Pestana Cardiothoracic surgery Flashcards
Infant with stridor and episodes of respiratory distress also have difficulty taking in milk
think vascular ring, which places pressure around the trachea and esophagus
diagnosis and management of an infant with a suspected vascular ring
barium swallow (shows extrinsic tracheal compression) surgery to correct the two aortic arches
diagnosis and management of ASD
diagnosis: echo
mgmt: surgical closure or cardiac cath
diagnosis and management of VSD
diagnosis: echo
mgmt: surgical closure or cardiac cath
diagnosis and management of PDA
diagnosis: echo
mgmt: indomethacin or surgical closure/embolization with coils if it does not close with medical management
diagnosis and management of tetralogy of fallot
diagnosis: echo
mgmt: surgical repair
diagnosis and management of ToGA
diagnosis: echo
mgmt: surgical repair
How do patients with tetralogy of fallot present?
5-6 year olds who are small for their age
bluish hue in the lips or finger tips +/- clubbing
cyanotic spells relieved by squatting
systolic murmur
CXR reveals small heart with diminished pulmonary vascular markings
EKG reveals RVH
What keeps patients with ToGA alive?
ASD, VSD, PDA, or a combination of these
diagnosis and management of aortic stenosis
diagnosis: echo
mgmt: valve replacement when echo demonstrates a transvalvular gradient >50mmHg or if there is CHF, angina, or syncope
diagnosis and management of aortic insufficiency
diagnosis: echo
mgmt: medical therapy but valve replacement when echo shows LV dilation
Acute aortic insufficiency occurs in which patient population? How should these patients be managed?
young drug addicts
mgmt: emergency valve replacement and long-term antibiotics
patients with prosthetic valves will require this
antibiotic prophylaxis for subacute bacterial endocarditis (ie when undergoing dental procedures)
diagnosis and management of aortic insufficiency
diagnosis: echo
mgmt: surgical commissurotomy or balloon valvuloplasty when symptoms become more disabling
diagnosis and management of mitral regurgitation
diagnosis: echo
mgmt: surgical annuloplasty
What is the primary indication to do cardiac catheterization in a patient with CAD
progressive, unstable, or disabling angina
how is a patient with single vessel CAD managed?
angioplasty and stent
how is a patient with triple vessel CAD managed?
coronary bypass (using the internal mammary as graft)
presentation of a patient with chronic constrictive pericarditis
dyspnea on exertion (rigid pericardium = impaired diastolic filling)
hepatomeagly + ascites
cardiac cath shows classic square root sign (occurs when diastolic filling suddenly stops because the fibrous pericardium has reached its maximum distensibility)
causes of chronic constrictive pericarditis
repeated episodes of pericarditis of various etiologies
previous cardiac surgery
radiation therapy
tuberculosis
management of a patient with chronic constrictive pericarditis 2
diuretics (removes excess fluid from body)
pericardiectomy - surgical removal of part or most of the scarred pericardium
first thing to do when a coin lesion is noted on a CXR
look for a previous, older CXR to see if the lesion has changed over time
if it hasn’t changed, it is unlikely to be cancer
next best step in management of a patient with suspected lung cancer (ie coin lesion has grown over time as visible on x-ray, hemoptysis, persistent cough)
suptum cytology and CT scan (chest + liver)
How do you make the diagnosis in a patient with suspected lung cancer (ie coin lesion has grown over time as visible on x-ray, hemoptysis, persistent cough, (+) sputum culture, (+) CT scan)
bronchoscopy with biopsy for central lesions
percutaneous biopsy for peripheral lesions
how is small cell cancer of the lung managed?
chemoRx and radiation Rx
how is non-small cell cancer of the lung managed?
surgery
How are central vs peripheral cancerous lesions of the lung managed surgically?
central: pneumonectomy
peripheral: lobectomy
before removing a cancerous lesion of the lung, what must you do?
determine residual function of the lung after resection via PFTs (esp FEV1) and VQ scan
what is the magical FEV1 number that will determine if a candidate is suitable for lung resection?
FEV1 > 800mL
