CLINICAL CASES Flashcards
Heart Attack (Myocardial Infarction)
- When the perfusion to the myocardium is insufficient to meet the metabolic needs of the tissue, leading to irreversible tissue damage
- Common cause is a TOTAL OCCLUSION of a MAJOR CORONARY ARTERY
Coronary Artery Disease
- Occlusion of a major coronary artery leading to inadequate oxygenation of an area of myocardium and cell death
- Patients can develop pain (ANGINA) or MYOCARDIAL INFARCTION (MI)
Percutaneous Coronary Intervention
- Catheter is inserted into FEMORAL ARTERY and passed through ILIAC ARTERIES into the ABDOMINAL AORTA, through THORACIC AORTA and to the CORONARY ARTERIES
- A fine wire is passed through coronary artery
- A fine balloon inflated widens it or a stent holds it open
- Suction extraction of a coronary thrombus and rotary ablation of plaque
Coronary Artery Bypass grafts
THE GREAT SAPHENOUS VEIN in the lower limb is harvested and used as a graft. It is divided into several pieces which is used to bypass blocked sections of coronary arteries.
Heart Attack Symptoms
- Chest heaviness/pressure
- Sweating
- Chest pain
- Nausea
- Left arm pain
Atrial septal defect (ASD)
Oxygenated blood flows from the left atrium (higher pressure) across to the right atrium (lower pressure)
PROBLEMS:
- Right atrial and right ventricular hypertrophy
- Enlargement of pulmonary trunk -> PULMONARY arterial hypertension
TREATMENT:
- Close using surgery
Ventriculoseptal defect (VSD)
Allow blood to move from the left ventricle (higher pressure) to the right ventricle (lower pressure)
PROBLEMS:
- Right ventricular hypertrophy
- Pulmonary arterial hypertension
Patent/Persistent Ductus Arteriosus (PDA)
When the DUCTUS ARTERIOSUS (connects left branch of the pulmonary artery to the inferior aspect of the aortic branch) fails to close at birth
PROBLEMS:
Oxygenated blood in the aortic arch passes into the left branch of the pulmonary artery producing PULMONARY HYPERTENSION
Venous access for central and dialysis lines
- AXILLARY, SUBCLAVIAN and INTERNAL JUGULAR VEINS are used to establish central venous access for administering large amounts of fluid, drugs and blood
- Dialysis lines inserted into patients with RENAL FAILURE -> Large volume of blood can be aspirated through one channel and re infused through a second
Using the superior vena cava to access the inferior vena cava
- A guidewire, catheter or line is passed from the SUPERIOR VENA CAVA through the RIGHT ATRIUM and into the INFERIOR VENA CAVA
COMMON ROUTE OF ACCESS FOR:
- TRANSJUGULAR LIVER BIOPSY
- TRANSJUGULAR INTRAHEPTIC PORTOSYSTEMIC SHUNTS (TIPS)
- Insertion of inferior vena cava filter to catch emboli dislodged from veins in the lower limb and pelvis
Coarctation of the Aorta
- Congenital abnormality in which the AORTIC LUMEN is constricted distal to the origin of the LEFT SUBCLAVIAN ARTERY
- Aorta narrows
- Blood supply to lower limbs and abdomen is diminished
- Collateral vessels develop around the chest wall and abdomen to supply the lower body
- Heart has to pump blood at higher pressure
Aorta & Trauma
Trauma is most likely to cause aortic trauma in these points:
- AORTIC VALVE
- LIGAMENTUM ARTERIOSUM
- Point of passing behind the MEDIAN ARCUATE LIGAMENT of the diaphragm to enter the ABDOMEN
Aortic Dissection
- When the wall of aorta splits longitudinally creating a false channel
- Occurs in ascending aorta or arch of the aorta -> blood flow in the coronary and cerebral arteries may be disrupted -> myocardial infarction/stroke
- Abdomen -> visceral vessels may be disrupted -> ischemia to the gut or kidneys
Aortic arch and its anomalies
- A right-sided arch of aorta occasionally occurs (ASYMPTOMATIC)
- Associated with DEXTOCARDIA (right-sided heart) with complete SITUS INVERSUS (left-to-right inversion of the body’s organs)
