Cardiothoracic Flashcards
Suspect this in a baby with stridor and episodes of respiratory distress with “crowing” respiration, during which the baby assumes a hyperextended position. They also have some difficulty swallowing.
Vascular rings exerting pressure on the tracheobronchial tree and esophagus. (Ps If only the respiratory symptoms are present, one should think of tracheomalacia.)
How is a morphological cardiac anomaly best diagnosed?
Echocardiogram
What PE characteristics will be observable when the heart has a left-to-right shunt?
Presence of a murmur, overloading of the pulmonary circulation, and long term damage to pulmonary vasculature
Suspect this in a patient with a minor, low-pressure, low-volume shunt. Patients typically grow into late infancy before it is recognized. A faint pulmonary flow systolic murmur and fixed split second heart sound are characteristic. A history of frequent colds is elicited.
Atrial septal defect
What will happen with Small, restrictive ventricular septal defects low in the muscular septum
Will produce a heart murmur, but otherwise few symptoms. They are likely to close spontaneously within the first 2 or 3 years of life.
Suspect this in a patient who in the first few months has a “failure to thrive,” a loud pansystolic murmur best heard at the left sternal border, and increased pulmonary vascular markings on chest x-ray.
Ventricular septal defect
Suspect this in a pt who becomes symptomatic in the first few days of life. There are bounding peripheral pulses and a continuous “machinery-like” heart murmur.
Patent ductus arteriosus
What can you use to achieve closure of a patent ductus arteriosus, provided the baby is premature and hasn’t gone into CHF.
Indomethacin
How do you fix a baby with a PDA who is full term, in CHF, or failed to close with indomethacin?
Surgical division (or embolization with coils)
What PE characteristics will you see in a right-to-left shunt?
Murmur, diminished vascular markings in the lung, and cyanosis
Although this heart anomaly is crippling, it often allows children to grow up into infancy. It is also the most common cyanotic anomaly, and thus any exam question in which a 5- or 6-year-old is cyanotic is bound to be this.
Tetralogy of Fallot
Suspect this in a 5 or 6 year old who is small for their age, have a bluish hue in the lips and tips of their fingers, clubbing, and spells of cyanosis relieved by squatting. There is a systolic ejection murmur in the left third intercostal space, a small heart, diminished pulmonary vascular markings on chest x-ray, and EKG signs of right ventricular hypertrophy.
Tetralogy of Fallot
Suspect this diagnosis in a 1- or 2-day-old child with cyanosis who is in deep trouble.
Transposition of the great vessels
How are babies with transposition of the great vessels kept alive for as long as they are?
Atrial septal defect, ventricular septal defect, or patent ductus (or a combination). But they die very soon if not corrected.
This heart condition produces angina and exertional syncopal episodes. There is a harsh midsystolic heart murmur best heard at the right second intercostal space and along the left sternal border.
Aortic stenosis
This heart condition produces wide pulse pressure and a blowing, high-pitched, diastolic heart murmur best heard at the second intercostal space and along the left lower sternal border, with the patient in full expiration.
Chronic aortic insufficiency
In what kind of patient might you see acute aortic insufficiency?
Young drug addicts, due to endocarditis
Suspect this in young drug addicts who suddenly develop congestive heart failure and a new, loud diastolic murmur at the right second intercostal space.
Acute aortic insufficiency s/p endocarditis
This heart condition produces dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, cough, and hemoptysis. There is a low-pitched, rumbling diastolic apical heart murmur. As it progresses, patients become thin and cachectic and develop atrial fibrillation.
Mitral stenosis
What history is associated with mitral stenosis?
Rheumatic fever, many years before presentation
Suspect this in a pt with exertional dyspnea, orthopnea, and atrial fibrillation. There is an apical, high-pitched, holosystolic heart murmur that radiates to the axilla and back.
Mitral regurgitation
When is surgical intervention for coronary disease indicated?
If one or more vessels have 70% (or greater) stenosis and there is a good distal vessel. Preferably, the patient should still have good ventricular function (you cannot resuscitate dead myocardium). The general rule is the simpler the problem, the more it is amenable to angioplasty and stent; whereas more complex situations do better with surgery.
Suspect this in a pt w/ dyspnea on exertion, hepatomegaly, and ascites, and shows a classic “square root sign” and equalization of pressures (right atrial, right ventricular diastolic, pulmonary artery diastolic, pulmonary capillary wedge, and left ventricular diastolic) on cardiac catheterization.
Chronic constrictive pericarditis
What are the chances that a coin lesion found on x-ray is malignant in a pt over 50?
80%, more if he’s a smoker
First thing to do w/ a pt who has a coin lesion in the lung on chest x-ray
Look at older chest x-rays. If coin lesion is unchanged, it’s not cancer and you don’t have to do the work up for cancer
After new coin lesion or infiltrate on chest X-ray makes you suspect lung cancer, what two non-intrusive tests should be ordered?
Sputum cytology and CT scan (including chest and liver)
Tx of small cell cancer of the lung
Chemoradiation. Operability and possibility of surgical cure applies only to non-small cell cancer.
