Acquired Heart Disease Flashcards
(23 cards)
The bypass condiuit with the highest patency rate is the _______
Interntal thoracic artery
- The most important criterion in conduit selection is graft patency
- 98% at 5 years and 85-90% at 10 years
- commonly left attached proximally to the subclavian artery
True about angina pectoris
- ANgina is typically substernal and may radiate to the elft upper extremoty, left neck or epigastrium
- myocardial ischemia
- Typical angina is relieved by rest and/or use of sublingual nitroglycerin
- Differential diagnosis
- MSK pain, pulmonary disorders, esophageal spasm, pericarditis, aoritc dissection, GERD, neuropathic pain, anxiety
A holosystolic murmur that is accompanied by a ventricular septal defect is associated with
Flow between chambers that have widely different pressures throughout systole
Left ventricular aneurysm
- Rupture is UNCOMMON
- symptoms icludes angina, CHF, ventricular arryhtmias, and rarely embolic phenomenon
- MRI is the best diagnosyic modality
Most common arrhythmia worldwide
Atrial fibrillation
- 0.4 to 1% that increases to 8% in those older than 80 years
- most serious complication of AF is thromboembolism with resultant stroke
The most common cause of acquired mitral stenosis
Rheumatic diease
- 60% of patients with pure MS
- Other causes
- left atrial myxoma
- ball valve thrombus
- mucopolysaccharidosis
- previous chest radiation, severe annular calcification
What valcular lesion is most commonly found in a patient with Ehlers-Danlos syndrome?
Aortic Insufficiency
- The most important cause of isolated aortic insufficienct is patients undergoing aortic valve repalcement is aortic root disease (50%)
Tricuspid stenosis
- commonly a result of organic disease, such as rheumatic heart disease and endocarditis
- Other less common causes of obstruction to the right atrial emptying
- congenital tricuspid atresia
- right atrial tumors
- endomyocardial fibrosis
The most common cardiac tumor
myxoma
- 75% of the time, arise from the imteratrial septum near the fossa ovalis in the left atrium
- peduncualted with a gelatinous consistency, and the surface may be smooth (65%), villous, or friable
- internally, they contain hemorrhage, cysts, necrosis, or calcifications
- Histologically, these tumors contain ccells that arise from a multipotent mesenchyme and are contained within a mucopolyssacharide stroma
the most common primary cardiac tumor in childre
Rhabdomyosarcoma
- myocardial hamartomas
- multicentric in the ventricles
- 50% of cases are associated with tuberous sclerosis
- most disappear spontaneously
- Fibromas
- congenital lesions than 1/3 of the time are found in children younger than 1 year
- solitary tumors founf in inner interventricular septum
Patients undergoing mechanical mitral valve repalcement
- Have increased left atrial size
- concomitant AF
- higher risk for thromboembolism
- INR 2.5 or 3.5 times normal
An abosulte contracindication to a coronary artery bypass operation
- Chronic CHF and ischemic cardiomyopathy wotj no signs of angina
- poor distal vessel quality
- poor = 100% mortality
- fair = 90% mortality
- good = 10% mortality
Approximately 50% of benign cardiac tumors are
myxomas
- Other benign tumors
- papilalry fibroelastomas, lipomas, rhabdomyomas, fibroms, hemangiomas, teratomas, lymphangiomas
- Malignant
- angiosarcoma, rhabdomyosarcoma, fibrosarcoma, leiomyosarcoma, liposarcoma, malugnant lymphomas
The majority of cardiac myxomas arise from
the left atrium
Rhandomyomas
- They are often multicentric
- They are the most common primary cardiac tumor in children
- they often disappear spontaneously
A patient present with a history of fatigue and dypnea. he is found to have hepatomegaly, ascites, and an elevated jugular venous pulse. Heart sounds are normal, no murmurs are present and the heart is of normal size. The pulse pressure is decreased by palpation, ECG is normal for low voltage. Diagnosis?
Constrictive pericarditis
- Classical presentation : jugular venous distention with kussmaul sign, diminished cardiac apical impulses, peripheral edema, ascites, pulsatile liverm a pericardial knock, and signs of liver dysfunction
- Pericardial knock : early diastolic
- CVP often elevated 15-20 mmHg., low voltage QRS, CXR may show calcification of the pericardium, CT or MRI shows increased pericardial thickness (>4mm) and calcification, dialtion of the IVCm deformed contoursm and flattening of leftward shift of the ventricular septum
- Echocardiography : best to distinguised pericardial constriction from restrictive cardiomyopatju
Effects anticipated after insertion of an intra-aortic balloon pump
- Decrease in preload
- Decrease myocardial oxygen consumption
- Improvement of cardiac index
- coronary blood flow increase
- augmentation of diastolic perfusion of the coronary arteries and decreased afterload
Pericarditis is usually treated with
A short course of NSAIDS
- some patients require judicious use of steroid or IV antibiotics
- In cases of purulent pyogenic pericarditis
- surgical exploration and drainage
- tamponade
- pericardiocentesis except if thick, viscous, clotted fluid
The most common cause of if isolated AI in patients undergoing AVR is
Aortic root disease
During cardiopulmonary bypass anticoagulation, the range of heparin needed to increase the activated clotting time to greater than 450 seconds
300 to 400
- The basic CPB circuit
- venous cannulae
- venous resorvoir oump
- oxygenator
- filter
- arterial cannula
- Once adequate anticoagulation is achieved, arterial cannulation is performed through a purse-string suture or through a side graft, which is sewn on the native artery
Eligibility criteria for mechanical support as destination therapy
- Medically refractory NYHA class III or IV heart failure for at least 60 days
- Peak oxygen consumption <12 mL/kg/min or failure to wean from continuous IV inotropes
- Left ventricualr ejection fraction <25%
- Presence of a contraindication for heart transplantation
- >65 years
- Irreversible pulmonary hypertension
- chronic renal failure
- insulin dependent DM with end organ damage
- other clinically significant comorbidities
Angiosarcomas
- Agressive and rapidly invade adjacent structures
- 47 to 89% presents with liver, lung, or brain mets
Primary cardiac malignancies are ver rae, but when they occurm they tend to have a right sided predominance and extracardiac extension
- Leiomyosarcoma : sessile masses with mucous appearance that are typically found in the posterior wall of the left atrium
Age-related calcific AS causes some degree of AI in approximately
75%
