Pestana- 6. Cardiothoracic Surgery Flashcards
What do you expect if a baby goes into respiratory distress with “crowing respirations” and assumes a hyperextended position?
vascular rings
What other symptoms (other than respiratory) should you think of with vascular rings?
pressure on esophagus causing difficulty swallowing
What should be on your differential with vascular rings?
tracheomalacia
How do you rule out tracheomalacia?
bronchoscopy
How do you diagnose vascular rings?
barium swallow (shows typical extrinsic compression from abnormal vessel)
How do you treat vascular rings?
surgery to divide the smaller of the two aortic arches
What is the best way to diagnose morphologic cardiac anomalies?
echocardiogram
What type of congenital heart defect has a faint pulmonary flow systolic murmur and fixed split S2?
ASD
What is the most common outcome for small, restrictive VSDs low in the muscular septum?
spontaneous closure within 2-3 years of life
Where are most VSDs anatomically?
high in the membranous septum
What is the typical physical exam finding in VSDs?
pansystolic murmur at left sternal border
What do you see on CXR in a patient with a VSD?
increased pulmonary vascular markings?
When will a PDA become symptomatic?
in the first few days of life
What is the typical physical exam findings in PDA?
bounding peripheral pulses
“machinery-like” heart murmur
How can you achieve closure of a PDA in a premature infant?
indomethacin
What are the two options for closure of PDA in a baby who cannot be treated with indomethacin?
- Surgical division
- Radiological embolization with metal coils
What is the most common cyanotic congenital heart defect?
Tetralogy of Fallot
What will a child with Tetralogy of Fallot look like?
small
blue lips and fingers
clubbing
cyanosis spells relieved by squatting
What is the typical physical exam finding in Tetralogy of Fallot?
systolic ejection murmur in left 3rd intercostal space
What will an EKG in Tetralogy of Fallot show?
right ventricular hypertrophy
What allows a child with transposition of the great vessels to stay alive?
ASD
VSD
PDA
What do you think of with harsh midsystolic heart murmur at the right second intercostal space and along the left sternal border?
aortic stenosis
What are the surgical indications in aortic stenosis?
- Gradient >50 mmHg
- First indication of CHF, angina or syncope
What do you think of with a wide pulse pressure and blowing, high-pitched, diastolic heart murmur best heard at the second intercostal space and along the left lower sternal border?
chronic aortic insufficiency
When should you do a valvular replacement for chronic aortic insufficiency?
at first evidence on echo of LV dilatation
What do you suspect in a patient who suddenly develops a loud, diastolic murmur at hte right second intercostal space?
acute aortic insufficiency 2/2 endocarditis (drug user)
How do you treat acute aortic insufficiency?
emergency valve replacement and long-term abx
What should you suspect in a patient with DOE, orthopnea, cough and hemoptysis and a low-pitched, rumbling diastolic apical heart murmur?
mitral stenosis
What usually causes mitral stenosis?
rheumatic fever
What issue usually develops after mitral stenosis progresses over time?
a-fib
What do you suspect in a patient with an apical, high-pitched, holosystolic heart murmur that radiates to the axilla and back?
mitral regurgitation
How do you treat mitral regurg?
Annuloplasty (repair valve) preferred over prosthetic replacement
At what percentage stenosis is intervention for coronary disease indicated?
> /=70%
When (in coronary artery disease) is an angioplasty or stent preferred?
single vessel disease (that is not left main or LAD)
When would you typically use multiple coronary bypass in coronary artery disease treatment?
triple vessel disease
What vessel do you use for the most important vessel bypass?
internal mammary
What should you do if a heart surgery patient has a CO of
measure the pulmonary wedge pressure (LEDP)
What does a PCWP of 0-3 indicate?
patient needs more IV fluids
What does a PCWP of >20 indicate?
ventricular failure
What are the signs of chronic constrictive pericarditis?
dyspnea on exertion
hepatomegaly
ascites
What are the typical cardiac catheterizaiton findings in chronic constrictive pericarditis?
- “square root sign”
- equalization of pressures (RA, RV diastolic, PA diastolic, PCWP, LV diastolic)
What is the likelihood that a coin lesion over the lungs will be malignant in a patient over 50?
80%
After comparing a coin lesion to an old CXR, what are the next two tests to perform?
- Sputum cytology
- CT scan (chest and liver included)
What type of lung cancer is not treated with surgery?
small cell
How do you predict the operability of lung cancer?
by predicting residual function after resection
What is the minimum predicted FEV1 for operability of lung cancer?
800 mL
How do you predict future FEV1 in a patient who is to receive surgery for lung cancer (pneumonectomy)?
FEV1 then ventilation-perfusion scan
