Cardiac Flashcards
first sign of L to R shunt / CHF in children
hepatomegaly
R to L shunt first sx
cyanosis, squatting improves
Eisenmenger
L to R shunt turns into R to L shunt
causes of congenital L to R shunt
VSD, ASD, PDA
causes of congenital R to L shunt
tetralogy of Fallot
PDA patent ductus arteriosus connection
descending aorta to LEFT pulmonary artery (shunt away from lungs inutero)
becomes ligamentum arteriosum
neonatal ductus venosum
connection from portal vein and IVC (shunt away from liver in utero)
foramen ovale
shunt blood away from lungs; in between R and L atria
MC congenital heart defect
VSD
dx of VSD
ECHO
80% close spontaneously by 6 mo
if large enough, can cause CHF in 4-6 wks of life with FTT as pulmonary vascular resistance decreases and shunt increases
mgmt of VSD
LARGE > 2.5cm: 1 YO
medium 2-2.5cm: 5 YO
or… as soon as failure to thrive
can start med therapy as: diuretics and digoxin
types of atrial septal defect
ostium secundum 80% centrally located > ostium primum
ostium primum associated with what else
Downs syndrome, MV/TV issues, cushion defect, AV canal defects
dx ASD
ECHO
CHF if >2 cm in kids, otherwise emboli in adults
mgmt ASD
1-2 YO if found (earlier if associated with canal defects)
meidical mgmt of asd and vsd
diuretics and digoxin
4 parts of Tetralogy of fallot
- VSD
- pulmonary stenosis
- overriding aorta
- RV hypertrophy
mgmt of Tetralogy
B-blocker + repair @ 3-6 mo
repair of Tetralogy of fallot
remove RVOT obstruction, enlarge the outflow tract and repair the VSD
PDA patent ductus arteriosus sx
BOUNDING pulses, widened pulse pressure, machine like murmur
mgmt PDA
indomethacin in neonates
otherwise, L thoracotomy surgical ligation
aortic coarcation dx
suspect in HTN young person; hypotensive legs
CXR with scalloping from big intercostals
CTA to confirm
mgmt of coarctation
resect the narrowing
vascular ring presentation
difficulty swallowing, respiratory distress, neck hyperextnsion (TRACHEA AND ESOPHAGUS ARE ENCIRCLES BY AORTIC ARCHES
vascular ring dx
barium swallow with bronchoscopy
mgmt of vascular ring
divide the smaller of the two arches
indications for CABG (L main vs others)
70% for most arteries
50% for left main
efficacy of stent/grafting coronaries
IMA (off SCA) 95% 20 yr patency >
saph vein 80% 5 yr patency >
DES 80% 1 yr patency
worst risk factor for CABG
preop CARDIOGENIC SHOCK»_space;> emergency operation, age, low EF
bioprosthetic contraindication
only lasts 10-15 years so don’t use in kids
indication for AS valve repair
symptomatic (worst sx is syncope > angina > DOE)
correlates with peak gradient >50mm Hg, valve area < 1.0 cm
MC valve lesions
AS from calcification/degeneration
MR cause
leaflet prolapse
MR indication to repair
symptomatic (mostly pulmonary congestion, Afib)
MS alternative to replacement
balloon commissurotomy (do this as first procedure before OR)
constrictive pericarditis square root sign
during RHC.
equalization of right atrial = right venticular = pulmonary artery = wedge = left ventricular diastolic pressures!
mgmt of constrictive pericarditis
pericardiectomy
MC sites for endocarditis
AV for prosthetic, MV for native
MC bug for endocarditis
S. aureus (also for IVDU) per Fiser
MC valve affected in IVDU
RIGHT !!
mgmt of endocarditis
MEDICINE FIRST
then, valve replacement (if fails, valve failure, abscess, pericarditis)
MC met to heart
LUNG ca
MC primary benign and malignant of heart
benign: myxoma
malignant: angiosarcoma
indication to open the chest after sternotomy
> 500cc in 1st hour
250 cc/hr x 4 hours
Aortic valve replacement indication?
Aortic valve area nL 3-4 cm2… so <1 cm2 needs to be fixed.
Typically concurrent with aortic jet velocity > 4m/sec or transvalvular gradient >40 mm Hg
2 operative indications for blunt cardiac injury?
- cardiac tamponade and
- disrupted cardiac valves
MC EKG abnormality in BCI
ST and PVCs
less common abnormality BCI
T or ST segment changes
sinus brady
AV conduction defects
RBBB
Afib
Vtach
VFib
what MUST you get if dysrhythmia or HD instability after BCI?
Echo
tamponade physiology 3 phases
1 elevated pericardial pressure & decreased vetricular diastolic filling = increased HR
2. decreased diastolic filling, decreased coronary perfusion, decreased SV = pallor, anxiety, diaphoresis
3. loss compensation and coronary perfusion = cardiac arrest
icd for surgery
pacer in asynchronous
defib turn oFF
can just put magnet over to get reset pacer and turn off defib as well
post MI ventricular septal rupture
hypotn, pansystolic murmur
3-7 days after
STEP UP IN OXYGEN CONTENT BETWEEN RA AND PA (L to R shunt)
dx on Echo
tx: IABP and patch it
post MI papillary muscle rupture
severe mitral regurgitation with hypotension and pulmonary edema
3-7 days after
dx echo
tx IABP and replace valve
DES restenosis in 1 yr
20%
worst px AS sx
syncope (mean survival 3 yrs )
