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Surgery > cardio > Flashcards

cardio Flashcards

1
Q

things to focus on in the PE -important stuff

A

General assessment of overall condition
Skin: open sores/rashes (any infection source)

Mouth/teeth (again infection source)

Lungs - esp if suspected heart failure

Swelling/ulcers in extremities

Pulses

Varicosities (particularly legs for conduit)

Cardiac exam: JVD, rub, murmur, S3 or S4

Scars on chest/legs- raditation causes scar tissue on the chest that can cause problems

Swelling in extremities

Basic abdominal/neuro exam

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2
Q

stress echo is used to look particularly at

A

coronary artery

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3
Q

transesophageal echo helps look at the

A

valves

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4
Q

carotid ULS is used for

A

helps to insure this individual is not going to have a stroke during surgery

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5
Q

ABI are used to tell you about

A

PID

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6
Q

troponin indicative of NSTEMI

A

> .05 suspect unstabel angina

Troponin 0.10 → 0.20

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7
Q

class I indications for coronary bypass

A

<50% left main coronary artery
>70% proximal LAD and Cx stenosis

multi-vessel disease in a asymptomatic ot because stents don’t last as long as graphs do

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8
Q

low risk for bypass

A

<4%

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9
Q

when would you take most meds until

when would you stop ACE/ARB/Metformin

A

Continue ASA, beta-blockers, non-nephrotoxic meds until surgery
Stop ACE/ARB/metformin ~48h prior

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10
Q

what is a special consideration and might need to stop these earlier

A

Stop anticoagulation - many kinds!

Each one is different for how long, usually 2-7 days

Sometimes need a heparin drip if critical stenosis which is stopped right before surgery

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11
Q

CABG

A

coronary artery bypass grafting

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12
Q

mortality for CABG if low or average risk

A

Summit is around 0.7% for low/average risk

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13
Q

LIMA

A

left internal mammarry artery

is used in CABG

also known as the internal thoracic artery

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14
Q

CABG use these vessels

A

LIMA

Greater saphenous vein for other grafts

some facilities use the radial artery

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15
Q

what is a on-pump

A

This may be performed either with the help of a heart-lung bypass machine (traditional CABG, performed via a thoracotomy),

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16
Q

on pump

A

on a beating heart (off-pump CABG, and minimally invasive direct CABG).

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17
Q

Intra-aortic balloon pump

A

can insert at the end of case if a pt is having a hard time coming off bypass

when the heart is pushing blood out it is deflated and when the heart is relaxed and filling it inflates so that blood can not come back into the aorta

when the balloon deflates it creates a vacuum decreasing after-load

this is left in for a couple days until the heart heals

inserted after cardiogenic shock as well as a bridge to surgery

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18
Q

what is dressler syndrome

what is the tx

A

Post-pericardiotomy syndrome

autoimmune febrile pericarditis or pleuritis that may occur 1–6 weeks following

Fever, malaise
Chest pain, with or without associated dyspnea
Tachycardia
Pericardial friction rub

2-4 weeks after surgery

seen with fever and plueritic chest pain

NSAIDs controversial postoperatively ‘
Usually give colchicine

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19
Q

heart arrhythmia seen as a complication of CABG

A

MCC
afibb MC?

peak on post opp day TWO

all pts are on telemetry

want the rate to be lower

might have them go on amioderone

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20
Q

complications of CABG

A

afibb
CVA
AKI
cardiac tamponade

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21
Q

med management post op

A

ASA, statin, and beta-blocker

Postoperative long-term treatment with antiplatelet drugs (e.g., 100 mg aspirin 1-0-0) is required to reduce the risk of subsequent myocardial ischemia!

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22
Q

typically discharge pt on day following CABG

A

Typically discharge patients on POD #4 or 5 barring complications

wound healing post op week 2

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23
Q

murmur of AS

A

Murmur: systolic crescendo-decrescendo vs holosystolic at right upper sternal border

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24
Q

average survival withou A-S t valve replacement

A

Average survival without valve replacement is 2-3 years once severe

Best heard in the 2nd right intercostal space

Valsalva and standing from squatting decreases or does not change the intensity of the murmur (in contrast to hypertrophic cardiomyopathy).

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25
Q

mneumonic for AS

A

SAD (syncope, angina, dyspnea)

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26
Q

mechanical valve replacement require

A

coumadin for life

not the case with a biprostehtic valve

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27
Q

TAVR

A

Transcatheter AVR (TAVR): patients with high surgical risk or contraindication

can deploy valve through the groin

much safer than surgical

medicare covers TAVR for medium to high risk pts

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28
Q

TAVR common complciations

A

higher need for pacemaker with TAVR

greater risk of heart block

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29
Q

common causes of aortic insufficiency

A

connective tissue disorder (marfans)

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30
Q

AI murmur

A

early diastolic

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31
Q

AI surgical indications

A

moderate to servere with reduced EF <50%

32
Q

primary MR

A

MCC rheumatic heart disease especially in other parts of the world

33
Q

secondary MR

A

CAD

34
Q

surgical indications for MR

A

symptomatic and EF >30%

if <30% greater surgical risk

if asymptomatic but lower EF might consider surgery

35
Q

replacing the valve vs repair

A

repairs last longer than
replacing the valve but with

endocaritits you have to replace the valve

36
Q

MCC of mitral valve stenosis

A

Almost always from rheumatic fever

37
Q

management of mitral valve stenosis

A

Often managed by Interventional Cardiology with percutaneous mitral balloon commissurotomy

might relpace valve

38
Q

78yo male presents to ED with SOB and altered mental status, with PMH of COPD, liver cirrhosis, CHF, cocaine and EtOH abuse, and HTN

pulses paradoxus and sinus tach

A

EKG-pulses paradoxis

ECHO AND XRAY – cardiomegaly

–> pericardial effusion NEED >1CM effusion on echon for centisis

The fluid can be either bloody (e.g., following aortic dissection) or serous (usually idiopathic)

BECK’S triad
hypotension, muffled heart sounds, distended neck veins!

39
Q

tx of pericardial effusion

A

Typically surgical approach is subxiphoid pericardial window
Leave pericardial drain in place until drainage slows

need this if you have less than 1cm of

40
Q

what determines the tx of tamponade

A

unstable—> pericardicentesis

hemodynamically stable–> pericardial window

41
Q

Pericardial window

A

an incision in the peridardium is made that allows continual drainage from the pericardial space into the pleural cavity to prevent a cardiac tamponade
Commonly indicated for effusion due to underyling malignancy
Hemodynamic monitoring

42
Q

presentation of AD

A

It commonly occurs in hypertensive males between the 4th and 6th decade. Patients complain of a sudden onset and severe pain radiating into the thorax, back, or abdomen. Initial chest x-ray shows a widened mediastinum.

43
Q

diagnostic imaging in AD

A

The diagnosis is confirmed with a contrast-enhanced CT in stable patients and transesophageal echocardiography in unstable patients.

44
Q

what determines tx of AD

A

type A is the emergency
(ascending)

type B is less urgent

(descending still getting blood flow)

tear of the intima media adventitia

45
Q

surgical tx of AD

A

takes like 7 hours
Open surgery with a polyester graft implantation

Possibly, endovascular treatment: aortic stent implantation (only in type B dissections and if the operative risk is too high)

46
Q

other than HTN what is common etiology of AD

A 
HTN
Pregnancy
Cocaine
Chest trauma
Iatrogenic
Syphilitic aortitis
Arteriosclerosis
HLD
Smoking
Many congenital factors, including connective tissue disorders
47
Q

type B AD management

A

Target value of the systolic blood pressure is ∼ 90–120 mm Hg
IV labetalol, esmolol, or propanolol (best initial )
Followed by IV sodium nitroprusside (vasodilator)

48
Q

MC locations of AD

A

~2.2 cm above the aortic root
Distal to the left subclavian artery
Aortic arch

49
Q

Pneumomediastinum (or mediastinal emphysema)

air can be seen

A

throughout
even in the neck

check for crepitus in a young man that presentes with SOB

coughing –> ruptured alveoli–> eep

50
Q

tx of Pneumomediastinum

A

Treatment is usually observation

Esophageal injuries more commonly require intervention or close following

51
Q

Mallory-Weiss syndrome:

A

longitudinal laceration at the GE junction

non-transmural

Often from varices, portal HTN

Hematemesis, melena, dizzy, abd pain

Upper endoscopy (really a GI thing)

52
Q

Boerhaave syndrome

A

esophageal rupture from force or trauma

True surgical emergency
Mortality of 35-40%

53
Q

triad of boerhaave

A

Mackler triad of

chest pain,

vomiting,

and subcutaneous emphysema

54
Q

mallory weiss presentations

A

Patients typically present with a history of

epigastric pain and

hematemesis.

55
Q

diagnostic of mallory weiss

A

Esophagogastroduodenoscopy

chest xray for booerhaves

56
Q

what stage of lung cancer can you use lobectomy & mediastinal lymph node

A

Stages I/II

57
Q

Stage IIIA lung cancer mgnmt

A

: potentially resectable disease: multimodality

58
Q

Stage IV lung cancer mgnmt

A

Stage IV: chemotherapy

59
Q

MC sxs of lung cancer

A 
Cough
Chest pain
Shortness of breath
Hemoptysis
Wheezing
Dysphagia/Hoarseness
Recurring infections such as bronchitis and pneumonia
Weight loss and loss of appetite
Fatigue
60
Q

Metastatic signs and symptoms:

A

NEW bone or joint pain

neuro sxs
mets to brain

61
Q

85% of all lung cancers are

A

NSCLC

62
Q

NSCLC is

A

NSCLC comprises a number of cancer types, including peripheral adenocarcinoma and central squamous cell carcinoma.

63
Q

VATS

A

video assisted thorascopy

Can be used for a bunch of things

64
Q

classifications of pleural effusion

A

classified as transudative
due to congestive heart failure, liver cirrhosis

exudative
pneumonia, malignancies, PE), depending on the underlying cause.

65
Q

presentation of pleural effusion

A

Typically presents

with dyspnea and a dry cough.

66
Q

tx of plerual effusion usually involves

A

Typically recommend ultrasound-guided thoracentesis (most often by Interventional Radiology) with pleural fluid analysis if it’s the first time

67
Q

pleaural fluid serum LDH in trans vs exudative

A

<2/3 Upper LMN
= trans

> 2/3 upper LMN is exudative

68
Q

cylothorax

A

lymph filling up the lung

somatostatin and octreotide

69
Q

tension ptx presentation

A

Hypotension
hypoxia
chest pain
dyspnea

70
Q

Catamenial ptx:

A

endometrial tissue in the plura

(rare) women 30-40yo, within 48h of menstruation, right-sided
Thought to be from endometriosis of the pleura

71
Q

pleurodesis

A

mechanical or talc

can basically cause the lung to stick to the wall

72
Q

tx of ptx usually involves

A

VATS with bleb resection

73
Q

chest tubes on xray should be

A

inside the wall

74
Q

pleura vac

A

never take a chest tube off of this!

direct communication to the lung and will introduce air if taken off

NEVER CONNECT CHEST TUBE TO WALL SUCTION can cause lung to herniate

connect it the the pleruavac

if you need to change the pleuravac clamp it first

75
Q

heimlick valve

A

can be used if pt wants to go home

76
Q

chest tubes should always be set to

A

If a chest tube is on suction, it is connected to a canister, on CONTINUOUS suction (not intermittent), usually -20cm H2O

77
Q

water seal means …

A

Water seal” means off suction because there is a column of water that “seals” the end of the chest tube system (don’t want air getting back in, it’s a closed system

water or suction

Surgery (18 decks)

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