Chapter 26: Cardiac Flashcards Preview

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Flashcards in Chapter 26: Cardiac Deck (82):
1

What kind of shunts cause cyanosis?

Right to left shunts

2

Why do children squat in right to left shunts?

To increase SVR and decrease right to left shunts

3

R -> L shunts cause cyanosis. What can this lead to?

Polycythemia, strokes, brain abscess, endocarditis

4

Shift from L -> R shunt to R -> L shunt

Eisenmenger's syndrome

5

What causes Eisenmenger's syndrome?

Increasing pulmonary vascular resistance (PVR) and pulmonary HTN; this condition is generally irreversible

6

What do left to right shunts cause?

CHF: manifests as failure to thrive, increased HR, tachypnea, hepatomegaly; CHF in children, hepatomegaly

7

What is the first sign of a left to right shunt?

Hepatomegaly

8

L -> R shunts (CHF)

VSD, ASD, PDA

9

R -> L shunts (cyanosis)

tetralogy of Fallot

10

Connection between descending aorta and left pulmonary artery (PA); blood shunted away from lungs in utero

Ductus arteriosus

11

Connection between portal vein and IVC; blood shunted away from liver in utero

Ductus venosum

12

Fetal circulation:
- To placenta
- From placenta

to placenta: 2 umbilical arteries
from placenta: 1 umbilical vein

13

MC congenital heat defect

VSD (L -> R shunt)

14

% of VSD that close spontaneously

80% (usually by age 6 months)

15

Usually cause symptoms after 4-6 weeks of life, as PVR decrease, and shunt increased

Large VSDs (can get CHF - tachypnea, tachycardia - and failure to thrive)

16

Medical treatment: VSD

Diuretics and digoxin

17

Usually timing of repair:
- Large VSDs (shunt > 2.5)
- Medium VSDs (shunt 2-2.5)

Large: 1 year of age
Medium: 5 years of age

18

Most common reason for earlier repair of VSD

Failure to thrive

19

L->R shunt
- Usually symptomatic when shunt > 2 -> CHF (SOB, recurrent infections)
- Can get paradoxical emboli in adulthood
- Medical tx: diuretics and digoxin

Atrial septal defect

20

Most common (80%); centrally located ASD

Ostium secundum

21

Can have mitral valve and tricuspid valve problems; frequent in Down's syndrome

Ostium primum (or atrioventricular canal defects or endocardial cushion defects)

22

Usual timing of repair ASD

1-2 years of age (age 3-6 months with canal defects)

23

VSD
Pulmonic stenosis
Overriding aorta
RVH

Tetralogy of Fallot

24

MC congenital heart defect that results in cyanosis

Tetralogy of Fallot

25

Medical treatment: tetralogy of fallot

Beta-blocker

26

Usual timing of repair: tetralogy of fallot

3-6 months of age

27

Repair: tetralogy of fallot

RV outflow tract obstruction (RVOT) removal, RVOT enlargement, and VSD repair

28

L-> R shunt
- Requires surgical repair through left thoracotomy if it persists

Patent ductus arteriosus (PDA)

29

Causes PDA to close; rarely successful beyond neonatal period

Indomethacin

30

Most common cause of death in the United States

Coronary artery disease

31

Risk factors: coronary artery disease

Smoking, HTN, male gender, family history, hyperlipidemia, diabetes

32

Medical treatment: coronary artery disease

Nitrates, smoking cessation, weight loss, statin drugs, ASA

33

Branches of left main coronary artery branches

Left anterior descending (LAD) and circumflex (Cx) arteries

34

Location of most atherosclerotic lesions

Most atherosclerotic lesions are proximal

35

Complications of myocardial infarction

- VSR (ventricular septal rupture)
- Papillary muscle rupture

36

Hypotension, pansystolic murmur, usually occurs 3-7 days after MI; have a step-up in oxygen content between right atrium and pulmonary artery secondary to L->R shunt

VSR (ventricular septal rupture)

37

Why is there a step up in oxygen content in ventricular septal rupture?

Step-up in oxygen content between the right atrium and pulmonary artery secondary to L->R shunt.

38

Dx / Tx: ventricular septal rupture

Dx: echo
Tx: IABP to temporize, patch over septum

39

Get severe mitral regurgitation with hypotension and pulmonary edema; usually occurs 3-7 days after MI

Papillary muscle rupture

40

Dx / Tx: papillary muscle rupture

Dx: echo
Tx: IABP to temporize, replace valve

41

Restonosis rate in drug-eluting stent

Restenosis in 20% at 1 year

42

5 year potency of saphenous venous graft

80% 5-year patency

43

What is the internal mammary artery a branch of?

Subclavian artery

44

- Best conduit for CABG (>95% 20 year potency when placed to LAD)
- Collateralizes with superior epigastric artery

Internal mammary artery

45

For CABG procedure: causes arrest of the heart in diastole; keeps the heart protected and still while grafts are placed

Potassium and cold solution cardioplegia

46

Best indications for CABG

- > 70% stenosis significant for most areas except left main disease.
- Left main disease (> 50% stenosis considered significant
- 3 vessel disease (LAD, Cx, and right coronary artery)
- 2 vessel disease involving the LAD
- Lesions not amenable to stenting

47

High mortality risk factors in coronary artery disease

Pre-op cardiogenic shock (#1 risk factor).
Emergency operations.
Age.
Low EF.

48

Most common valve lesion, calcification produces stenosis

Aortic stenosis

49

What type of valve does not require anticoagulation?

Bioprosthetic tissue valves

50

When would you consider bioprosthetic tissue valves?

For patients who want pregnancy, have contraindication to anticoagulation, are older (>65) and unlikely to require another valve in their lifetime, or have frequent falls

51

How long does bioprosthetic tissue valve last?

Lasts 10-15 years -> not as durable as mechanical valves

52

Why are bioprosthetic tissue valves contraindicated in children and younger patients?

Because of rapid calcification in children and young patients, use of tissue valves is contraindicated in those populations.

53

Valvular lesion most from degenerative calcification

Aortic stenosis

54

Cardinal symptoms of aortic stenosis

- DOE: mean survival 5 years
- Angina: mean survival 4 yrs
- Syncope: mean survival 3 yrs

55

Worst of the cardinal symptoms of aortic stenosis

Syncope: mean survival is 3 years

56

Indications for operation in aortic stenosis

When symptomatic (usually have a peak gradient > 50 mmHg and a valve area

57

Valve disease causing dilation of the left ventricle

Mitral regurgitation (MR)

58

Key index of disease progression in patients with MR

Ventricular function

59

Arrhythmia common in mitral regurgitation

Atrial fibrillation: is common, in end-stage disease, pulmonary congestion occurs

60

Indications for operation in mitral regurgitation

When symptomatic or if severe mitral regurgitation

61

Rare now, most from rheumatic fever
- Get pulmonary edema and dyspnea

Mitral stenosis

62

Indication for operation in mitral stenosis

When symptomatic (usually have valve area

63

Often used as 1st procedure for mitral stenosis

Balloon commissurotomy to open valve often used as 1st procedure (not as invasive)

64

Symptoms of endocarditis

Fevers, chills, sweats

65

Most common site of prosthetic valve infections

Aortic valve endocarditis

66

Most common site of native valve infections

Mitral valve endocarditis

67

Responsible for 50% of cases of endocarditis

Staphylococcus aureus

68

Most common organisms causes endocarditis in drug abusers

Pseudomonas

69

Most common site of endocarditis in drug abusers

Left sided endocarditis

70

Initial treatment of endocarditis

Medical therapy first: successful in 75%, sterilizes valve in 50%

71

Indications for surgery in endocarditis

Failure of antimicrobial therapy, severe valve failure, perivalvular abscesses, pericarditis

72

Most common benign tumor of the heart

Myxoma; 75% in LA

73

Most common malignant tumor of the heart

Angiosarcoma

74

Most common metastatic tumor to the heart

Lung cancer

75

Tx: coming off cardiopulmonary bypass and aortic root vent, blood is dark and aortic perfusion cannula blood is red

Tx: ventilate the lungs

76

Have the lowest oxygen tension of any tissue in the body

Coronary veins: due to high oxygen extraction by myocardium

77

Swelling of the upper extremities and face
- Most cases secondary to lung CA invading the SVC

Superior vena cava (SVC) syndrome

78

Treatment of tumors causing SVC syndrome

These tumors are unresectable since the tumor has invaded the mediastinum.
- Tx: emergent XRT

79

Mediastinal bleeding: when do you need to re-explore after cardiac procedure?

> 500 cc for 1st hour or > 250cc/hr for 4 hours

80

Risk factors for mediastinitis

Obesity, used of bilateral internal mammary arteries, diabetes

81

Tx: mediastinitis

Debridement with pectoralis flaps, can also use omentum

82

Pericardial friction rub, chest pain, SOB
- EKG: diffuse ST-segment elevation in multiple leads

Treatment?

Post-pericardiotomy syndrome

TX: NSAIDS, steroids