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06 - absite > Chapter 26: Cardiac > Flashcards

Chapter 26: Cardiac Flashcards

1
Q

What kind of shunts cause cyanosis?

A

Right to left shunts

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2
Q

Why do children squat in right to left shunts?

A

To increase SVR and decrease right to left shunts

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3
Q

R -> L shunts cause cyanosis. What can this lead to?

A

Polycythemia, strokes, brain abscess, endocarditis

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4
Q

Shift from L -> R shunt to R -> L shunt

A

Eisenmenger’s syndrome

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5
Q

What causes Eisenmenger’s syndrome?

A

Increasing pulmonary vascular resistance (PVR) and pulmonary HTN; this condition is generally irreversible

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6
Q

What do left to right shunts cause?

A

CHF: manifests as failure to thrive, increased HR, tachypnea, hepatomegaly; CHF in children, hepatomegaly

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7
Q

What is the first sign of a left to right shunt?

A

Hepatomegaly

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8
Q

L -> R shunts (CHF)

A

VSD, ASD, PDA

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9
Q

R -> L shunts (cyanosis)

A

tetralogy of Fallot

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10
Q

Connection between descending aorta and left pulmonary artery (PA); blood shunted away from lungs in utero

A

Ductus arteriosus

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11
Q

Connection between portal vein and IVC; blood shunted away from liver in utero

A

Ductus venosum

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12
Q

Fetal circulation:

  • To placenta
  • From placenta
A

to placenta: 2 umbilical arteries

from placenta: 1 umbilical vein

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13
Q

MC congenital heat defect

A

VSD (L -> R shunt)

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14
Q

% of VSD that close spontaneously

A

80% (usually by age 6 months)

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15
Q

Usually cause symptoms after 4-6 weeks of life, as PVR decrease, and shunt increased

A

Large VSDs (can get CHF - tachypnea, tachycardia - and failure to thrive)

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16
Q

Medical treatment: VSD

A

Diuretics and digoxin

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17
Q

Usually timing of repair:

  • Large VSDs (shunt > 2.5)
  • Medium VSDs (shunt 2-2.5)
A

Large: 1 year of age
Medium: 5 years of age

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18
Q

Most common reason for earlier repair of VSD

A

Failure to thrive

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19
Q

L->R shunt

  • Usually symptomatic when shunt > 2 -> CHF (SOB, recurrent infections)
  • Can get paradoxical emboli in adulthood
  • Medical tx: diuretics and digoxin
A

Atrial septal defect

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20
Q

Most common (80%); centrally located ASD

A

Ostium secundum

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21
Q

Can have mitral valve and tricuspid valve problems; frequent in Down’s syndrome

A

Ostium primum (or atrioventricular canal defects or endocardial cushion defects)

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22
Q

Usual timing of repair ASD

A

1-2 years of age (age 3-6 months with canal defects)

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23
Q

VSD
Pulmonic stenosis
Overriding aorta
RVH

A

Tetralogy of Fallot

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24
Q

MC congenital heart defect that results in cyanosis

A

Tetralogy of Fallot

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25
Q

Medical treatment: tetralogy of fallot

A

Beta-blocker

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26
Q

Usual timing of repair: tetralogy of fallot

A

3-6 months of age

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27
Q

Repair: tetralogy of fallot

A

RV outflow tract obstruction (RVOT) removal, RVOT enlargement, and VSD repair

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28
Q

L-> R shunt

- Requires surgical repair through left thoracotomy if it persists

A

Patent ductus arteriosus (PDA)

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29
Q

Causes PDA to close; rarely successful beyond neonatal period

A

Indomethacin

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30
Q

Most common cause of death in the United States

A

Coronary artery disease

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31
Q

Risk factors: coronary artery disease

A

Smoking, HTN, male gender, family history, hyperlipidemia, diabetes

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32
Q

Medical treatment: coronary artery disease

A

Nitrates, smoking cessation, weight loss, statin drugs, ASA

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33
Q

Branches of left main coronary artery branches

A

Left anterior descending (LAD) and circumflex (Cx) arteries

34
Q

Location of most atherosclerotic lesions

A

Most atherosclerotic lesions are proximal

35
Q

Complications of myocardial infarction

A
  • VSR (ventricular septal rupture)

- Papillary muscle rupture

36
Q

Hypotension, pansystolic murmur, usually occurs 3-7 days after MI; have a step-up in oxygen content between right atrium and pulmonary artery secondary to L->R shunt

A

VSR (ventricular septal rupture)

37
Q

Why is there a step up in oxygen content in ventricular septal rupture?

A

Step-up in oxygen content between the right atrium and pulmonary artery secondary to L->R shunt.

38
Q

Dx / Tx: ventricular septal rupture

A

Dx: echo
Tx: IABP to temporize, patch over septum

39
Q

Get severe mitral regurgitation with hypotension and pulmonary edema; usually occurs 3-7 days after MI

A

Papillary muscle rupture

40
Q

Dx / Tx: papillary muscle rupture

A

Dx: echo
Tx: IABP to temporize, replace valve

41
Q

Restonosis rate in drug-eluting stent

A

Restenosis in 20% at 1 year

42
Q

5 year potency of saphenous venous graft

A

80% 5-year patency

43
Q

What is the internal mammary artery a branch of?

A

Subclavian artery

44
Q
  • Best conduit for CABG (>95% 20 year potency when placed to LAD)
  • Collateralizes with superior epigastric artery
A

Internal mammary artery

45
Q

For CABG procedure: causes arrest of the heart in diastole; keeps the heart protected and still while grafts are placed

A

Potassium and cold solution cardioplegia

46
Q

Best indications for CABG

A
  • > 70% stenosis significant for most areas except left main disease.
  • Left main disease (> 50% stenosis considered significant
  • 3 vessel disease (LAD, Cx, and right coronary artery)
  • 2 vessel disease involving the LAD
  • Lesions not amenable to stenting
47
Q

High mortality risk factors in coronary artery disease

A

Pre-op cardiogenic shock (#1 risk factor).
Emergency operations.
Age.
Low EF.

48
Q

Most common valve lesion, calcification produces stenosis

A

Aortic stenosis

49
Q

What type of valve does not require anticoagulation?

A

Bioprosthetic tissue valves

50
Q

When would you consider bioprosthetic tissue valves?

A

For patients who want pregnancy, have contraindication to anticoagulation, are older (>65) and unlikely to require another valve in their lifetime, or have frequent falls

51
Q

How long does bioprosthetic tissue valve last?

A

Lasts 10-15 years -> not as durable as mechanical valves

52
Q

Why are bioprosthetic tissue valves contraindicated in children and younger patients?

A

Because of rapid calcification in children and young patients, use of tissue valves is contraindicated in those populations.

53
Q

Valvular lesion most from degenerative calcification

A

Aortic stenosis

54
Q

Cardinal symptoms of aortic stenosis

A
  • DOE: mean survival 5 years
  • Angina: mean survival 4 yrs
  • Syncope: mean survival 3 yrs
55
Q

Worst of the cardinal symptoms of aortic stenosis

A

Syncope: mean survival is 3 years

56
Q

Indications for operation in aortic stenosis

A

When symptomatic (usually have a peak gradient > 50 mmHg and a valve area

57
Q

Valve disease causing dilation of the left ventricle

A

Mitral regurgitation (MR)

58
Q

Key index of disease progression in patients with MR

A

Ventricular function

59
Q

Arrhythmia common in mitral regurgitation

A

Atrial fibrillation: is common, in end-stage disease, pulmonary congestion occurs

60
Q

Indications for operation in mitral regurgitation

A

When symptomatic or if severe mitral regurgitation

61
Q

Rare now, most from rheumatic fever

- Get pulmonary edema and dyspnea

A

Mitral stenosis

62
Q

Indication for operation in mitral stenosis

A

When symptomatic (usually have valve area

63
Q

Often used as 1st procedure for mitral stenosis

A

Balloon commissurotomy to open valve often used as 1st procedure (not as invasive)

64
Q

Symptoms of endocarditis

A

Fevers, chills, sweats

65
Q

Most common site of prosthetic valve infections

A

Aortic valve endocarditis

66
Q

Most common site of native valve infections

A

Mitral valve endocarditis

67
Q

Responsible for 50% of cases of endocarditis

A

Staphylococcus aureus

68
Q

Most common organisms causes endocarditis in drug abusers

A

Pseudomonas

69
Q

Most common site of endocarditis in drug abusers

A

Left sided endocarditis

70
Q

Initial treatment of endocarditis

A

Medical therapy first: successful in 75%, sterilizes valve in 50%

71
Q

Indications for surgery in endocarditis

A

Failure of antimicrobial therapy, severe valve failure, perivalvular abscesses, pericarditis

72
Q

Most common benign tumor of the heart

A

Myxoma; 75% in LA

73
Q

Most common malignant tumor of the heart

A

Angiosarcoma

74
Q

Most common metastatic tumor to the heart

A

Lung cancer

75
Q

Tx: coming off cardiopulmonary bypass and aortic root vent, blood is dark and aortic perfusion cannula blood is red

A

Tx: ventilate the lungs

76
Q

Have the lowest oxygen tension of any tissue in the body

A

Coronary veins: due to high oxygen extraction by myocardium

77
Q

Swelling of the upper extremities and face

- Most cases secondary to lung CA invading the SVC

A

Superior vena cava (SVC) syndrome

78
Q

Treatment of tumors causing SVC syndrome

A

These tumors are unresectable since the tumor has invaded the mediastinum.
- Tx: emergent XRT

79
Q

Mediastinal bleeding: when do you need to re-explore after cardiac procedure?

A

> 500 cc for 1st hour or > 250cc/hr for 4 hours

80
Q

Risk factors for mediastinitis

A

Obesity, used of bilateral internal mammary arteries, diabetes

81
Q

Tx: mediastinitis

A

Debridement with pectoralis flaps, can also use omentum

82
Q

Pericardial friction rub, chest pain, SOB
- EKG: diffuse ST-segment elevation in multiple leads

Treatment?

A

Post-pericardiotomy syndrome

TX: NSAIDS, steroids

06 - absite (44 decks)

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