Cardiothoracic Flashcards

1
Q

Indications for CABG?

A

> 70% left main stem stenosis
symptomatic patients with >70% proximal LAD stenosis
symptomatic patients with >70% in all three vessels
concomitant valvular disease which requires replacement
vessel disease in a diabetic

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2
Q

CABG procedure?

A

midline sternotomy
conduit (saphenous vein, left internal mammary artery, radial artery) is anastomosed

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3
Q

Complications of CABG?

A

death
stroke
re-sternotomy for bleeding or tamponade
chest infection
atrial fibrillation
wound infection
renal failure

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4
Q

Mechanical vs Bioprosthetic valves?

A

mechanical:
>20yrs
require warfarin
noisy

bioprosthetic:
10yrs
no need for warfarin
silent

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5
Q

Causes of aortic stenosis?

A

‘wear and tear’ calcific degeneration
bicuspid valve
rheumatic disease

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6
Q

Presentation of aortic stenosis?

A

SAD
syncope
angina
dyspnoea

ejection systolic crescendo-decrescendo murmur loudest in aortic area radiating to carotids
heaving apex beat

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7
Q

Investigations in aortic stenosis?

A

ECG (left ventricular hypertrophy)
TTE (degree of stenosis)

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8
Q

Indications for valve replacement in aortic stenosis?

A

mean gradient across valve >40 mmHg
symptomatic

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9
Q

Surgical options in aortic stenosis?

A

open surgical aortic valve replacement via thoracotomy
transcatheter aortic valve implantation (TAVI)

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10
Q

Causes of mitral regurgitation?

A

mitral valve prolapse due to ischaemia (papillary muscle rupture)
rheumatic disease
infective endocarditis
CT disorders

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11
Q

Presentation of mitral regurgitation?

A

acute MR -> CCF
chronic MR -> exertional dyspnoea
orthopnoea
displaced apex beat
AFib

pansystolic murmur loudest at apex and radiating to axilla
+/- third heart sound

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12
Q

Investigations for mitral regurgitation?

A

TTE
TOE

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13
Q

Indications for surgery in mitral regurgitation?

A

acute MR
severe chronic MR

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14
Q

Surgical approach to mitral regurgitation?

A

open valve replacement
endovascular Mitra clip if open surgery contraindicated

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15
Q

Causes of mitral stenosis?

A

rheumatic heart disease most common

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16
Q

Presentation of mitral stenosis?

A

rumbling mid-diastolic murmur at apex
signs of RHF
AFib
left parasternal heave
tapping apex beat

17
Q

Investigations for mitral stenosis?

A

CXR (enlarged left atrium)
TTE
TOE

18
Q

Surgical approach for mitral stenosis?

A

percutaneous valvotomy
open mitral valve replacement

19
Q

Causes of aortic regurgitation?

A

rheumatic disease
Marfan’s and CT disorders
large vessel vasculitis
infective endocarditis
aortic dissection

20
Q

Presentation of aortic regurgitation?

A

early diastolic murmur heard better on end expiration and leaning forwards

acute AR (dissection or endocarditis)
signs of LVF
chronic AR:
wide pulse pressure
water hammer pulse

21
Q

Investigations for aortic regurgitation?

A

CXR (cardiomegaly)
TTE

22
Q

Indications for surgery in aortic regurgitation?

A

acute AR is surgical emergency
chronic AR if left ventricular dilatation >5.5cm

23
Q

Classification of pneumothorax?

A

primary spontaneous
secondary spontaneous
traumatic

tension
non-tension

24
Q

Features of pneumothorax?

A

dyspnoea
chest pain
tachypnoea
hyper resonant hemithorax
absent breath sounds

25
Q

Investigations for pneumothorax?

A

CXR
CT thorax more accurate for sizing

26
Q

Complications of pneumothorax?

A

tension pneumothorax
pneumomediastinum
haemo-pneumothorax
recurrent pneumothorax

27
Q

Mx of pneumothorax?

A

conservative if small and asymptomatic (O2 and repeat CXR)

if >2cm rim of air:
needle aspiration in second intercostal space midclavicular line
chest tube insertion in 4th-5th intercostal space in mid-axillary line

VATS for bullectomy and pleurodesis

28
Q

Causes of secondary spontaneous pneumothorax?

A

chronic airway and alveolar disease
systemic CT disease
malignant lung and chest diseases

29
Q

Borders of the safe triangle for chest drain insertion?

A

lateral border of pectoralis major
anterior border of latissimus dorsi
fifth intercostal space

30
Q

Insertion of chest tube technique?

A

insert just above the rib to avoid the neurovascular bundle
attach to underwater seal
never lift underwater seal above the bed to avoid water entering the pleural space