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
