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Cardiothoracics Flashcards

(58 cards)

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1
Q

What is often used as a graft in CABG?

A

Saphenous vein

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2
Q

What is the circumflex artery?

A
  • Originates from LCA

- Supplies the LA + posterior LV

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3
Q

What is the LAD artery?

A
  • From LCA

- Supplies the anterior LV + anterior septum

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4
Q

What is the RCA?

A

Supplies the RA, RV, inferior LV and posterior septum

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5
Q

What happens during a CABG?

A
  • Cardiopulmonary bypass
  • Cardioplegia-> stop heart beating
  • Graft inserted-> usually saphenous vein, free graft (whole vessel put somewhere new)
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6
Q

How does CP bypass work?

A
  • Machine takes blood from VC/RA
  • Adds O2 and removes CO2
  • Adds heparin to prevent clotting
  • Blood back to ascending aorta
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7
Q

What is cardioplegia?

A
  • During CABG-> stops heart beating
  • Use high K+ solution into circulation-> spontaneously starts when stop infusion
  • In arrythmias-> CV or temporary pacing
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8
Q

What are the complications of CABG?

A
  • Slow recovery-> resume normal activity in 3 months
  • Death
  • Stroke
  • Infection
  • AKI
  • Cognitive impairment
  • MI
  • AF
  • Vein can stenose over time (intimal hyperplasia)-> arterial less affected so better
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9
Q

What are some congenital cardiac conditions?

A
  • ASD
  • VSD
  • Coarctation of aorta
  • PDA
  • Tetralogy of Fallot
  • Ebstein’s anomaly
  • Transposition of great arteries
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10
Q

What is cyanotic heart disease?

A
  • When deoxygenated blood enters the systemic circulation
  • Due to bypassing the pulmonary circulation + lungs
  • Right to left shunt
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11
Q

What is acyanotic heart disease?

A
  • Left to right shunt-> left heart pressure higher than right
  • Can become right to left if really bad-> Einsenmenger’s
  • EG ASD, VSD, PDA
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12
Q

What is Eisenmenger syndrome?

A
  • Pulmonary pressure becomes higher than systemic

- Blood flows from right heart to left heart and causes cyanosis

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13
Q

What are some complications of congenital heart disease?

A
  • Heart failure
  • Arrhythmias
  • Endocarditis
  • Stroke
  • Pulmonary HTN
  • Eisenmenger
  • Pregnancy complications
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14
Q

What is an atrial septal defect?

A

Hole between 2 atria causing blood flow between

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15
Q

What are the types/causes of atrial septal defect?

A
  • Patent foramen ovale-> not always classified as ASD
  • Ostium secondum-> septum secondum doesn’t close
  • Ostium primum-> septum primum fails to close + causes AVSD
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16
Q

What is the pathophysiology of atrial septal defect?

A
  • Acyanotic-> LA to RA shunt
  • Blood oxygenated-> flows through pulmonary vessels + lungs
  • Increased flow-> right overload + strain-> pulmonary HTN + RHF
  • Can lead to Eisenmenger-> shunt reverses
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17
Q

How does atrial septal defect present?

A
  • Asymptomatic + pick up on antenatal scans
  • Older-> dyspnoea, stroke, DVT, AF, atrial flutter
  • Murmur-> mid-diastolic, crescendo-decrescendo, loudest at left sternal border
  • Fixed split second heart sound-> blood in RV that has to empty before pulmonary valve closes
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18
Q

How is atrial septal defect managed?

A
  • Watch + wait if small
  • Surgery-> percutaneous transvenous catheter closure or open
  • Anticoagulants-> reduce stroke risk
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19
Q

What is ventricular septal defect?

A
  • Hole in septum between ventricles

- Causes left to right shunt-> can switch if severe

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20
Q

What is ventricular septal defect associated with?

A
  • In isolation
  • Down’s
  • Turner’s
  • After MI-> ischaemia
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21
Q

How does ventricular septal defect present?

A
  • Asymptomatic + pick up on scans

- Pansystolic murmur-> left lower sternal border at IC spaces 3 + 4

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22
Q

What causes a pansystolic murmur?

A
  • VSD
  • Mitral regurgitation
  • Tricuspid regurgitation
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23
Q

What causes a mid-diastolic murmur?

A

-Atrial septal defect

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24
Q

How is ventricular septal defect managed?

Study These Flashcards
A
  • Surgical-> transvenous catheter closure or open heart

- Antibiotic prophylaxis before surgery-> for IE

25
What is coarctation of the aorta?
Narrowing of aortic arch-> usually around ductus ateriosus
26
What is coarctation of the aorta associated with?
- Turner's syndrome | - Recurrence after treatment
27
What is the pathophysiology of coarctation of the aorta?
- Narrowing of arch - Reduced pressure of blood flowing to distal arteries - Increased pressure proximally-> heart + three branches
28
What are the three artery branches on the aortic arch?
- Brachiocephalic - Left common carotid - Left subclavian
29
How does coarctation of the aorta present?
- Often HTN in adulthood-> 1st sign - Systolic murmur-> below left clavicle + scapula - 4 limb BP-> high from arteries with supply before narrowing + low in those after - LV heave - Underdeveloped left arm-> reduced left subclavian artery flow - Underdeveloped legs - CT angiography shows
30
How is coarctation of the aorta managed?
- CT angiography can confirm - None if symptom free - Percutaneous balloon angioplasty +/- stent - Open heart - Medical management HTN
31
What is pericardial effusion?
- Excess fluid in pericardial sac - Acute or chronic - Transudate (low protein) or exudate (inflammation) - Can be blood, pus, gas etc
32
What is the pathophysiology of pericardial effusion?
- Pericardium/pericardial sac surrounds heart - Potential space-> usually <50ml - Effusion-> fills space + pressure on heart - Harder to expand when filling (diastole) - Tamponade-> raised intra-pericardial pressure + affects heart function
33
What is the function of the pericardium?
- <50ml fluid - Separates heart from mediastinum - Lubrication-> allow heart to beat without friction - Is a potential space-> usually touch
34
What is cardiac tamponade?
- pericardial effusion large enough to affect heart function - reduces filling + cardiac output - emergency + needs drainage
35
What causes transudative pericardial effusion?
Transudative (low protein)-> CHF or pulmonary HTN (increased venous pressure + reduced drainage)
36
What causes exudative pericardial effusion?
- Infection-> TB, HIV - Autoimmune-> SLE, RA - Injury-> MI, surgery - Uraemia-> secondary to renal impairment - Cancer - Medications-> MTX
37
What can cause pericardial effusion due to bleed?
- Rupture of heart or aorta from MI - Trauma - Type A aortic dissection
38
How does pericardial effusion present?
- Can be slow or quick - Chest pain, SOB, fullness feeling, orthopnoea - Worsens + press on structures - Hiccups-> phrenic nerve - Dysphagia-> oeseophagus - Hoarse voice-> recurrent laryngeal - Quiet heart on auscultation - Pulsus paraxodus - Hypotension - Raised JVP - Pericardial rub-> infection
39
How is pericardial effusion diagnosed?
- Echo-> size + function | - Fluid analysis-> protein, bacterial, PCR, cytology, tumour markers
40
How is pericardial effusion managed?
- Treat underlying cause + drain - Inflammatory-> NSAIDs, colchicine, steroids - Needle pericardiocentesis-> US guided - Surgical-> pericardial window
41
What is thoracic aortic aneurysm?
- Dilation of thoracic aorta - Ascending-> 4.5cm< - Descending-> 3.5cm
42
Where does blood collect in a false aortic aneurysm?
- Inner intima + media layers ruptured | - Within adventitia-> outer layer
43
What is the cause of thoracic aortic aneurysm?
- After surgery - RTA - Infection
44
Where does blood collect in a true aortic aneurysm?
3 layers are intact but dilated so within vessel
45
How does thoracic aortic aneurysm present?
- Asymptomatic - Chest pain - Back pain - Trachea/left bronchus compression-> cough, SOB, stridor - Hiccups - Dysphagia - Hoarse voice
46
How is thoracic aortic aneurysm diagnosed?
- Echo | - CT or MRI angiogram
47
How is thoracic aortic aneurysm managed?
- Risk factor reduction - Surveillance - TEVAR - Open surgery
48
What are the complications of thoracic aortic aneurysm?
- Aortic dissection - Ruptured aneurysm - Aortic regurgitation
49
What are the symptoms of ruptured thoracic aortic aneurysm?
- Haematemesis - Haemoptysis - Tamponade - Severe chest/back pain - Haemodynamic instability - Collapse - Death
50
How is ruptured thoracic aortic aneurysm managed?
Emergency replacement of aorta with graft
51
What are some indications for heart transplant?
- CHF - IHD - Cardiomyopathy - Congenital heart disease
52
What are some indications for lung transplant?
- COPD - Pulmonary fibrosis - CF - Pulmonary HTN
53
When is heart or lung transplant done?
Within 6 hours of donor death
54
How is heart or lung transplant performed?
- Donor organ given cold ischaemic time-> cooled to reduce damage - CP bypass - Implant - Reperfused + warmed
55
What is required after heart or lung transplant?
Lifelong immunosuppressant-> avoid rejection
56
What are some side effects of immunosuppressants?
- Diabetes - Osteoporosis - Cushing's - Infections - SKin cancer - Non-Hodgkin lymphoma
57
What is a complication of heart transplant?
Cardiac allograft vasculopathy-> narrowing of CAs in donor heart
58
What are some complications of lung transplant?
- Primary graft dysfunction-> oedema, damage, hypoxia - Bronchiolitis obliterans syndrome - Dehiscence of bronchial anastamosis

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