heart disease and fixes Flashcards
transcatheter aortic valve replacement
aortic stenosis but open heart surgery not an optionnew bovine valve directly over old, inserted via giant cath
tricuspid atresia
no tricuspid valveASD / VSD allow for pulmonary system access
Fontan procedure
fix tricuspid atresia
ASD
left to right shunt, increases heart workload
VSD
left to right shunt, increases workload of heartsize determines %age blood into lungs for re-oxygenationcan be congenital or post MI!
transposition of the great vessels
two separate circulations right to aorta, left to lungsoften occurs withASDPFOPD- keeps patient alive but insufficient for growth
tetralogy of fallot
- PULMONARY STENOSIS * (increased R pressure) VSDR to L shunt (cyanotic)
hypertrophic cardiomyopathy aka
idiopathic hypertrophic subaortic stenosis
what is hypertrophic cardiomyopathy
increased muscle mass @ septum obstructs LV outflow- ↓ SV- mitral regurg (pulled into LVOT) - diastolic dysfunction: can’t relaxaka idiopathic hypertrophic subaortic stenosis
diagnosis of hypertrophic cardiomyopathy
Echo - septal wall hypertrophy- ↑ pressure gradient LV & aorta12 lead EKG- LV hypertrophyphysical- systolic murmur
pre-systolic atrial impulse with harsh systolic murmur @ 4-5th ICS LSB
hypertrophic cardiomyopathy
low CO syndrome
temporary heart failure due to surgery
poor man’s leg lift test
suspected hypovolemia, complements CVPpatient supine, lift leg 15-20 seconds, see SBP rise 10-15 points = hypovolemic
ominous sign of pericardial effusion/tamponade
equalization of filling pressures in setting of low CI/CO
suspect tamponade - next steps
call surgeonbedside echocheck chest tubesprepare to open chest at OR or bedside (can arrest any time)
metabolic acidosis markers post-op
pH lt 7.35lactate gt 2 mmol/L
potential cardiovascular causes of metabolic acidosis post-op
hypotensionlow CO/CIischemia
metabolic acidosis post-op due to
lactate produced in anaerobic conditions (from cellular pyruvate)TISSUE HYPOPERFUSION
gt 200 mL/hour chest tube
RED FLAG for hemorrhage
coagulopathy markers/fixes
plt lt 80000- transfusion promotes clotsINR gt 1.5- FFP rapid correction- vit K takes too longPTT gt 40 - protamine if heparinfibrinogen lt 150- cryoprecipitate (factors I, VIII, XIII, von willebrand’s)
