reconstruct
Adjuvant chemo/rad probably improves survival but limited benefit
Cold agglutination
Autoantibodies against RBCs cause clumping and micro/small vessel clots
Immediately avoid hypothermia and cold pledgia. Switch to normothermia and warm cardioplegia. Maybe. Flush retrograde w warm pledge
.8-4%
Post cabg antiplatelet
ASA within 6 hours
DAPT in year following CABG is reasonable (2b rec)
Preop antibiotics
Cephalosporin alone ok if no prosthetic valve or graft going in and low risk
Vanc should be given for those at risk of MRSA
Given before incision (within 60 mins)
CRT
CRT is recommended for symptomatic patients with heart failure (HF) in sinus rhythm with LV ejection fraction (LVEF) ≤35%, QRS duration ≥150 ms, and left bundle branch block (LBBB) QRS morphology.
Lead must be placed sufficiently lateral
Inadvertant LV lead placement in pacer
Accidentally cross septum and lead is placed to LV
Surgery to remove is indicated due ot high thromboembolic risk
Warfarin in pregnancy
Risk to fetus is in first trimester (6-12) weeks and for doses above 5mg. Less than 5mg doses ok to continue
reasonable to keep coumadin on in 2nd/3rd trimester. Stop coumadin and start heparin prior to delivery
Coarctation of aorta in adult
F>M
stenting is superior to balloon angioplasty and surgery to remove coarctation with end to end anastamosis not usually possible in patients over 8 yo.
Planned reintervention is necessary for post stent.
HOCM tx
Septal myectomy
Often SAM improves after myectomy
ICD indicated if family history of SCD, prior cardiac arrest, spontaneous VT, syncope, lV wall thickness >3cm, abdnormal BP response to exercise
BiV pacing
indicated for QRS >120
GHENT criteria
Long criteria list but most important To diagnose marfans:
Ectopia lentis
Aortic dilation/dissection
Family history
FB1 gene (by itself not diagnostic.)
