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Surgery > Cardiothoracics > Flashcards

Cardiothoracics Flashcards

1
Q

What is often used as a graft in CABG?

A

Saphenous vein

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2
Q

What is the circumflex artery?

A
  • Originates from LCA

- Supplies the LA + posterior LV

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3
Q

What is the LAD artery?

A
  • From LCA

- Supplies the anterior LV + anterior septum

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4
Q

What is the RCA?

A

Supplies the RA, RV, inferior LV and posterior septum

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5
Q

What happens during a CABG?

A
  • Cardiopulmonary bypass
  • Cardioplegia-> stop heart beating
  • Graft inserted-> usually saphenous vein, free graft (whole vessel put somewhere new)
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6
Q

How does CP bypass work?

A
  • Machine takes blood from VC/RA
  • Adds O2 and removes CO2
  • Adds heparin to prevent clotting
  • Blood back to ascending aorta
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7
Q

What is cardioplegia?

A
  • During CABG-> stops heart beating
  • Use high K+ solution into circulation-> spontaneously starts when stop infusion
  • In arrythmias-> CV or temporary pacing
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8
Q

What are the complications of CABG?

A
  • Slow recovery-> resume normal activity in 3 months
  • Death
  • Stroke
  • Infection
  • AKI
  • Cognitive impairment
  • MI
  • AF
  • Vein can stenose over time (intimal hyperplasia)-> arterial less affected so better
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9
Q

What are some congenital cardiac conditions?

A
  • ASD
  • VSD
  • Coarctation of aorta
  • PDA
  • Tetralogy of Fallot
  • Ebstein’s anomaly
  • Transposition of great arteries
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10
Q

What is cyanotic heart disease?

A
  • When deoxygenated blood enters the systemic circulation
  • Due to bypassing the pulmonary circulation + lungs
  • Right to left shunt
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11
Q

What is acyanotic heart disease?

A
  • Left to right shunt-> left heart pressure higher than right
  • Can become right to left if really bad-> Einsenmenger’s
  • EG ASD, VSD, PDA
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12
Q

What is Eisenmenger syndrome?

A
  • Pulmonary pressure becomes higher than systemic

- Blood flows from right heart to left heart and causes cyanosis

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13
Q

What are some complications of congenital heart disease?

A
  • Heart failure
  • Arrhythmias
  • Endocarditis
  • Stroke
  • Pulmonary HTN
  • Eisenmenger
  • Pregnancy complications
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14
Q

What is an atrial septal defect?

A

Hole between 2 atria causing blood flow between

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15
Q

What are the types/causes of atrial septal defect?

A
  • Patent foramen ovale-> not always classified as ASD
  • Ostium secondum-> septum secondum doesn’t close
  • Ostium primum-> septum primum fails to close + causes AVSD
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16
Q

What is the pathophysiology of atrial septal defect?

A
  • Acyanotic-> LA to RA shunt
  • Blood oxygenated-> flows through pulmonary vessels + lungs
  • Increased flow-> right overload + strain-> pulmonary HTN + RHF
  • Can lead to Eisenmenger-> shunt reverses
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17
Q

How does atrial septal defect present?

A
  • Asymptomatic + pick up on antenatal scans
  • Older-> dyspnoea, stroke, DVT, AF, atrial flutter
  • Murmur-> mid-diastolic, crescendo-decrescendo, loudest at left sternal border
  • Fixed split second heart sound-> blood in RV that has to empty before pulmonary valve closes
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18
Q

How is atrial septal defect managed?

A
  • Watch + wait if small
  • Surgery-> percutaneous transvenous catheter closure or open
  • Anticoagulants-> reduce stroke risk
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19
Q

What is ventricular septal defect?

A
  • Hole in septum between ventricles

- Causes left to right shunt-> can switch if severe

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20
Q

What is ventricular septal defect associated with?

A
  • In isolation
  • Down’s
  • Turner’s
  • After MI-> ischaemia
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21
Q

How does ventricular septal defect present?

A
  • Asymptomatic + pick up on scans

- Pansystolic murmur-> left lower sternal border at IC spaces 3 + 4

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22
Q

What causes a pansystolic murmur?

A
  • VSD
  • Mitral regurgitation
  • Tricuspid regurgitation
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23
Q

What causes a mid-diastolic murmur?

A

-Atrial septal defect

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24
Q

How is ventricular septal defect managed?

A
  • Surgical-> transvenous catheter closure or open heart

- Antibiotic prophylaxis before surgery-> for IE

25
Q

What is coarctation of the aorta?

A

Narrowing of aortic arch-> usually around ductus ateriosus

26
Q

What is coarctation of the aorta associated with?

A
  • Turner’s syndrome

- Recurrence after treatment

27
Q

What is the pathophysiology of coarctation of the aorta?

A
  • Narrowing of arch
  • Reduced pressure of blood flowing to distal arteries
  • Increased pressure proximally-> heart + three branches
28
Q

What are the three artery branches on the aortic arch?

A
  • Brachiocephalic
  • Left common carotid
  • Left subclavian
29
Q

How does coarctation of the aorta present?

A
  • Often HTN in adulthood-> 1st sign
  • Systolic murmur-> below left clavicle + scapula
  • 4 limb BP-> high from arteries with supply before narrowing + low in those after
  • LV heave
  • Underdeveloped left arm-> reduced left subclavian artery flow
  • Underdeveloped legs
  • CT angiography shows
30
Q

How is coarctation of the aorta managed?

A
  • CT angiography can confirm
  • None if symptom free
  • Percutaneous balloon angioplasty +/- stent
  • Open heart
  • Medical management HTN
31
Q

What is pericardial effusion?

A
  • Excess fluid in pericardial sac
  • Acute or chronic
  • Transudate (low protein) or exudate (inflammation)
  • Can be blood, pus, gas etc
32
Q

What is the pathophysiology of pericardial effusion?

A
  • Pericardium/pericardial sac surrounds heart
  • Potential space-> usually <50ml
  • Effusion-> fills space + pressure on heart
  • Harder to expand when filling (diastole)
  • Tamponade-> raised intra-pericardial pressure + affects heart function
33
Q

What is the function of the pericardium?

A
  • <50ml fluid
  • Separates heart from mediastinum
  • Lubrication-> allow heart to beat without friction
  • Is a potential space-> usually touch
34
Q

What is cardiac tamponade?

A
  • pericardial effusion large enough to affect heart function
  • reduces filling + cardiac output
  • emergency + needs drainage
35
Q

What causes transudative pericardial effusion?

A

Transudative (low protein)-> CHF or pulmonary HTN (increased venous pressure + reduced drainage)

36
Q

What causes exudative pericardial effusion?

A
  • Infection-> TB, HIV
  • Autoimmune-> SLE, RA
  • Injury-> MI, surgery
  • Uraemia-> secondary to renal impairment
  • Cancer
  • Medications-> MTX
37
Q

What can cause pericardial effusion due to bleed?

A
  • Rupture of heart or aorta from MI
  • Trauma
  • Type A aortic dissection
38
Q

How does pericardial effusion present?

A
  • Can be slow or quick
  • Chest pain, SOB, fullness feeling, orthopnoea
  • Worsens + press on structures
  • Hiccups-> phrenic nerve
  • Dysphagia-> oeseophagus
  • Hoarse voice-> recurrent laryngeal
  • Quiet heart on auscultation
  • Pulsus paraxodus
  • Hypotension
  • Raised JVP
  • Pericardial rub-> infection
39
Q

How is pericardial effusion diagnosed?

A
  • Echo-> size + function

- Fluid analysis-> protein, bacterial, PCR, cytology, tumour markers

40
Q

How is pericardial effusion managed?

A
  • Treat underlying cause + drain
  • Inflammatory-> NSAIDs, colchicine, steroids
  • Needle pericardiocentesis-> US guided
  • Surgical-> pericardial window
41
Q

What is thoracic aortic aneurysm?

A
  • Dilation of thoracic aorta
  • Ascending-> 4.5cm<
  • Descending-> 3.5cm
42
Q

Where does blood collect in a false aortic aneurysm?

A
  • Inner intima + media layers ruptured

- Within adventitia-> outer layer

43
Q

What is the cause of thoracic aortic aneurysm?

A
  • After surgery
  • RTA
  • Infection
44
Q

Where does blood collect in a true aortic aneurysm?

A

3 layers are intact but dilated so within vessel

45
Q

How does thoracic aortic aneurysm present?

A
  • Asymptomatic
  • Chest pain
  • Back pain
  • Trachea/left bronchus compression-> cough, SOB, stridor
  • Hiccups
  • Dysphagia
  • Hoarse voice
46
Q

How is thoracic aortic aneurysm diagnosed?

A
  • Echo

- CT or MRI angiogram

47
Q

How is thoracic aortic aneurysm managed?

A
  • Risk factor reduction
  • Surveillance
  • TEVAR
  • Open surgery
48
Q

What are the complications of thoracic aortic aneurysm?

A
  • Aortic dissection
  • Ruptured aneurysm
  • Aortic regurgitation
49
Q

What are the symptoms of ruptured thoracic aortic aneurysm?

A
  • Haematemesis
  • Haemoptysis
  • Tamponade
  • Severe chest/back pain
  • Haemodynamic instability
  • Collapse
  • Death
50
Q

How is ruptured thoracic aortic aneurysm managed?

A

Emergency replacement of aorta with graft

51
Q

What are some indications for heart transplant?

A
  • CHF
  • IHD
  • Cardiomyopathy
  • Congenital heart disease
52
Q

What are some indications for lung transplant?

A
  • COPD
  • Pulmonary fibrosis
  • CF
  • Pulmonary HTN
53
Q

When is heart or lung transplant done?

A

Within 6 hours of donor death

54
Q

How is heart or lung transplant performed?

A
  • Donor organ given cold ischaemic time-> cooled to reduce damage
  • CP bypass
  • Implant
  • Reperfused + warmed
55
Q

What is required after heart or lung transplant?

A

Lifelong immunosuppressant-> avoid rejection

56
Q

What are some side effects of immunosuppressants?

A
  • Diabetes
  • Osteoporosis
  • Cushing’s
  • Infections
  • SKin cancer
  • Non-Hodgkin lymphoma
57
Q

What is a complication of heart transplant?

A

Cardiac allograft vasculopathy-> narrowing of CAs in donor heart

58
Q

What are some complications of lung transplant?

A
  • Primary graft dysfunction-> oedema, damage, hypoxia
  • Bronchiolitis obliterans syndrome
  • Dehiscence of bronchial anastamosis

Surgery (8 decks)

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