CARDIOTHORACIC SURGERY

Question 1

Atrial septal defect

Answer 1

L –> R shunt (overload pulmonary vasculature)

Faint pulmonary flow SYSTOLIC murmur
Fixed split 2nd heart sound

Question 2

Ventricular septal defect

Answer 2

L –> R shunt

Failure to thrive
Pansystolic murmur at left sternal border
Pulmonary vascular markings on CXR

Question 3

Patent ductus arteriosus

Answer 3

L –> R shunt

Machine like heart murmur with bounding peripheral pulses
No CHF yet? Close with indomethacin (NSAID)

Question 4

Tetralogy of Fallot

Answer 4

R –> L shunt

Often found in 5-6 year olds with cyanosis

Small for their age
Bluish hue to lips/fingers
Clubbing
Cyanosis relieved by squatting

Systolic ejection murmur at left 3rd intercostal space
Small heart
Diminshed pulmonary vascular markings

EKG shows right ventricular hypertrophy
Diagnose with echocardiogram

Question 5

Transposition of the great vessels

Answer 5

R –> L shunt

Keep kids alive with ASD, VSD, PDA - use PGE to do this

Echocardiogram for diagnosis

Question 6

Aortic stenosis

Answer 6

Angina and exertional syncope
Mid systolic heart murmur at aortic valve area

Echocardiogram workup

Valvular replacement if gradient is >50mmHg

Question 7

Aortic insufficiency

Answer 7

Wide pulse pressure
Blowing diastolic heart murmur

Replace valve if echocardiogram shows LV dilatation

Question 8

What do patients with prosthetic valves need?

Answer 8

Abx prophylaxis for subacute bacterial endocarditis

Question 9

Mitral stenosis

Answer 9

Rheumatic fever that has damaged the heart valve

Dyspnea on exertion
Orthopnea
Paryxosmal nocturnal dyspnea
Cough and hemoptysis

Rumbling diastolic murmur

Patients become thin and cachetic
Develop atrial fibrillation

Surgical repair with commissurotomy or balloon valvuloplasty

Question 10

Mitral regurgitation

Answer 10

Valvular prolapse

Exertional dyspnea
Orthopnea
Atrial fibrillation

Holosystolic heart murmur

Question 11

When is intervention indicated for coronary disease?

Answer 11

When 1+ vessels have 70% or more stenosis and there is a good distal vessel

Question 12

Chronic constrictive pericarditis

Answer 12

Dyspnea on exertion
Hepatomegaly
Ascites
Equalization of heart pressures

Question 13

1st thing to do if you see a coin lesion on CXR?

Answer 13

Look for an old CXR and compare the sizes

80% chance of being malignant in people over 50

No old CXR? Then sputum cytology and CT scan that includes chest and liver

Question 14

Small cell cancer of lung

Answer 14

No surgery

Chemo and radiation

Question 15

How to determine if non-small cell lung cancer patient is a surgical candidate

Answer 15

Determine FEV1 and the fraction that comes from each lung
Figure out what would be left after your resection
If it’s