Cardiac Surgery Flashcards
Indications for aortic valve stenosis intervention?
Severe stenosis evidence (area of valve <1cm) \+ 1 if the following: - symptomatic - EJECTION FRACTION <50% - already was gonna do another surgery
Afib for 6 hours post CABG- what to do?
Afib after cabg should resolve within 24 hours, benign afib
<24 hours long Afib means just rhythm control (Amiodarone) and rate control (b blockers)
Otherwise cardioversion
3 complications (mistakes) that can occur following femoral artery access establishment?
- hematoma (just a mass in groin)
- pseudoaneurysm (systolic bruit, PULSATILE mass - cuz artery anurysm) - due to inadequate closure of the puncture site during surgery
- AV fistula (both vein and artery punctured (accidental) can cause blood flow between them )
AV Fistula complication? Explain 3:
- edema
- high output cardiac failure
- leg ischemia
- edema- hypertension of vein
- high output cardiac failure - high venous return= decr afterload cuz decr Svr, incr CO to keep up MAP
- leg ischemia (if femoral artery access tried to be gained and it avf made- cuz artery blood shunted into vein so less o2 to feed leg
Dx and tx of arteriovenous fistula
Dx- doppler ultrasound
Tx- small avfs close spontaneously, so just observation -or compression can be used
Large avfs- surgery
Dx and Tx of patient with: pain, pallor, paresthesia, poikilothermia, pulselessness, paralysis?
Dx Acute limb ischemia
Tx: immediate heparin infusion (to prevent further arterial thrombus propagation and stasis of blood distal to the block)
This then buys time for imaging (CT angiography to guide thrombolysis (surgical/ medicinal)
Patient has a fall- sternal and back pain now, BP of upper arms= 120 mmHg, lower legs are cold with diminished pulses. Hoarse voice. Dx?
Blunt thoracic aortic injury.
AORTIC ISTHMUS mc site- because its the transition between anterior and posterior area of chest
pt could have had an incomplete rupture of ascending aorta- which explains diff between upper and lower extremity BP
Hoarse voice could be because recurrent laryngeal nerve compression due to expanded adventitia (due to xtra high flow)
Blunt aortic trauma- Dx?
CT angiography best (pass pt under small CT machine, and draw up 3D image of his chest vessels)
Acute cardiac tamponade vs subacute
acute- small heart size and small effusion (pleural effusion seen on CXR
subacute- large heart with large effusion
MC causes of subacute c. tamponade
Malignancy Renal failure (uremia toxins)