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cardio Flashcards

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1
Q

things to focus on in the PE -important stuff

A

General assessment of overall condition
Skin: open sores/rashes (any infection source)

Mouth/teeth (again infection source)

Lungs - esp if suspected heart failure

Swelling/ulcers in extremities

Pulses

Varicosities (particularly legs for conduit)

Cardiac exam: JVD, rub, murmur, S3 or S4

Scars on chest/legs- raditation causes scar tissue on the chest that can cause problems

Swelling in extremities

Basic abdominal/neuro exam

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2
Q

stress echo is used to look particularly at

A

coronary artery

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3
Q

transesophageal echo helps look at the

A

valves

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4
Q

carotid ULS is used for

A

helps to insure this individual is not going to have a stroke during surgery

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5
Q

ABI are used to tell you about

A

PID

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6
Q

troponin indicative of NSTEMI

A

> .05 suspect unstabel angina

Troponin 0.10 → 0.20

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7
Q

class I indications for coronary bypass

A

<50% left main coronary artery
>70% proximal LAD and Cx stenosis

multi-vessel disease in a asymptomatic ot because stents don’t last as long as graphs do

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8
Q

low risk for bypass

A

<4%

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9
Q

when would you take most meds until

when would you stop ACE/ARB/Metformin

A

Continue ASA, beta-blockers, non-nephrotoxic meds until surgery
Stop ACE/ARB/metformin ~48h prior

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10
Q

what is a special consideration and might need to stop these earlier

A

Stop anticoagulation - many kinds!

Each one is different for how long, usually 2-7 days

Sometimes need a heparin drip if critical stenosis which is stopped right before surgery

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11
Q

CABG

A

coronary artery bypass grafting

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12
Q

mortality for CABG if low or average risk

A

Summit is around 0.7% for low/average risk

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13
Q

LIMA

A

left internal mammarry artery

is used in CABG

also known as the internal thoracic artery

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14
Q

CABG use these vessels

A

LIMA

Greater saphenous vein for other grafts

some facilities use the radial artery

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15
Q

what is a on-pump

A

This may be performed either with the help of a heart-lung bypass machine (traditional CABG, performed via a thoracotomy),

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16
Q

on pump

A

on a beating heart (off-pump CABG, and minimally invasive direct CABG).

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17
Q

Intra-aortic balloon pump

A

can insert at the end of case if a pt is having a hard time coming off bypass

when the heart is pushing blood out it is deflated and when the heart is relaxed and filling it inflates so that blood can not come back into the aorta

when the balloon deflates it creates a vacuum decreasing after-load

this is left in for a couple days until the heart heals

inserted after cardiogenic shock as well as a bridge to surgery

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18
Q

what is dressler syndrome

what is the tx

A

Post-pericardiotomy syndrome

autoimmune febrile pericarditis or pleuritis that may occur 1–6 weeks following

Fever, malaise
Chest pain, with or without associated dyspnea
Tachycardia
Pericardial friction rub

2-4 weeks after surgery

seen with fever and plueritic chest pain

NSAIDs controversial postoperatively ‘
Usually give colchicine

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19
Q

heart arrhythmia seen as a complication of CABG

A

MCC
afibb MC?

peak on post opp day TWO

all pts are on telemetry

want the rate to be lower

might have them go on amioderone

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20
Q

complications of CABG

A

afibb
CVA
AKI
cardiac tamponade

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21
Q

med management post op

A

ASA, statin, and beta-blocker

Postoperative long-term treatment with antiplatelet drugs (e.g., 100 mg aspirin 1-0-0) is required to reduce the risk of subsequent myocardial ischemia!

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22
Q

typically discharge pt on day following CABG

A

Typically discharge patients on POD #4 or 5 barring complications

wound healing post op week 2

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23
Q

murmur of AS

A

Murmur: systolic crescendo-decrescendo vs holosystolic at right upper sternal border

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24
Q

average survival withou A-S t valve replacement

A

Average survival without valve replacement is 2-3 years once severe

Best heard in the 2nd right intercostal space

Valsalva and standing from squatting decreases or does not change the intensity of the murmur (in contrast to hypertrophic cardiomyopathy).

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25
mneumonic for AS
SAD (syncope, angina, dyspnea)
26
mechanical valve replacement require
coumadin for life not the case with a biprostehtic valve
27
TAVR
Transcatheter AVR (TAVR): patients with high surgical risk or contraindication can deploy valve through the groin much safer than surgical medicare covers TAVR for medium to high risk pts
28
TAVR common complciations
higher need for pacemaker with TAVR greater risk of heart block
29
common causes of aortic insufficiency
connective tissue disorder (marfans)
30
AI murmur
early diastolic
31
AI surgical indications
moderate to servere with reduced EF <50%
32
primary MR
MCC rheumatic heart disease especially in other parts of the world
33
secondary MR
CAD
34
surgical indications for MR
symptomatic and EF >30% if <30% greater surgical risk if asymptomatic but lower EF might consider surgery
35
replacing the valve vs repair
repairs last longer than replacing the valve but with endocaritits you have to replace the valve
36
MCC of mitral valve stenosis
Almost always from rheumatic fever
37
management of mitral valve stenosis
Often managed by Interventional Cardiology with percutaneous mitral balloon commissurotomy might relpace valve
38
78yo male presents to ED with SOB and altered mental status, with PMH of COPD, liver cirrhosis, CHF, cocaine and EtOH abuse, and HTN pulses paradoxus and sinus tach
EKG-pulses paradoxis ECHO AND XRAY -- cardiomegaly --> pericardial effusion NEED >1CM effusion on echon for centisis The fluid can be either bloody (e.g., following aortic dissection) or serous (usually idiopathic) BECK'S triad hypotension, muffled heart sounds, distended neck veins!
39
tx of pericardial effusion
Typically surgical approach is subxiphoid pericardial window Leave pericardial drain in place until drainage slows need this if you have less than 1cm of
40
what determines the tx of tamponade
unstable---> pericardicentesis hemodynamically stable--> pericardial window
41
Pericardial window
an incision in the peridardium is made that allows continual drainage from the pericardial space into the pleural cavity to prevent a cardiac tamponade Commonly indicated for effusion due to underyling malignancy Hemodynamic monitoring
42
presentation of AD
It commonly occurs in hypertensive males between the 4th and 6th decade. Patients complain of a sudden onset and severe pain radiating into the thorax, back, or abdomen. Initial chest x-ray shows a widened mediastinum.
43
diagnostic imaging in AD
The diagnosis is confirmed with a contrast-enhanced CT in stable patients and transesophageal echocardiography in unstable patients.
44
what determines tx of AD
type A is the emergency (ascending) type B is less urgent (descending still getting blood flow) tear of the intima media adventitia
45
surgical tx of AD
takes like 7 hours Open surgery with a polyester graft implantation Possibly, endovascular treatment: aortic stent implantation (only in type B dissections and if the operative risk is too high)
46
other than HTN what is common etiology of AD
``` HTN Pregnancy Cocaine Chest trauma Iatrogenic Syphilitic aortitis Arteriosclerosis HLD Smoking Many congenital factors, including connective tissue disorders ```
47
type B AD management
Target value of the systolic blood pressure is ∼ 90–120 mm Hg IV labetalol, esmolol, or propanolol (best initial ) Followed by IV sodium nitroprusside (vasodilator)
48
MC locations of AD
~2.2 cm above the aortic root Distal to the left subclavian artery Aortic arch
49
Pneumomediastinum (or mediastinal emphysema) air can be seen
throughout even in the neck check for crepitus in a young man that presentes with SOB coughing --> ruptured alveoli--> eep
50
tx of Pneumomediastinum
Treatment is usually observation Esophageal injuries more commonly require intervention or close following
51
Mallory-Weiss syndrome:
longitudinal laceration at the GE junction non-transmural Often from varices, portal HTN Hematemesis, melena, dizzy, abd pain Upper endoscopy (really a GI thing)
52
Boerhaave syndrome
esophageal rupture from force or trauma True surgical emergency Mortality of 35-40%
53
triad of boerhaave
Mackler triad of chest pain, vomiting, and subcutaneous emphysema
54
mallory weiss presentations
Patients typically present with a history of epigastric pain and hematemesis.
55
diagnostic of mallory weiss
Esophagogastroduodenoscopy chest xray for booerhaves
56
what stage of lung cancer can you use lobectomy & mediastinal lymph node
Stages I/II
57
Stage IIIA lung cancer mgnmt
: potentially resectable disease: multimodality
58
Stage IV lung cancer mgnmt
Stage IV: chemotherapy
59
MC sxs of lung cancer
``` Cough Chest pain Shortness of breath Hemoptysis Wheezing Dysphagia/Hoarseness Recurring infections such as bronchitis and pneumonia Weight loss and loss of appetite Fatigue ```
60
Metastatic signs and symptoms:
NEW bone or joint pain | neuro sxs mets to brain
61
85% of all lung cancers are
NSCLC
62
NSCLC is
NSCLC comprises a number of cancer types, including peripheral adenocarcinoma and central squamous cell carcinoma.
63
VATS
video assisted thorascopy Can be used for a bunch of things
64
classifications of pleural effusion
classified as transudative due to congestive heart failure, liver cirrhosis exudative pneumonia, malignancies, PE), depending on the underlying cause.
65
presentation of pleural effusion
Typically presents | with dyspnea and a dry cough.
66
tx of plerual effusion usually involves
Typically recommend ultrasound-guided thoracentesis (most often by Interventional Radiology) with pleural fluid analysis if it’s the first time
67
pleaural fluid serum LDH in trans vs exudative
<2/3 Upper LMN = trans >2/3 upper LMN is exudative
68
cylothorax
lymph filling up the lung somatostatin and octreotide
69
tension ptx presentation
Hypotension hypoxia chest pain dyspnea
70
Catamenial ptx:
endometrial tissue in the plura (rare) women 30-40yo, within 48h of menstruation, right-sided Thought to be from endometriosis of the pleura
71
pleurodesis
mechanical or talc | can basically cause the lung to stick to the wall
72
tx of ptx usually involves
VATS with bleb resection
73
chest tubes on xray should be
inside the wall
74
pleura vac
never take a chest tube off of this! direct communication to the lung and will introduce air if taken off NEVER CONNECT CHEST TUBE TO WALL SUCTION can cause lung to herniate connect it the the pleruavac if you need to change the pleuravac clamp it first
75
heimlick valve
can be used if pt wants to go home
76
chest tubes should always be set to
If a chest tube is on suction, it is connected to a canister, on CONTINUOUS suction (not intermittent), usually -20cm H2O
77
water seal means ...
Water seal” means off suction because there is a column of water that “seals” the end of the chest tube system (don’t want air getting back in, it’s a closed system water or suction

Surgery (18 decks)

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