Cardiothoracic surgery. Flashcards
What are the 3 major complications of mechanical heart valves
Thrombus
Infective endocarditis
Haemolysis causing anaemia
What is the initial investigation of choice for diagnosing congenital heart defects
Echo
What are some types of cyanotic congenital heart diseases
When deoxygenated blood enters systemic circulation- bypass lungs - a right to left shunt
-Ventricular septal defect
-Atrial septal defect
-Patent ductus arteriosus
-Transposition of the great arteries
Usually people aren’t cyanotic from these as left side pressure is much greater than right so left flows to right more
What are the different types of atrial septal defects and what is their presentation
Patent foramen ovale- foramen ovale doesn’t close
Ostium secondum- septum secondum doesn’t close
Ostium primum- septum primum doesn’t close
Blood moves from left atrium to right due to pressur e - increased flow to right= right sided heart failure and pulmonary HTN
dyspnoea, stroke, AF
Mid-systolic crescendo decrescendo murmur loudest at upper left sternal border
Fixed split of the second heart sound
What is the management of atrial septal defects
Surgical closeure - percutaenous transvenous catheter or open heart surgery
Anticoags- aspirin, warfarin and DOACs used to reduced risk of clots and stroke
What are the different types of ventricular septal defects and what is their presentation
Can be associated with Down’s/ Turner’s syndrome
can happen after MI
Left to right shunt causing pulmonary hypertension and right sided HF
Presentation
Asymptomatic can present in adultnood
Pan systolic murmur more prominent in left lower sternal border in 3rd and 4th intercostal spaces- systolic thrill
Management: Transvenous catheter closure or open heart surgery
Increased risk of Infective endocarditis in these patients- antibiotic prophlaxis
What are the features and management of coarctation of the aorta
Narrowing of the aortic arch can be associated with Turner’s syndrome
Increases pressure in vessels above the narrowing- heart, brachiocephalic, left common carotid and left subclavian artery
Systolic murmur below left clavicle and scapula
Higher BP in limbs off the aorta before narrowing
-left ventricular heave, underdevelopment of left arm and legs
CT angiography needed
Percutaenous balloon angioplasty with stent insertion
Open surgical repair
What are the causes of a transudative pericardial effusion
Increased venous pressure causing reduced drainage
-Congestive HF
-Pul hypertension
What are the causes of an exudative pericardial effusion
Inflammatory processes
-Infection - TB, HIB, Coxsackie, EBV
-Autoimmune/ inflam
-Injury (MI, trauma, surgery)
-Uraemia - renal impairment
-Cancer
-Meds - methotrexate
What other features can be present due to pericardial effusion
Hiccups- if effusion compresses phrenic nerve
Dysphagia if effusion compresses oesophagus
Hoarse voice- if effusion compresses the recurrent laryngeal nerve
What signs are present in a pericardial effusion
-Quiet heart sounds, pulsus paradoxus, hypotension, raised JVP, fever, pericardial rub
What is the choice of investigation in a pericardial effusion
ECHO
Then fluid analysis to show underlying cause
High protein content - exudate
Bacterial culture
Viral PCR
Cytology and tumour markers
What is the management of a pericardial effusion
Inflam causes- treat with Aspirin, NSAIDs, colchicine, steroids
Drain effusion
Needle Pericardiocentesis
Surgical drainage
What is a false aneurysm
When the two layers (intima and media) rupture and there is dilation of the aorta but blood is contained within the outer - adventicia layer - due to trauma
What is a true aneurysm
3 layers of the aorta are intact but dilated
Aortic dissection is where blood enters between the intima and media layers
What are the normal sizes of the thoracic aorta before aneurysm
Ascending aorta- 4.5cm
Descending aorta 3.5cm
What are the features of a rupture aortic aneurysm
Bleeding into the mediastinum
Haematemsis
Haemoptysis
Cardiac tamponade
Severe chest/ back pain, collapse, death
Emergency surgery needed with synthetic graft
What investigation is first line in pneumothorax
Erect chest X-ray
No lung markings
What is the management of a pneumothroax
Erect CXR to diagnose
Measure size- horizontally from lung edge to inside chest wall at level of hilum
No SOB and less than 2cm rim of air on CXR
-No treatment and follow up in 2-4 weeks
SOB and/ or more than 2cm rim of air
Aspiration and reassessment
When aspiration fails twice- chest drain
Surgical management if this fails/ penumo reoccurs- pleurodesis
Where is a chest drain inserted for a pneumothorax
Triangle of safety
5th ICS
Midaxillary line
Anterior axillary line
During normal respiration the water will rise and fall due to pressure changes
Air will also bubble through the drain to show it is working- will stop bubbling when pneumothroax resolves
What are the 2 main complications of a pneumothorax
Air leaks around the drain site
Surgical emphysema - air collects in subcutaenous tissues
What are the signs of a tension pneumo
One way valve- air goes in can’t get out
Tracheal deviation away from side it’s on
Reduced air entry
Increased resonance to percussion
Tachycardia
Hypotension
What are the pros and cons of biprosthetic vs mechanical valves
Bi prosthetic- life span approx 10 yrs
Mechanical- long life span but need life long warfarin with iNR target 2.5-3.5
When is a TAVI used
Patients are too high risk for open valve replacement
Catheter into femoral artery
Biprosthetic valve so patients don’t need warfarin
