Flashcards in Cardiothoracic 1 Deck (20):
Events that suggests lung empyema contains anaerobic organisms?
#History of alcoholism
#Recent operation or aspiration
70-year-old woman develops pneumonia. Receives antibiotics and condition improves. One week later notices increased pain in chest, increased cough, recurrent fever. CXR shows pleural effusion in right lung field. Likely diagnosis? Causal organisms? Management?
S pneumoniae in community, S aeurus in hospital
#evacuate pus (Chest tube drainage)
#reexpand long (Chest tube drainage)
Failure to expeditiously use chest drainage in lung empyema may lead to? Management?
Thoracotomy and decortication (removal of inflammatory tissue trapping long) via minithoracotomy or VATS
53-year-old man with NIDDM, Three-year history of angina, 30 pack year smoking history, hypercholesterolemia presents with increasingly frequent severe chest pain. Now has angina at rest. ECG demonstrates ischemic pattern – diagnosis? Management?
Pre-infarction angina (emergency)
#Bedrest, sedation, oxygen,
#beta blockers, nitroglycerin, aspirin, heparin
Normal ejection fractions?
Children – 90%
Young adults – 70-80%
Older – 50-60%
Coronary blockage that significantly reduces survival and is an indication for bypass? Associated with?
Left main; sudden-death
Viable alternatives to coronary artery bypass? Problem?
Percutaneous transcatheter coronary angioplasty – 30-60% reobstruct within one year
Conduits used in coronary artery bypass?
Saphenous vein and internal mammary artery (best)
Basic steps of coronary artery bypass?
#grafts are sewn (In free grafts, inflow portion sewn to aorta)
Cardioplegia solution – purpose? Mechanism?
Stops heart and diastole, protect it from ischemia, provides motionless field for surgeon
High potassium (60 mEq/L)
Complications of cardiopulmonary bypass?
Inflammatory response that might lead to respiratory and myocardial complications postoperatively
When to use off-bypass coronary surgery?
#patients with one or two easily accessible arteries
42-year-old with no one heart murmur experiences severe shortness of breath and fatigue. ECHO shows severe mitral regurgitation – mechanism?
Myxomatous degeneration of mitral valve (possibly from ischemia if myocardium)
Barlow syndrome? Difference in men versus women
Prolapse of the mitral valve;
Marker of severe mitral valve disease versus common disorder that rarely progresses
Most common causes of mitral stenosis?
Rheumatic fever and scarlet fever
Surgical management of mitral valve disease?
Mitral stenosis – Commissurotomy (split the commissures and reconstitute the lumen by mechanical dilators)
Mitral regurgitation – excise redundant portions of mitral leaflets and reinforce annulus with annuloplasty ring
Causes of aortic statuses?
Findings associated with aortic stenosis that decrease life expectancy?
Shortness of breath, angina, syncope
Workup for aortic stenosis? Results that indicated surgery as an option?
#Cardiac catheterization – lumen size, pressure gradient, ventricular function, CAD
#Carotid Doppler – rule out carotid artery obstruction
High grade aortic valve stenosis with preserved ventricular function