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Surgery > Cardiothoracic > Flashcards

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

Surgery (10 decks)

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