cardiothoracic surgery Flashcards
why is CABG needed?
usually due to atherosclerosis leading to MI, angina, stroke, TIA, PAD, mesenteric ischaemia
how is CABG done?
a graft vessel is taken from usually saphenous vein to bypass a blockage. The machine takes blood from RA or VC, pumps through it and adds O2 and removes CO2 and puts it back into AA. Heparin added to prevent clotting. Cardioplegia is achieved through high concentration potassium and cardioversion or adrenaline used to restore heart beat. Recovery around 3m.
what is intimal hyperplasia?
when a vein used in CABG becomes stenosed
what are complications of CABG?
death, stroke, infection, AKI, CI, MI, AF
what is pericardial effusion?
it is fluid in the pericardial sac - transudate, exudate (inflammation), blood, pus, gas
cardiac tamponade when the intracardial pressure is raised
reduces expansion - reduced CO
what are the causes for pericardial effusion?
decreased drainage - transudative - CHF, pulmonary HTN
inflammatory - exudative - infection, AI, injury, uraemia, cancer, medications
acute tamponade - MI, aortic dissection A, trauma
how does pericardial effusion present and how is it investigated?
presentation - SOB, CP, fullness, orthopnoea, hiccups, dysphagia, hoarseness, quiet HS, pulsus paradoxus, hypotension, increased JVP, fever, pericardial rub
ix: echo, fluid analysis, bacterial culture, viral PCR, cytology, tumour markers
how is pericardial effusion managed?
NSAID, aspirin, colchicine, needle pericardiocentesis, or surgical drainage, pericardial window or pericardiectomy is rare
summarise cyanotic heart disease?
right to left shunt - ASD, VSD, PDA, TGA
left>right pressure - Eisenmenger syndrome
complications: arrhythmias, HF, endocarditis, stroke, pulmonary HTN, Eisenmengers
summarise ASD?
usually PFO, ostium secundum or primum, dyspnoea, stroke, AF or flutter, mid systolic crescendo decrescendo murmur, fixed split second heart sound
mx: transvenous catheter closure or open heart sx, anticoagulants
summarise VSD?
pansystolic murmur over LLSE in 3rd ICS
systolic thrill on palpation
mx: transvenous catheter closure, open heart sx, ABx prophylaxis
summarise coarctation of the aorta?
usually around DA, HTN, systolic murmur below left clavicle, BP difference, LV heave, underdeveloped left arm and leg
ix: CT angiography,
mx: emergency surgery at birth if severe, percutaneous balloon angioplasty and stenting, open repair, manage HTN
summarise prosthetic heart valves?
usually a midline sternotomy scar
bioprosthetic - porcine - 10y lifespan
mechanical - 20y lifespan - need lifelong warfarin (can be starr edwards, tilting disc or st jude) - clicks replace S1 and S2
can get thrombus, IE and anaemia
summarise aortic stenosis?
ejection systolic murmur high pitched, crescendo decrescendo in systole, radiate to carotids, slow rising pulse, exertional syncope, narrow pulse pressure
causes: RHD, idiopathic
mx if severe: transcatheter aortic valve through femoral artery under XR guidance - bioprosthetic
summarise mitral regurgitation?
2nd most common
reduced EF, CCF, pansystolic high pitched whistling murmur, 3rd HS
causes: RHD, idiopathic, IE, IHD, CTD
what is the main risk of valve replacement?
IE: 2.5% of surgical valve replacements or 1.5% of TAVI
15% mortality
gram +ve cocci such as staph, strep or entero
summarise heart and lung transplant?
they mostly come from deceased donors - indications are IHD, cardiomyopathy, CHD, COPD, PF, CF, pulm HTN
variations - single or double lung, heart and lung, heart
lateral thoracotomy scars for lung and midline sternotomy for heart
time between the death and donation is cold ischaemic time - cooled down and operation started immediately as soon as transplant arrives
cardioplegia, bypass, cardioversion
post transplant steroids and immunosuppression
complications - cardiac allograft vasculopathy, primary graft dysfunction, bronchiolitis obliterans syndrome, dehiscence of bronchial anastomases
what are the most common types of lung cancer?
non small cell - 80% and small cell - 20%
which lung cancer is most likely to have paraneoplastic syndrome?
SCLC - neurosecretory granules
how does mesothelioma present?
asbestos link, SOB, cough, reduced weight, clubbing, haemoptysis, pneumonia, paraneoplastic syndromes
what is the 2ww criteria for lung cancer?
CXR if >40 with clubbing, lymphadenopathy, recurrent chest infections, increased platelets, lung cancer chest signs
consider if >40 with 2MUS and never smoked or >40 with 1 MUS and smoker - MUS: cough, SOB, fatigue, weight loss, reduced appetite
how is lung cancer investigated?
CXR (hilar enlargement, peripheral opacities, pleural effusion, collapse, staging CT, PET CT, bronchoscopy with endobronchial US, histology and biopsy)
how is lung cancer managed?
NSCLC: segmentectomy, lobectomy, pneumonectomy, RT
SCLC: chemo and RT
endobronchial treatment with stenting and debulking
where does thoracic aortic aneurysm commonly occur?
in the ascending aorta
