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Surgery: Pestana's > Cardiothoracic > Flashcards

Cardiothoracic Flashcards

1
Q

What symptoms can be seen with Vascular rings?

A

(Congenital) Pressure on tracheobronchial tree and esophagus by a ring formed from the aorta and surrounding vessels.
Stridor and episodes of respiratory distress with “crowing” respiration where babies assume hyperextended position (difficulty swallowing).

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2
Q

What should come to mind if only the respiratory symptoms of vascular rings are present?

A

Trahceomalacia (flaccidity of the tracheal support cartilage which leads to tracheal collapse especially when increased airflow is demanded)

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3
Q

How are vascular rings diagnosed?

A

Barium swallow showing atypical esophageal compression

Bronchoscopy showing segmental tracheal compression (rules out diffuse tracheomalacia)

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4
Q

What does surgery do in vascular rings?

A

Divides smaller of the two aortic arches

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5
Q

What is an echocardiogram best used for?

A

Diagnosing morphologic cardiac abnormalities

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6
Q

What group of congenital conditions are characterized by he presence of a murmur, overloading of the pulmonary circulation, and long-term damage to the pulmonary vasculature?

A

Left-t-right shunts

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7
Q

What is an Atrial septal defect? When is it usually recognized?

A

Very minor, low pressure, low volume shunt. Usually recognized in late infancy

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8
Q

What is characteristic of an atrial septal defect?

A

Faint pulmonary flow systolic murmur and fixed split second heart sound

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9
Q

How is a atrial septal defect diagnosed?

A

Echocardiogram

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10
Q

How can a atrial septal defect be managed?

A

Closured can be done surgically or via cardiac catherization

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11
Q

What type of shunt can produce a murmur, but is otherwise asymptomatic?

A

A small, restrictive ventricular septal defect localized low in the muscular septum. These are likely to close spontaneously within the first 2 or 3 years of life

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12
Q

Where are ventricular septal defects more serious?

A

High in the membranous septum

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13
Q

What can happen with a ventricular septal defect?

A

Leads to trouble early on. Failure to thrive within the first few months of life, a loud pansystolic murmur heard at the left sternal border, increased pulmonary vascular makings on CXR,

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14
Q

How are ventricular septal defects managed?

A

Echocardiogram and surgical closure

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15
Q

Symptoms of patent ductus arteriosus; when does it present? how is it diagnosed?

A

Bounding peripheral pulses and “machinery-like” heart murmur. Presents on first days of life. Diagnosed by echo

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16
Q

What is the treatment of Patent ductus arteriosus?

A

For premature babies w/o heart failure: closure with indomethacin.

For those that don’t close, with heart failure or full-term babies: surgical division or embolization with coils

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17
Q

Which are the most common Right-to-left shunts?

A
  1. Tetralogy of Fallot (TOF)

2. Transposition of the great vessels (TGV)

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18
Q

What do Right-to-left shunts share?

A

Murmur, diminished vascular markings in the lung and cyanosis

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19
Q

Signs and symptoms of TOF:

A
  • most common cyanotic anomaly and usually begins at infancy (5-6 years)
  • child small for age
  • bluish hues in lips and tips of fingers
  • -clubbing
  • spells of cyanosis relieved by squatting
  • systolic ejection murmur at 3rd left intercostal space
  • small heart
  • diminished pulmonary vascular markings
  • right ventricular hypertrophy on EKG
20
Q

How is TOF diagnosed? Treated?

A

Diagnosed by Echo, Treated surgically

21
Q

Signs and symptoms of TGV:

A
  • severe trouble early on
  • children are kept alive by VSD, ASD, or patent Ductus but die soon if not fixed
  • 1-2 day old with cyanosis
22
Q

How is TGV diagnosed?

A

Same as TOF

23
Q

Signs and symptoms of Aortic stenosis (AS):

A
  • angina and excertional syncopal episodes

- harsh midsystolic murmurat right second intercostal space and left sternal border

24
Q

When is surgery indicated for AS:

A

-Valvular replacement when gradient > 50mmHg or at first indication of CHF, angina or syncope

25
Q

Signs and symptoms of chronic aortic insufficiency (AI):

A
  • wide pulse pressure

- blowing, high pitched diastolic murmur at second intercostal space and left lower sternal border

26
Q

When is surgery for AI indicated?

A
  • Patients are followed

- Valve replacement at first signs of left ventricular dilation on Echo

27
Q

Signs and symptoms of acute AI:

A
  • sudden development of heart failure

- new, loud diastolic murmur at right second intercostal space

28
Q

What is the most common etiology of acute AI? How is it managed?

A
  • Endocarditis in young drug addicts
  • Emergency valve replacement is indicated and long-term antibiotics needed (prophylaxis for subacute bacterial endocarditis)
29
Q

Signs and symptoms of Mitral stenosis (MS):

A
  • dyspnea on exertion
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • cough
  • hemoptysis
  • low-pitched, rumbling, diastolic apical murmur
  • patients become thin and cachectic
  • patients develop Afib
30
Q

What is the most common cause of MS? How is it managed?

A
  • Rheumatic fever years before presentation
  • Echo needed for workup
  • Valve replacement needed as symptoms become disabling (surgical missurotomy or balloon valvuloplasty)
31
Q

Signs and symptoms of Mitral regurgitation (MR):

A
  • Excerptional dyspnea
  • orthopnea
  • Afib
  • apical, high-pitched, holosystolic murmur radiating to the axilla and back
32
Q

What is the most common cause of MR? How is it managed?

A
  • Valvular prolapse
  • Same workup and surgical indications as MS
  • Valve repair preferred over valve replacement (annuloplasty)
33
Q

What does the typical patient with coronary disease look like?

A

Middle-aged sedentary man with hx of smoking, DM2, hypercholesterolemia, family hx of CAD.

34
Q

Indications for catheterization/ revascularization:

A
  • Progressive, unstable, disabling angina

- One or more vessels with >70% occlusion w a good distal vessel

35
Q

How is CAD managed:

A
  • Single vessel disease (not Left main or LAD): angioplasty and stent
  • Tripple vessel disease: Coronary bypass (Likely from internal mammary artery)
36
Q

what s important about post-op care of heart surgery patients?

A
  • Cardiac output needs to be optimized
  • If low CO then measure pulmonary wedge pressure
  • wedge pressure: 0-3 => Need more IV fluids
  • wedge pressure: >20 ==> Ventricular failure
37
Q

Signs and symptoms of chronic constrictive pericarditis:

How is it managed?

A
  • dyspnea on exertion
  • hepatomegaly
  • ascites
  • “square root” sign
  • equalization of pressures (RA, RV diastolic, PA diastolic, PCW, LV diastolic)
  • Tx with surgical therapy
38
Q

What does a coin lesion on a CXR mean?

A

-80% chance of malignant cancer on a patient > 50 years old. Even higher if there’s a hx of smoking.

39
Q

What is the first thing to do if a coin lesion is seen on a CXR?

A

-Check an older (1-2 year) CXR. An unchanged lesion is less likely to be cancer.

40
Q

What tests should be done first when lung cancer is suspected?

A
  • sputum cytology

- CT scan

41
Q

How is lung cancer diagnosed?

A

Done in sequence until dx made:

  • Cytology
  • Bronchoscopy and biopsies (central lesions)
  • Percutaneous biopsy (Peripheral lesions)
  • Video Assisted Thoracic Surgery and Wedge resection
42
Q

What determines the specific sequence of diagnostic workup?

A
  • Higher probability of cancer
  • Assurance that surgery can be done
  • Chances that surgery may be curative
43
Q

How is small cell cancer of the lung treated?

A

Chemotherapy and radiation. Surgery only plays a role in non-small cell cancer

44
Q

How are central lung lesions treated? peripheral lesions?

A

Central: pneumonectomy
Peripheral: lobectomy

45
Q

How is operability of lung cancer stablished?

A
  • Residual function after resection.
  • minimum FEV1 of 800 mL is needed after resection (Check for FEV1 from each lung and figure out what would remain after surgery)
  • Important if clinical findings of like COPD, SOB, are seen
  • If <800 mL, do not continue testing: patient is not surgical candidate (Chemo and RT used instead)
46
Q

What does surgical cure of lung cancer depend on?

A

Extent of metastases

47
Q

How can metastases of lung cancer be identified?

A
  • CT scan for nodal metastases, mets to other lung or liver
  • CT + PET for actively growing tumor
  • Endobronchial ultrasound (invasive) to sample mediastinal nodes
  • Hilar mest can be resected with pneumonectomy
  • Nodal mets to carina or mediastinum preclude from curative resection

Surgery: Pestana's (13 decks)

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