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Fiser absite > Chapter 26 – Cardiac > Flashcards

Chapter 26 – Cardiac Flashcards

1
Q

What do right to left shunt cause?

A

Cyanosis; this can lead to polycythemia, strokes, brain abscess, endocarditis, hypertrophic osteoarthropathy

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2
Q

How do children compensate for right to left shunt?

A

Squat to increase SVR and decrease right to left shunting

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3
Q

What is Eisenmenger’s syndrome?

A

Shift from left to right to right to left shunt; sign of increasing pulmonary vascular resistance and pulmonary hypertension, generally irreversible

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4
Q

What to left to right shunts cause?

A

CHF; can manifest as failure to thrive, tachycardia, tachypnea, hepatomegaly

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5
Q

What is the first sign of left to right shunting in children?

A

Hepatomegaly

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6
Q

What causes a left to right shunt?

A

VSD, ASD, PDA

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7
Q

What causes a right to left shunt?

A

Tetralogy of Fallot, transposition of the great vessels, truncus arteriosus

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8
Q

What is ductus arteriosus?

A

Connection between descending aorta and left pulmonary artery, blood shunted away from lungs in utero

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9
Q

What is ductus venosum?

A

Connection between portal vein and IVC, blood shunted away from liver

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10
Q

How many umbilical arteries and veins are there?

A

Two umbilical arteries, one umbilical vein

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11
Q

What is the most common congenital heart defect?

A

Ventricular septal defect

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12
Q

VSD causes what type of shunt?

A

Left to right

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13
Q

What is the course of VSDs?

A

Most close spontaneously by six months; large VSD’s cause symptoms after 4 to 6 weeks as PVR decreases and shunt increases; get CHF, failure to thrive, tachypnea and tachycardia

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14
Q

Medical treatment for VSD’s?

A

Diuretics and digoxin

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15
Q

What is the timing of repair of the VSDs?

A

With CHF: most common reason for repair; before school-age if does not close spontaneously; PVR greater than 4-6 Woods units; PVR greater than 10-12 to Woods units contraindication for repair

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16
Q

What type of shunt does ASD cause?

A

Left to right

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17
Q

What is ostium secundum?

A

Most common, centrally located, PFO; can have anomalous pulmonary venous return, IVC can connect the left atrium

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18
Q

What is ostium premium?

A

Also known as atrioventricular septal defects or endocardial cushion defects; defect more inferior, can get mitral valve and coronary sinus defects, caused by deficiency in remnants of left horn of sinus venosum

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19
Q

What are possible complications as an adult with ASD?

A

Can get paradoxical emboli and arrhythmias

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20
Q

What is the medical treatment of ASD?

A

Diuretics and digoxin

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21
Q

Timing of repair of ASD?

A

Volume overload, before school-age if does not close spontaneously, PVR greater than 10 to 12 woods units contraindication for repair; all need repair

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22
Q

What is the Tetralogy of Fallot?

A

VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy

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23
Q

What type of shunt does T of F cause?

A

Right to left

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24
Q

What is the most common congenital heart defect that results in cyanosis?

A

T of F

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25
Q

What is the medical treatment for T of F?

A

Beta blocker

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26
Q

What is the timing of operation for T of F?

A

Increasing cyanosis; Blalock-Taussig shunt can be used for palliation to delay repair

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27
Q

What is definitive repair for T of F?

A

RV outflow tract obstruction division, patch enlargement of outflow tract, VSD repair

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28
Q

What is the most common syenite disorder presenting in the first week of life?

A

Transposition of the great vessels

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29
Q

What type of shunt does transposition of the great vessels cause?

A

Right to left

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30
Q

Where does the mixing usually happen with transposition of the great vessels?

A

Most often through ASD; VSD or PDA can serve as additional mixing conduit

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31
Q

Medical treatment for transposition of the great vessels?

A

Atria septostomy, PGE1

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32
Q

When is the optimal time and method of repair for transposition of the great vessels?

A

Early switch with coronary reimplantation posteriorly in the first 2 to 3 weeks of life while LVIV is still getting high resistance

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33
Q

What type of shunt does truncus arteriosus cause?

A

Right to left

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34
Q

How do neonates present with truncus arteriosus?

A

CHF, 80% die in first year

35
Q

Medical treatment for truncus arteriosus?

A

Diuretic, digoxin, fluid restriction, after load reduction

36
Q

Timing and method of repair of truncus arteriosus?

A

Onset of tachypnea, sign of decreased PVR; Repair VSD, remove PA from aorta, repair aorta, restore RV outflow tract with Dacron graft to PA

37
Q

What type of shunt does a PDA cause?

A

Right to left

38
Q

What is the treatment for PDA?

A

Indomethacin causes PDA to close, rarely successful beyond the neonatal period; usually requires surgical repair through left thoracotomy, PGE1 keeps PDA open

39
Q

Where does coarctation of the aorta occur?

A

Just distal to the left subclavian artery

40
Q

What syndrome is coarctation of the aorta associated with?

A

Turner syndrome

41
Q

What is rib notching caused by with coarctation of the aorta?

A

From the IMA and intercostal collaterals

42
Q

How can coarctation of the aorta present?

A

Profound CHF

43
Q

What is the treatment for coarctation of the aorta?

A

All require treatment, try to perform end to end repair

44
Q

What is the treatment for univentricular heart?

A

Fontan procedure to direct all vena cava blood to the PA, best approach is to attach the right atrium and SVC to the PA directly; normal PA pressure and normal PVR’s prerequisite

45
Q

What is the treatment for hypoplastic left heart?

A

Norwood procedure; main PA becomes outlet tract for what is to become single ventricle physiology

46
Q

What is anomalous pulmonary venous return?

A

Goes to SVC instead of left atrium; most often seen in patients with ASD’s

47
Q

What are vascular rings? how do they present? What is the treatment?

A

Double aortic arch most common, may manifest as recurrent pulmonary infections or dysphagia, trachea most commonly affected; divide smaller arch through left thoracotomy

48
Q

What is the most common cause of death in the United States?

A

Coronary artery disease

49
Q

What are risk factors for coronary artery disease?

A

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

50
Q

What is medical treatment for coronary artery disease?

A

Nitrates, smoking cessation, weight-loss, statin drugs, aspirin

51
Q

What is the most common type of circulation of the heart?

A

Right dominant – posterior descending artery comes off of right coronary artery

52
Q

What is left dominant circulation?

A

Posterior descending artery comes off the circumflex coronary artery

53
Q

Are most atherosclerotic lesions proximal or distal?

A

Proximal

54
Q

What are complications of myocardial infarction?

A

VSD - 5 to 7 days post MI, papillary muscle rupture, free wall rupture - most likely to occur 3 to 7 days post MI, LV aneurysm – most commonly occurs after large, transmural, interior,

55
Q

What is the rate of restenosis after PTCA?

A

20 to 30% in less than one year

56
Q

What is the patency rate of saphenous vein graft?

A

80 to 90% at five years

57
Q

What is the patency of internal mammary artery?

A

Greater than 90% at 10 years; the best conduit for CABG

58
Q

What causes arrest of the heart in diastole and keeps the heart protected and still while grafts are placed during CABGs procedure?

A

Potassium and cold solution cardioplegia

59
Q

What are high mortality risk factors for CA BG?

A

1 emergency operations, age, reoperation, low EF

60
Q

What is the most common valve lesion?

A

Aortic stenosis

61
Q

What is the most common cause of valve dysfunction?

A

Rheumatic heart disease; mitral most commonly involved valve

62
Q

What are the indications for tissue valves?

A

Patients who want pregnancy, contraindication to anticoagulation, older and unlikely to require another valve, frequent falls

63
Q

Contraindications for tissue valves?

A

Because of rapid calcification in children and young patients use is contraindicated in these populations, chronic renal dialysis

64
Q

Mitral stenosis causes what symptoms?

A

Pulmonary congestion, can develop mural thrombi with 50% to cerebral circulation

65
Q

What is the key index of disease progression in patients with mitral regurgitation?

A

Ventricular function; in end-stage disease, left atrium becomes less compliant leading to pulmonary congestion and right-sided heart failure

66
Q

Indications for operation for mitral regurgitation?

A

Symptoms may not develop until after irreversible heart dysfunction has occurred, repair indicated for any functional class II heart failure

67
Q

Physiologic effects of aortic stenosis?

A

Adequate CO and normal systemic pressures maintained until late in disease; LV hypertrophy leads to decreased ventricular compliance and pulmonary congestion, LV failure ultimately develops

68
Q

Cardinal symptoms of a aortic stenosis?

A

Angina 65%, syncope 25%, heart failure

69
Q

Physiologic effects of aortic insufficiency?

A

Volume loading strain on LV, LV becomes dilated, increased wall tension

70
Q

Indications for operation for aortic insufficiency?

A

Functional class II heart failure

71
Q

What is the most common site of prosthetic valve infections with endocarditis?

A

Aortic valve

72
Q

What is the most common site of native valve infections?

A

Mitral valve

73
Q

Bacteria responsible for endocarditis?

A

Most commonly staph aureus 50%

74
Q

Indications for surgery for endocarditis?

A

Failure of antimicrobial therapy, valve failure, perivalvular abscess, pericarditis

75
Q

What patients require periprocedural endocarditis prophylaxis?

A

Prosthetic valves, rheumatic heart disease, congenital cardiac malformations, mitral valve prolapse with regurgitation, previous history of bacterial endocarditis; first-generation cephalosporin

76
Q

What is the most common benign tumor of the heart? Malignant? Metastatic?

A

The nine – myxoma, malignant – angiosarcoma, metastatic – lung

77
Q

What do you do if a patient coming off of cardiopulmonary bypass with aortic root vent blood that is dark and aortic perfusion cannula blood that is red?

A

Ventilate the lungs

78
Q

What veins have the lowest oxygen tension of any tissue in the body?

A

Coronary veins due to high oxygen extraction by myocardium

79
Q

What is superior vena cava syndrome? Treatment?

A

Swelling of the upper extremities and face most commonly secondary to lung cancer invading the SVC tumors unresectable, radiation

80
Q

What is idiopathic hypertrophic subaortic stenosis?

A

Too much volume causing pulmonary edema due to stenosis region; not enough afterload will cause the aortic outflow tract to collapse also resulting in pulmonary edema

81
Q

When do you need to re-explore for mediastinal bleeding?

A

Greater than 500 mL for first hour or greater than 250 mL/h for four hours

82
Q

What is postpericardiotomy syndrome? Treatment?

A

Pericardial friction rub, fever, chest pain, SOB; treatment – NSAIDs, steroids

83
Q

What is the first sign of cardiac tamponade on echo?

A

Decreased right atrial diastolic filling

Fiser absite (58 decks)

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