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Pestanas Surgical Notes > Chapter 6: Cardiothoracic Surgery > Flashcards

Chapter 6: Cardiothoracic Surgery Flashcards

1
Q

What types of symptoms do vascular rings produce?

A

Symptoms of pressure on the tracheobronchial tree and pressure on the esophagus.

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2
Q

What are some of the first symptoms of vascular rings?

A
  1. Stridor

2. Episodes of respiratory distress with “crowing” respiration during which the baby assumes a hyperextended position

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3
Q

What are some of the latter symptoms of vascular rings?

A

The latter revolve around some difficulty swallowing

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4
Q

What if only the respiratory symptoms occur, is it vascular rings?

A

No, one should think of tracheomalacia

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5
Q

What does a barium swallow show with vascular rings?

A

Shows typical extrinsic compression from the abnormal vessel

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6
Q

What does bronchoscopy show with vascular rings?

A

Segmental tracheal compression and rules out diffuse tracheomalacia.

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7
Q

What does the surgery do for babies with vascular rings?

A

Divides the smaller of the 2 aortic arches.

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8
Q

What is the best way to diagnose morphologic cardiac anomalies (congenital or acquired)

A

Echocardiogram

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9
Q

What do all Left to Right shunts have in common?

A
  1. Presence of a murmur
  2. Overloading of the pulmonary circulation
  3. Long-term damage to the pulmonary vasculature
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10
Q

Describe the pressure and volume of a Atrial septal defect

A

Very minor, Low pressure, low volume shunt

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11
Q

What is the characteristic sound of an atrial septal defect?

A
  1. A soft mid systolic murmur along the upper sternal border

2. wide, fixed split second heart sound

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12
Q

What is diagnostic for an ASD?

A

Echocardiogram

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13
Q

How can an ASD be corrected?

A

Closure can be achieved surgically or by cardiac cauterization

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14
Q

What type of VSD produces a slight murmur but with few other symptoms?

A

Small, restrictive VSD low in the muscular septum produce a heart murmur, but otherwise few symptoms

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15
Q

How can a small, restrictive VSD be corrected?

A

Likely to close spontaneously within the first 2 or 3 years of life

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16
Q

Where are VSD typically located?

A

High in the membranous septum

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17
Q

When does a VSD present?

A

Trouble early on.

Within the first few months there will be “failure to thrive”

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18
Q

What does a VSD murmur sound like?

A

A loud pansystolic murmur best heard at the left sternal boarder and increased pulmonary vascular markings on chest X-ray

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19
Q

What are some complications that may occur with Left to Right shunts?

A
  1. Pulmonary hypertension
  2. Right ventricular hypertrophy due to the pulmonary hypertension
  3. Left ventricular hypertrophy due to more blood returning to the L heart than normal
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20
Q

Why does Right ventricular hypertrophy occur in a L–> R shunt?

A

Pulmonary hypertension increases the AFTERLOAD the R. ventricle must contract against to eject blood, which causes CONCENTRIC hypertrophy of the R. ventricle.

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21
Q

Why does Left ventricular hypertrophy occur in a L–> R shunt?

A

Increases Left ventricle volume (preload) and produces an eccentric type of L. ventricular hypertrophy

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22
Q

What is there a danger of occurring in a L–> R shunt if it goes uncorrected?

A

Eisenmenger syndrome. Reversal of the hunt because the pressure in the right side of the heart is greater than the pressure in the left.
Signs= cyanosis and clubbing of fingers

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23
Q

What is the most common congenital heart defect?

A

VSD

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24
Q

What other diseases are associated with the presence of a VSD?

A
  1. Cri du chat syndrome

2. Fetal alcohol syndrome

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25
Q

What are the next steps for a VSD?

A

Do an echocardiogram and surgical closure. 50% spontaneously close.

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26
Q

Most common ASD?

A

Patent foramen ovalue (secundum type)

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27
Q

ASD is associated with what other conditions?

A
  1. Fetal Alcohol Syndrome

2. Down syndrome (primum type)

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28
Q

What is a paradoxical embolus and what is it associated with?

A

Is a venous clot material in the systemic circulation and associated with ASD

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29
Q

When do Patent ductus arterioles become symptomatic?

A

Symptomatic in the first few days of life.

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30
Q

What does a PDA sound like?

A
  1. Bounding peripheral pulses

2. Continuous machine-like murmur

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31
Q

What is diagnostic for a PDA?

A

Echocardiogram

32
Q

When can a PDA be closed with a medication and what is that medication?

A

In premature infants who have not gone into congestive heart failure, closure can be achieved with indomethacin

33
Q

When do babies with a PDA need surgery?

A
  1. babies who do not close
  2. Babies who are already in failure
  3. Full term babies
    Need surgical division or radiological embolization with metal coils
34
Q

What is differential cyanosis?

A

Child has a pink upper body and a cyanotic lower body due to a reversal of shunt in PDA

35
Q

What does indomethatcin do?

A

Inhibits prostaglandin E2, a vasodialator

36
Q

How are all the Right to left shunts similar?

A
  1. Presence of a murmur
  2. Diminished vascular markings
  3. Cyanosis
37
Q

What is the most common cyanotic anomaly?

A

Tetralogy of Fallot

38
Q

What are some of the characteristics of Tetraology of Fallot?

A

Children are small for their age, have a bluish hue in the lips and tips of their fingers, clubbing and spells of cyanosis relieved by squatting.

39
Q

What does the murmur sound like for Tetralogy of Fallot?

A
  1. Systolic ejection murmur in the left third intercostal space (crescendo/deccrescendo) results in RV outflow tract obstruction
  2. small heart
  3. diminished pulmonary vascular markings on chest xray
  4. EKG show signs of RVH
40
Q

What is diagnostic for Tetralogy of Fallot?

A

Echocardiogram, surgrical repair is done

41
Q

How are kids with transposition of the great vessels kept alive?

A

The kids are kept alive by an ASD, VSD or PDA. but die very soon if not corrected

42
Q

When is a transposition diagnosed?

A

1 or 2 day old child with cyanosis who is in deep trouble, ask for echocardiogram

43
Q

What are the chances a coin lesion found on chest X-ray is malignant in people over 50?

A

80% and even higher if there is a history of smoking.

44
Q

If a coin lesion is found what is the first step that should be done when trying to determine if it is malignant?

A

Finding an older ( a year or two) chest X-ray shows the same unchanged lesion then it is not cancer.

45
Q

If you suspect lung cancer what is the first steps to diagnosis?

A
  1. Chest xray ( which may have been order because of persistent cough or hemoptysis)
46
Q

What are two noninvasive tests that should be done if you have suspected cancer of the lung?

A
  1. sputum cytology

2. CT scan (including chest and liver)

47
Q

What does diagnosis of cancer of the lung REQUIRE?

A
  1. bronchoscopy
  2. biopsies (for central lesions)
  3. percutanous biopsy (for peripheral lesions)
48
Q

What if the biopsies for lung cancer are unsuccessful in diagnosing lung cancer?

A

Video assisted thoracic surgery (VATS) and wedge resection may be needed.

49
Q

When do you really do VATS and wedge resection?

A
  1. the probability of cancer
  2. the assurance that surgery can be done (residual pulmonary function will suffice)
  3. the chance that the surgery may be curative (no mets)
50
Q

How is small cell cancer of the lung treated?

A

With chemotherapy and radiation

NO SURGERY

51
Q

What type of lung cancer is operable?

A

Non small cell cancer

52
Q

How is operability of lung cancer predicted?

A

Residual function after resection

53
Q

What type of surgery do you need for a central lesion?

A

Pneumonectomy

54
Q

What type of surgery do you need for a peripheral lesion?

A

Removed with lobectomy

55
Q

What is the minimum FEV1 for operability of lung cancer?

A

800 mL is needed.

56
Q

What do you need to determine for operability of lung cancer?

A
  1. Determine FEV1
  2. Determine fraction that comes from each lung (by ventilation perfusion scan)
  3. Figure out what would remain after pneumonectomy
57
Q

What happens if FEV1 is less than necessary?

A

Stop expensive test, Patient is not a surgical candidate and treat with chemotherapy and radiation.

58
Q

What does the potential cure by surgical removal of lung cancer depend on?

A

Extent of mets.

59
Q

How are hilar metastases treated?

A

Can be removed with the pneumonectomy

60
Q

How are nodal metastases at the carina or medistinum treated?

A

They preclude curative resection.

61
Q

What types of scans identify nodal metastasis?

A

CT scan and PET

62
Q

What is a more invasive way to sample mediastinal nodes?

A

Endobronchial ultrasound

63
Q

What are some physical symptoms of Aortic stenosis?

A

Produces angina

Exertional syncopal episodes

64
Q

What does an aortic stenosis murmur sound like?

A

Harsh mid systolic heart murmur best heard at the right second intercostal space and along the left sternal border.

65
Q

How do you start workup with aortic stenosis?

A

Echocardiogram.

66
Q

When is surgical valvular replacement indicated in aortic stenosis?

A

If there is a gradient of more than 50 mmHg or at the first indication of congestive heart failure, angina or syncope.

67
Q

How does chronic aortic insufficiency present?

A

Produces wide pulse pressure and a blowing, high-pitched, diastolic heart murmur best hearts at the second intercostal space and along the left lower sternal border with the patient in full expiration.

68
Q

When should valvular replacement occur for people with chronic aortic insufficiency?

A

at the first evidence on echocardiogram of beginning left ventricular dilation.

69
Q

When is acute aortic insufficiency seen?

A

Because of endocarditis, seen in young drug addicts who suddenly develop congestive heart failure and a new loud diastolic murmur at the right second intercostal space

70
Q

What is the treatment for acute aortic insufficiency?

A

Emergency valve replacement and long term antibiotics are needed.

71
Q

Why do patients with prosthetic valves need antibiotic prophylaxis?

A

For subacute bacterial endocarditis.

72
Q

What is mitral stenosis caused by years before presentation?

A

Rheumatic fever

73
Q

What are the symptoms of mitral stenosis?

A
  1. Dyspnea on exertion
  2. Orthopena
  3. Paroxysmal nocturnal dyspnea
  4. Cough
  5. Hemoptysis
74
Q

What is the murmur associated with mitral stenosis?

A

Low-pitched rumbling diastolic apical heart murmur

75
Q

What happens when mitral stenosis progresses?

A

Patients become thin and cachetctic and develop A. Fib.

Pestanas Surgical Notes (5 decks)

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