heart disease & fixes Flashcards
transcatheter aortic valve replacement
aortic stenosis but open heart surgery not an option
new bovine valve directly over old, inserted via giant cath
tricuspid atresia
no tricuspid valve
ASD / 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 heart
size determines %age blood into lungs for re-oxygenation
can be congenital or post MI!
transposition of the great vessels
two separate circulations right to aorta, left to lungs
often occurs with ASD PFO PD - keeps patient alive but insufficient for growth
tetralogy of fallot
- PULMONARY STENOSIS * (increased R pressure)
VSD
R 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 relax
aka idiopathic hypertrophic subaortic stenosis
diagnosis of hypertrophic cardiomyopathy
Echo
- septal wall hypertrophy
- ↑ pressure gradient LV & aorta
12 lead EKG
- LV hypertrophy
physical
- 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 CVP
patient 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 surgeon
bedside echo
check chest tubes
prepare to open chest at OR or bedside (can arrest any time)
