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
ascedning aorta diameter
descending aorta diameter
ascedning aorta diameter –> less than 4.5cm
descending aorta diameter–> less than 3.5cm
complications thoracic aortic aneurysm
aortic dissection
ruptured aneurysm
aortic regurigitation if near aortic valvee
signs of thoracic aortic aneurysm rupture
haemetemesis
haemoptyisis
cardiac tamponade
= blood in mediastinum going into these palces
ejection systolic murmur
high pitch
crescendo-decrescendo character
slow rising pulse and narrow pulse pressure
may complain exertional syncope
what valve issue
aortic stenosis
casues of aortic stenosis
idiopathic age related calcifications
rheumatic heart disease
pansystolic high pitch murmur
may hear 3rd heart sound
valve with issue
mitral regurgitation
mitral regurgitation can casue what
congestive heart failure =
leaking casues a reduced ejection fraction and backlog of blood
casues of mitral valve regurgitation
idiopathic wekaening with age
ischemic heart disease
infective endocarditits
rheumatic heart disease
Connective tissue disorders - Ehlers danlos syndrome , marfan syndrome
what organisms normally vcasues infective endocariditis
gram postigie
enterococcus
staphylcoccus
streptococcus
complications of mechanical heart valve
need be on life long warfarin
thrombus fomration
infective endocarditits
haemolysis casuing anemia
which heart valve needs life long warfarin and what inr
mechanical
INR 2.5-3.5= higher than AF targer which is 2-3
