heart disease & fixes

Question 1

transcatheter aortic valve replacement

Answer 1

aortic stenosis but open heart surgery not an option

new bovine valve directly over old, inserted via giant cath

Question 2

tricuspid atresia

Answer 2

no tricuspid valve

ASD / VSD allow for pulmonary system access

Question 3

Fontan procedure

Answer 3

fix tricuspid atresia

Question 4

ASD

Answer 4

left to right shunt, increases heart workload

Question 5

VSD

Answer 5

left to right shunt, increases workload of heart

size determines %age blood into lungs for re-oxygenation

can be congenital or post MI!

Question 6

transposition of the great vessels

Answer 6

two separate circulations right to aorta, left to lungs

often occurs with
ASD
PFO
PD
- keeps patient alive but insufficient for growth

Question 7

tetralogy of fallot

Answer 7

• PULMONARY STENOSIS * (increased R pressure)
  VSD
  R to L shunt (cyanotic)

Question 8

hypertrophic cardiomyopathy aka

Answer 8

idiopathic hypertrophic subaortic stenosis

Question 9

what is hypertrophic cardiomyopathy

Answer 9

increased muscle mass @ septum obstructs LV outflow

• ↓ SV
• mitral regurg (pulled into LVOT)
• diastolic dysfunction: can’t relax

aka idiopathic hypertrophic subaortic stenosis

Question 10

diagnosis of hypertrophic cardiomyopathy

Answer 10

Echo

• septal wall hypertrophy
• ↑ pressure gradient LV & aorta

12 lead EKG
- LV hypertrophy

physical
- systolic murmur

Question 11

pre-systolic atrial impulse with harsh systolic murmur @ 4-5th ICS LSB

Answer 11

hypertrophic cardiomyopathy

Question 12

low CO syndrome

Answer 12

temporary heart failure due to surgery

Question 13

poor man’s leg lift test

Answer 13

suspected hypovolemia, complements CVP

patient supine, lift leg 15-20 seconds, see SBP rise 10-15 points = hypovolemic

Question 14

ominous sign of pericardial effusion/tamponade

Answer 14

equalization of filling pressures in setting of low CI/CO

Question 15

suspect tamponade - next steps

Answer 15

call surgeon
bedside echo
check chest tubes
prepare to open chest at OR or bedside (can arrest any time)

Question 16

metabolic acidosis markers post-op

Answer 16

pH lt 7.35

lactate gt 2 mmol/L

Question 17

potential cardiovascular causes of metabolic acidosis post-op

Answer 17

hypotension
low CO/CI
ischemia

Question 18

metabolic acidosis post-op due to

Answer 18

lactate produced in anaerobic conditions (from cellular pyruvate)

TISSUE HYPOPERFUSION

Question 19

gt 200 mL/hour chest tube

Answer 19

RED FLAG for hemorrhage

Question 20

coagulopathy markers/fixes

Answer 20

plt lt 80000
- transfusion promotes clots

INR gt 1.5

• FFP rapid correction
• vit K takes too long

PTT gt 40
- protamine if heparin

fibrinogen lt 150
- cryoprecipitate (factors I, VIII, XIII, von willebrand’s)