Cardiothoracic Surg Flashcards
What are indications for thoracoscopic cervico-dorsal sympathectomy?
- Raynaud’s Phenomenon
- Hyperhidrosis
- Reflex sympathetic dystrophy
- intractable angina
What are features of Pancoast tumour
Horner’s syndrome
Brachial neuralgia
Erosion of first rib
opacity over apex of lung in CXR
Most common side effect of thoracoscopic cervio-dorsal sympathectomy
Compensatory sweating over other parts of the body
Symptoms of Horner’s syndrome
miosis - constricted
ptosis
anhidrosis - usually one sided
What are some conditions that can cause constrictive pericarditis
TB
RA
Mediastinal irradiation
viral infection
What are treatment options for stove in chest (flail chest)
intubation
positive pressure ventilation
tracheostomy
fixing the rib fracture with stainless steal wires
What is associated with the poorest prognosis in patients with aortic stenosis?
syncope angina pectoris congestive heart failure palpations exertional dyspnoea
CHF
in a rupture of thoracic aorta associated with chest trauma where is the most common place it ruptures
proximal descending aorta
its where the ligamentum arteriosus lies
- type B dissection
What are the most common congenital heart lesions and how do they present
you can get early or late presentations
R to L shunt is early - blue,
- tetraology of fallot
- transposition of great vessels
L to R shunt is late - breathless
- VSD
- PDA
- ASD
What are common causes of heart lesions in paeds
Maternal diseases
- rubella - PDA, pulmonary artery stenosis
- SLE - Complete heart block (anti-Ro and anti-La Ab)
- Diabetes
Drugs
- warfarin
- fetal alcohol syndrome - VSD, PDA, ASD, tetralogy of Fallot
- lithium
Chromosomal abnormality Down syndrome (T21) - AV septal defect (endocardial cushion), VSD, ASD Edwards syndrome (T18) Patau syndrome (T13) Turner syndrome (45XO) - Bicuspid aortic valve, coarctation of aorta DiGeorge syndrome (22q11.2del) - Truncus arteriosus, tetralogy of Fallot Williams syndrome (7q11.23microdel) - Supravalvular aortic stenosis, pulmonary artery stenosis Noonan syndrome (PTPN11 mutation+) - HOCM, ASD, pulmonary valve stenosis
Characteristics of ASD
80% of ASDs are secundum meaning it involves the FO
clinical features usually includes recurrent chest infections
may present with arrythmias in 4th decade
PE:
ESM ULSE - due to increased flow across pul valve L-R shunt
mid diastolic - LLSE flow across tricuspid
fixed split P2 - delayed pul valve closure
partial AVSD - apical pansystolic from AV regurgitation
CXR - large heart, extended pul art, increased pulmonary vascular markings
ECG - RBBB with R axis deviation
RV dilatation can be present in significant ASD
Characteristics of VSD
most common heart defects 30% SMALL VSD - <3mm - asymptomatic - loud pansystolic murmur can self resolve, maintain dental hygiene
large VSD
>3mm
causes HF - breathless, failure to thrive, recurrent chest infections
hepatomegaly, active precordium
soft pansystolic murmur the softer the larger the VSD
loud P2 as increased pulmonary pressure
manage HF and surgery
PDA
persistent ductus arteriosus
machine like murmur left infraclavicular region
collapsing bounding pulse
paradoxical splitting
closure of PDA - to prevent IE
NSAIDS - indomethacin or ibuprofen
coil or occlusion devices via cardiac catheter at 1yo
surgical ligation
tetralogy of fallot
most common cyanotic congenital heart disease
anterosuperior displacement of the infundibular septum
PROVe pulmonary infundibular stenosis RVH - boot shaped heart Overriding aorta VSD
you may see the child squatting - increase SVR/afterload will reduce R to L shunt
loud harsh ESM at ULSE
clubbing in older children
if severely cyanosed - blalock taussing shunt to increase peripheral BF - tube between the subclavian and pulmonary artery
