cardiology surgery incorrects Flashcards
patient with a heart attack undergoes cardiac catheterization. sudden onset hypotension, tahcycardia, flat neck veins and back pain
diagnosis?
1st line investigation?
management?
retroperitoneal hematoma
CT scan of abdomen and pelvis with contrast!!!!
bed rest, monitoring, IV fluids
in ACUTE mitral regurgitation, what is the atrial size? LV size? left ventricular ejection fraction?
left atrial and lv are normal as there is no time for dilation. as result the pressure transmitted to lungs causing pulmonary edema -> crackles.
lv ejection fraction is normal or increased
pregnant woman experiencing palpitations. midsysolic murmur at upper left sternal border. echo shows a dilated right ventricle
most likely cause?
atrial septal defect - left to right shunting via atriums cause RIGHT sided volume overload. (risk of right sided heart failure.
(as atriums on top and ventricles below). atrial stretching -> a fib.
echo shoes dilated atrium and ventricle
NOT a VSD or PDA as these are distal to atrioventricular valves. left to right shunt as well, but it just means that more blood is pumped from right ventricle to lungs -> LEFT SIDED volume overload
patient was undergoing a laparascopic cholecystectomy and immediately the needle was placed in the peritoneal space, patient developed severe bradycardia, and AV block.
most likely cause?
peritoneal stretching!!!
laparascopic surgery requires insufflation of CO2 in to abdomen. intraabdominal pressure -> stretch receptors on abdomen -> increase in vagal tone -> bradycardia, av block, sometimes asystole
patient after a fall, CXR shows widened mediastinum. severe chest pain. most likely diagnosis?
other findings in this situation?
what investigation confirms the diagnosis??
blunt aortic injury
pseudocoarctation - upper extremity HTN and lower extremity hypotension
hoarse voice - left recurrent laryngeal nerve compression
CT angiography!!
patient just had heart surgery.
clicking when he bends over, on palpation of sternum, there is rocking and clicking.
most likely diagnosis?
management?
sternal dehiscence
may also be diagnosed via displaced sternal wire on radiography.
abdominal pain, fever and leukocytosis shortly after abdominal aortic aneurysm repair. most likely diagnosis?
3 months of fatigue, low grade fevers and palpitations. now has acute left sided weakness.
brain imaging reveals multiple small, acute infarcts.
echo shows a mass in left atrium.
most likely diagnosis?
intracardiac tumour!! - aka myxoma!!
embolization of tumour fragments -> stroke, acute limb ischemia
valve obstruction -> murmur, dyspnea, syncope
constitutional symptoms - fever, weight loss
not infective endocarditis - as echo would show valvular vegetations not a mass
not rhuematic heart disease as mitral stenosis develops yearss after intial event
multiple embolic strokes due to endocarditis
investigation for malignancy -> CT scan of chest and abdomen, colonoscopy
hypercoagulability work-up
patient with chronic back pain, intermittent bilateral heel pain. impaired spinal mobility and limited chest expansion
exertional shortness of breath and apical impulse diplaced to left
most likely diagnosis?
aortic regurgitation!!!
complication of ankylosing spondylitis!!!!
Revised cardiac risk index
for cardio surgery.
learn it, especially when no further testing is needed
following cardiothoracic surgery. signs of infection of the sternum
diagnosis and management?
acute postoperative mediastinitis
chest and sternal imaging!!!
INTRAVENOUS antibiotics and surgical debridement
expected hemodynamic alterations in mitral stenosis -> elevated pulmonary artery pressures and normal LV pressure
surgery is indicated in patients with severe MR both symptomatic and ASYMPTOMATIC if LVEF is </= ?
60%
how does a left ventricular aneurysm present months after a myocardial infarction?
ECG findings?
echo findings
HEART failure!!!! most common -> raised jvp, bibasilar crackles.. heart failure because the aneurysm has distorted the ventricle wall and reduced the ejection fraction
less commonly- ventricular arrhythmia, systemic embolization, chest pain
ECG - persistent ST elevation and deep Q waves!!!!
echo = thin and diskinetic ventricular wall
