Cardiothoracic Flashcards
whats pericardial effusion
potential space of the pericardail cavity fills with fluid - can be pus, trasnudates, exudates, blood, gas- associated with acterial infection
amount and locartion can vary
inward pressure on heart makes heart diffifuclt to expand ion diastole
cardiac tamponade
effusion large enough to raise the pericardail pressure so have less filling in diastole and so have less cardiac output in systole - emergency- rapud draiage required
casues of pericardail effusion thats transudative - low protein
transudate- low protein :
rasied venous pressure reduces drainage from the pericardial cavity casues are pulmonary hypertension and congestive heart failure
casues of pericardial effusion thats exudative - high protein -
may occur in inflammatory process affecting the pericardium- pericarditits
infection- TB, HIV, coxsackie virus, epstein barr virus others
autoimmune and inflammatory- SLE , rheumatoid arthritis
injury to pericardium- after MI, open heart surgery, trauma
uraemia secondary to renal impairment
cancer
meds- methotrexate
bleeding cxasues of pericardial effusion
these are rapid onset with cardiac tamponade normally
WHERE HAVE RUPTURE OF HEART OR AORTA
MI
aortic dissection type A
trauma
presentation of pericardial effusion
onset symptoms shpws onset of how quickly effusion develops
cardiac tamponade: haemodynamically compromise and collaspe
may be asymtpoamtic until pressure rises:
sob
chest pain
feeling fullness in chest
orthopnoea
may compress structures:
compress phrenic nerve–> hiccups
compress oesophagus–> dysphagia
compress recurrent laryngeal nerve–> hoarse voice
quiet heart sounds
pulsus paradoxus–> large fall bp on inspiration
hypotension
fever in pericarditis
pericardial rub in pericarditis
diagnsois pericardail effusion
echo first
fluid analysis
management pericardai leffusion
treat underlying cause - inflamamtion may give aspirin, nsaids, colchicine, steroids
drain effusion if needed- needle pericardiacentesis
or srugical drainage, pericardail window/ pericardiectomy(rare)
thoracic aortic aneurysm
dilation of thoracic aorta
risk factors of aortic aneurysm
male
increased age
smoking
hypertension
fam hist
CVD
marfan/ other connective tissue disorders
presentation thoracic aortic aneurysm
often asymtpomatic
can take up space in mediatinum
- chest/back pain
- hiccups - phrenic nerve compression
- trachea/left bronchus compression- SOB, cough, stridor
- oesophageal compression= dysphagia
recurrent laryngeal nerve compression = hoarse voice
how to diagnose thoracic aortic aneurysm
echocardiogram- first line
CT/MR angiogram
whats a fasle and a true aneurysm
false - intima and media breached and blood containted between the adventitia and its dilated = dissection
true- all layers dilated
how to manage thoracic aortic aneurysm
modify risk facotrs- stop smoking, healthy diet and exercise. optomise treatment of ht, diabetes, hyperlipidaemia
surveillanece
thoracic enovascualr aortic repair= catheter and sten in via femoral artery
open surgery - remove section and graft
wheres thoracic aortic aneurysm most common
ascending aorta
