Fiser Chapter 26 CARDIAC Flashcards Preview

ABSITE > Fiser Chapter 26 CARDIAC > Flashcards

Flashcards in Fiser Chapter 26 CARDIAC Deck (44):
1

Shunt causing cyanosis

R to L shunt

2

Children squatting does what

Increases SVR and decreases R to L shunt

3

Cyanosis from R to L shunt can lead to what

Polycythemia, stroke, brain abscess, endocarditis

4

Eisenmenger's syndrome

L -> R shunt switches to R -> L shunt

Sign of increasing pulmonary vascular resistant and pulmonary HTN, and is generally irreversible

5

Shunt causing CHF

L to R shunt

Manifests as failure to thrive, tachycardia, tachypnea, hepatomegaly

6

First sign of CHF in children

Hepatomegaly

7

Causes of L to R shunts

VSD
ASD
PDA

8

PDA causes what kind of shunt

L to R

9

Causes of R to L shunts

Tetralogy of Fallot

10

Ductus arteriosus

Connection between descending aorta and Left pulmonary artery; blood shunted away from lungs in utero

11

Ductus venosum

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

12

Fetal circulation at placenta

2 umbilical arteries (take blood away from fetus)

1 umbilical vein (brings blood to fetus)

13

Most common congenital heart defect

VSD causing a L -> R shunt

80% close spontaneously by 6 months

Large VSDs usually cause symptoms after 4-6 weeks old, as PVR decreases and shunt increases

Cx: CHF (tachypnea, tachycardia) and FTT (failure to thrive)

Tx: Diuretics, digoxin, repair

14

VSD timing of repair

FTT: most common reason for earlier repair

Medium (shunt 2-2.5): 5yo

Large (shunt > 2.5): 1yo

15

ASD types

Ostium secundum is most common; centrally located

Ostium primum (or atrioventricular canal defects or endocardial cushion defects); can have mitral valve and tricuspid valve problems; frequent in Down's syndrome

16

ASD

L -> R shunt

Usually symptomatic when shunt > 2 -> CHF (SOB, recurrent infections)

Can get paradoxical emboli in adult hood

Tx: Diuretics and digoxin

17

ASD timing of repair

1-2yo

If canal defects: 3-6 months old

18

Tetralogy of Fallot

PROV:
-Pulmonic stenosis
-R ventricular hypertrophy
-Overriding aorta
-VSD

R to L shunt -> cyanosis

Tx: Beta blocker, repair at 3-6 months old

19

Most common congenital heart defect that results in cyanosis

Tetralogy of Fallot

20

Tetralogy of Fallot repari

-RV outflow tract obstruction removal, RVOT enlargement, and VSD repair

21

PDA

L to R shunt

Tx: indomethacin to close, rarely successful beyond neonatal period, requires L thoracotomy for repair if persists

22

MCC death in US

CAD

23

CAD risk factors

-Smoking
-HTN
-Male
-Family hx
-HLD
-DM

24

CAD medical tx

-Nitrates, smoking cessation, weight loss, statins, ASA

25

Coronary arteries

LMA branches into LAD and LCx

26

Where are most atherosclerotic coronary lesions?

Proximal

27

MI complications

-Ventricular septal rupture
-Papillary muscle rupture

28

3-7 days after MI, patient has hypotension, pansystolic murmur, and a step-up in O2 content between R atrium and pulmonary artery

Ventricular septal rupture

Dx: Echo

Tx: IABP and patch over septum

29

3-7 days after MI, patient has severe mitral regurgitation with hypotension and pulmonary edema

Papillary muscle rupture

Dx: Echo

Tx: IABP, replace valve

30

Incidence in restenosis in CAD revascs

Drug-eluting stent: 80% at 1 year

Saphenous vein graft: 80% at 5 years

Internal mammary artery (off subclavian): 95% 20 year patency when placed to LAD; collateralizes with superior epigastric artery

31

What do you use to cause arrest of heart in diastole and keep heart protected and still while grafts are placed during CABG?

Potassium and cold solution cardioplegia

32

CABG indications

Left main > 50% stenosis or at other site > 70% stenosis

-Left main disease
-2-vessel disease involving LAD
-3 vessel disease (LAD, Cx, RCA)
-Lesion not amenable to stenting

33

High mortality risk factors for CABG

Pre-op cardiogenic shock is #1 risk factor

Emergency operations

Age

Low EF

34

Mechanism of aortic stenosis

Degenerative calcification

35

Benefit of bioprosthetic tissue valves

-Do not require anticoagulation

-But not as durable, last 10-15 years

-Use for patients who want pregnancy, have contraindication to AC, are older >65, and unlikely to require another valve in their lifetime, or have frequent falls
-Contraindicated in children and young patients d/t rapid calcification

36

DOE, angina, syncope

Aortic stenosis

Syncope is the worst with mean survival 3 years (versus 4 and 5 for angina and DOE)

37

AS indications for operation

Symptomatic (usually have peak gradient > 50 mm Hg and valve area < 1.0 cm^2)

38

Key index of disease progression in patients with MR

Ventricular function. Usually becomes dilated.

Other symptoms: A fib, pulmonary congestion

39

MR indications for operation

Symptomatic or severe MR

40

Pulmonary edema, dyspnea, hx of rheumatic fever

MS

41

MS indications for operation

Symptomatic (usually have valve area < 1 cm^2)

Balloon commissurotomy to open valve often used as 1st procedure

42

Patient with fever, chills, sweats, and heart murmur

Endocarditis, usually Staph aureus and Left sided (except drug users: pseudomonas? and Right sided)

43

Most common site of native valve vs prosthetic valve infections

Native: mitral

Prosthetic: aortic

44

Endocarditis tx

Medical tx successful in 75%, sterilizes valve in 50%

Surgery if failure of abx, severe valve failure, peri