Term
|
Definition
connects DESC AORTA and LEFT PULM ART
(shunt blood from lungs) |
|
|
Term
|
Definition
connects PORTAL V and IVC
(shunt blood from liver) |
|
|
Term
| # of umbilical art vs veins? |
|
Definition
2 umbilical arteries (to placenta)
1 umbo vein (from placenta) |
|
|
Term
| first sign of L->R shunt? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| basic manifestation of L to R vs R to L shunts? |
|
Definition
L-->R = CHF
R-->L = cyanosis |
|
|
Term
| method to reduce R-->L shunt often performed by children? |
|
Definition
| squat = inc SVR = inc flow to lungs |
|
|
Term
|
Definition
polycythemia
stroke
brain abscess
endocarditis |
|
|
Term
|
Definition
4Ts
-Tetralogy (MC cyanotic lesion)
-Transposition
-Truncus arteriosus
-Tricuspid atresia |
|
|
Term
| Treatment of R-->L shunts causing cyanosis? |
|
Definition
1. PGE-1 to keep ductus art open OR..
2. balloon atrial septostomy |
|
|
Term
| PGE-1: role in cyanotic heart disease? |
|
Definition
| used to keep open Ductus Art |
|
|
Term
| PPHys behind Eisenmenger's syndrome? |
|
Definition
Sign of inc pulm vascular resistance -->pulm HTN
(Left-->Right, turns Right-->left) |
|
|
Term
| MC congenital heart defect? |
|
Definition
|
|
Term
| % of VSD that close spont? |
|
Definition
|
|
Term
| When do pts with VSD first present with sxs? |
|
Definition
| if large VSD, present by 4-6 weeks. |
|
|
Term
|
Definition
|
|
Term
|
Definition
Large = at one year
Medium = at 5 years
Small = leave alone (80% close spont) |
|
|
Term
| MC indication for VSD repair |
|
Definition
|
|
Term
| what is a contraindication to VSD repair? |
|
Definition
PVR > 8 Woods units
*try to reverse with vasodilators..then repair* |
|
|
Term
|
Definition
|
|
Term
| ASD vs VSD % that close ? |
|
Definition
90% ASD
80% VSD
..at 1 year age |
|
|
Term
|
Definition
Ostium secundum
-centrally located, patent foramen ovale |
|
|
Term
|
Definition
Ostium primum
-AV septal defects, or endocardial cushion defects |
|
|
Term
|
Definition
1-2 years
(earlier if Sx not controlled) |
|
|
Term
|
Definition
indomethacin
(rarely works after neonatal period) |
|
|
Term
| Surg tx of persistent PDA? |
|
Definition
| Surgical ligation via left thoracotomy |
|
|
Term
| MC cyanotic congenital heart defect? |
|
Definition
|
|
Term
|
Definition
VSD
Pulm Stenosis
Overriding aorta
RVH |
|
|
Term
|
Definition
Tet spells
-cyanosis->child squats to inc SVR and inc pulm flow (decreases flow thru VSD) |
|
|
Term
| Morphologic abn found in tetralogy? |
|
Definition
| Anterior displacement of the infundibular septum |
|
|
Term
|
Definition
|
|
Term
| Surgical tx of tetralogy? |
|
Definition
-RV outflow tr obstruction divison
-Patch enlargement outflow tr
-VSD repair |
|
|
Term
| timing of tetralogy operation? |
|
Definition
| 3-6 months (earlier if worsening cyanosis) |
|
|
Term
| left vs right dom coronary artery meaning? |
|
Definition
-Right dominant (MC) = posterior desc off RCA
-Left dom (10%) = PDA off Circumflex |
|
|
Term
|
Definition
| left ant descending and cirucmflex |
|
|
Term
| location of most atherosclerotic lesions? |
|
Definition
|
|
Term
| patency rate of PCA/stent? |
|
Definition
90% @ 1 year
-saphenous v graft - 80% @ 5 y
-IMA = 90% @ 20 y |
|
|
Term
|
Definition
|
|
Term
| cadioplegia soln/timing of effect? |
|
Definition
K+ and cold soln
-arrest heart in diastole |
|
|
Term
|
Definition
Stenosis >70%
-left main disease
-left main equiv (LAD and prox circumflex)
-3 vessel disease
-2 vessel disease w/proximal LAD stenosis AND..
LVEF < 50% OR extensive iscehmia
-1 or 2 vessel disease w/large area on viable myocardium and high risk criteria
-Unstable angina, life threatening arrhythmia, ongoing ischemia despite non surgical therapy |
|
|
Term
| High mortality risk factors for CABG? |
|
Definition
#1 = pre-op cardiogenic shock
Emergency surgery
age
reop
low EF |
|
|
Term
| MC time-frame for mechanical cx after MI? |
|
Definition
|
|
Term
| DDx mechanical Cx after MI? |
|
Definition
1. Vent septal rupture: holosystolic at right sternal border
2. Pap m rupture: acute mitral regurg, holosystolic at axilla
3. Free wall rupture : fatal |
|
|
Term
| PA cath findings with L==>R shunt? |
|
Definition
Step-up in O2 content betwen RA and pulm artery
-ddx VSRupture vs pap muscle rupture after MI |
|
|
Term
| Tx options for mechanical cx after MI? |
|
Definition
| IABP (inc survival @ VSR and MR 2/2 papillary rupture) |
|
|
Term
| Timing of LV aneurysm after MI? |
|
Definition
late after large, transmural, anterior MI
-Sx CHF, arrhythmia, angina
-Surg vs refractory Sx |
|
|
Term
|
Definition
|
|
Term
|
Definition
Early: normal CO and pressures maintained
Late: LVH --> dec compliance-->pulm congestion-->LV fail |
|
|
Term
Aortic stenosis
-Cardinal Sx and implication for survival? |
|
Definition
Angina: 5 year mean survival
Syncope: 3 year
Dyspnea at rest: 2 year |
|
|
Term
| Valve area considered severe AS? |
|
Definition
|
|
Term
| Indications for AS repair? |
|
Definition
1. Sxs
2. Asympt + valve area < 0.6 cm2 |
|
|
Term
|
Definition
|
|
Term
|
Definition
| -LV dilation->inc wall tension (laplace)-->LV failure |
|
|
Term
Aortic insuff
-indications for OR? |
|
Definition
Symptomatic (HF, angina not 2/2 CAD)
-OR..Asympt w/either
1. EF<50
2. LV dilation (>70mm end diastolic measurement)
3.Root dilation > 4.5 |
|
|
Term
|
Definition
|
|
Term
| Complications/risks of mitral stenosis? |
|
Definition
-pulm congestion, a-fib
-mural thrombi formation (50% go to cerebral circ) |
|
|
Term
| Tx options for mitral stenosis? |
|
Definition
Balloon commissurotomy
-Surgery for severe MS/sxs |
|
|
Term
|
Definition
| Myxomatous degeneration (ie MVP) |
|
|
Term
|
Definition
LV dilation = inc wall tension
-Dec compliance of LA=>pulm congestion
--> +/-right sided HF +/-afib |
|
|
Term
Mitral regurg
-OR indications |
|
Definition
1. Sxs (>/= NYHA class 2)
2. Asympt with either
-EF< 60
-LV dilation (end systolic > 45 mm)
-Pulm HTN (PA systolic > 50)
-Afib |
|
|
Term
| Pros/cons of tissue valves? |
|
Definition
Pro: no AC needed
Con: rapid calcification in children/young pts (CONTRAINDICATED IN THESE PTS) |
|
|
Term
| contraindications for tissue valve? |
|
Definition
1. children, younger pts. (rapid calcification
2. Chronic renal dialysis (relative CI) |
|
|
Term
|
Definition
Fever
-chills, CHF, stroke |
|
|
Term
| Dx criteria for endocarditis? |
|
Definition
Major
+BCx, +ECHO
Minor
-new murmur
-vascular sxs (emboss, janeway)
-Worsening CHF
-Fever (mc 1-2 hrs after peak bacterem)
-Known RF
-Immune sign: Osler node, Roth spots |
|
|
Term
|
Definition
Osler = tender nodes @ pads of digits
Roth spots = retinal hemorrhages |
|
|
Term
|
Definition
Overall: Step Bovis
-acute endo: staph (Also mc iatrogenic)
-chronic endo: strep bovis
MC w/IVDA: pseudomonas (50% @ TV) |
|
|
Term
Endocarditis
-MC locations |
|
Definition
-MC on left side (unless IVDA)
-MC overall: aortic valve |
|
|
Term
| Initial abx vs Endocarditis? |
|
Definition
vanc and gent
-add rifampin if prosthetic |
|
|
Term
Endocarditis
-prognostic indicator for surgery pts? |
|
Definition
|
|
Term
Endocarditis
-survival after surgery? |
|
Definition
Native valve-->85%
Prosthetic valve --> 75%
*worse due to re-op, inc abscesses, erosion, aneurysm, inc fungal, insidious |
|
|
Term
Endocarditis
-peri-procedural prophy? |
|
Definition
-Prosthetic valves, hx valve surg
-Rheumatic heart dz
-Congen heart dz
-Hx endocarditis
*first gen ceph 1 day prior* |
|
|
Term
Acute HF treatment
-initial hemodynamic goals |
|
Definition
MAP> 60
CI 2.2
SVR < 800
Wedge 15-20 |
|
|
Term
Acute HF treatment
-initial tx |
|
Definition
LMNOP
-lasix (wedge 15-20)
-Morphine (venodilate, reudces after load)
-nitrate (venodilate
-O2
-Position (sitting) |
|
|
Term
Chronic HF treatment
-meds that reduce mortality? |
|
Definition
BBlk (carvedilol)
ACE-H
Spironolactone |
|
|
Term
|
Definition
-1st deg = prolonged PR int (>0.2 msec)
-2nd deg
--type 1 = progressively inc PR int
--type 2 = p wave randomly not f/b QRS
-3rd deg: no assoc btwn P and QRS |
|
|
Term
| Most worrisome heart block types? |
|
Definition
2nd deg type 2 (can degen to complete block)
3rd deg (complete block)
**BOTH REQUIRE PERMANENT PACEMAKER** |
|
|
Term
| MC location for aortic intimal tear? |
|
Definition
|
|
Term
| MCC death w/ ascending aortic dissection? |
|
Definition
| 2ndary to cardiac failure, MC from aortic insufficiency, tamponade, or rupture |
|
|
Term
| RF for type A dissection? |
|
Definition
HTN,connective tissue dz, fam hx,
bicuspid aortic valve, coarctation, aortitis (takayasu),
3rd trimester preg,
cardiac cath,
cocaine, aneurysm,
atheroslcerotic dz |
|
|
Term
| unique BP finding with aortic dissection? |
|
Definition
R>L arm BP
*use right radial for a line* |
|
|
Term
| Dissection classifications |
|
Definition
1.Stanford A vs B
2. Debakey class:
-type 1 = asc and desc
-type 2 = asc only
-type 3 = desc only |
|
|
Term
| lifetime aneurysm risk after aortic dissection? |
|
Definition
|
|
Term
| MCC ascending aortic aneurysm? |
|
Definition
| Cystic medial necrosis (ex marfans) |
|
|
Term
thoracic aortic aneurysm
-indications for repair |
|
Definition
sxs
rapid size inc (>0.5 cm/y)
> 5.5 cm @ ascending/arch
***6.5 @ thoracoabd*** |
|
|
Term
| MCC thoracic aortic aneurysm based on location? |
|
Definition
asc and arch = cystic medial necrosis
desc = atherosclerosis |
|
|
Term
Thoracoabd aneurysm repair
-% risk of paraplegia
-how to help prevent it? |
|
Definition
10% w/open surgery
1% w/stent graft
**re-implant intercostals below T8 to help prevent it** |
|
|
Term
Indications for aortic aneurysm repair based on size/location?
-difference for Marfans pts? |
|
Definition
1. Asc/arch = 5.5
2. desc thoracic/thoracoabd = 6.5
3. abd = 5.5
**marfans get repair at 0.5-1 cm lower than than normal** |
|
|
Term
| Indications for stand-alone MAZE? |
|
Definition
1. refractory Afib/can't tolerate meds
2. a fib for 6 months w/enlarged atrium
3. High risk embolic event (hypercoag state) or C.I to AC
4. s/p stroke despite AC |
|
|
Term
|
Definition
pulm vein isolation
**MAZE can be done OFF BYPASS** |
|
|
Term
|
Definition
|
|
Term
LIMA to LAD patency rate?
Saphenous v graft patency rate? |
|
Definition
90% @ 20 years
80% @ 5 years |
|
|
Term
Internal mammary artery
-br of..
-branches into.. |
|
Definition
-br of Subclavian artery
-br into musculophrenic and sup epigastric a
*also has br to intercostals* |
|
|
Term
| physiology of vasovagal episode? |
|
Definition
-Inc parasymp tone = dec HR
-dec symp tone = dec BP
==>syncope
*carotid stents can distend carotid body-->body thinks BP is high-->inc parasymp/dec symp tone** |
|
|
Term
|
Definition
|
|
Term
| Classic pres of post-op cardiac tamponade? |
|
Definition
1. Sudden cessation of mediastinal drainage
2. inc filling pressures (PA, CVP), hypoTN
3. +/- sudden dec UOP
*usually clinical, but get ECHO, CXR if needed* |
|
|
Term
|
Definition
OR if still has pulse
Open chest @ bedside if pulseless |
|
|
Term
| First sign of tamponade on ECHO? |
|
Definition
| right atrial diastolic compression |
|
|
Term
|
Definition
| Dec ventricular filling due to pericardial fluid |
|
|
Term
MC primary cardiac tumor
-overall vs benign vs malig
-MC pediatric primary heart tumor |
|
Definition
Myoxma = MC overall, MC benign
MC malig = angiosarcoma
MC peds = rhabdomyoma |
|
|
Term
|
Definition
|
|
Term
IHSS =
-pphys based on vol status?
-tx |
|
Definition
idiopathic hypertrophic subaortic stenosis
-vol up: overload, CHF
-vol down: LV outflow tract collapse, CHF
**usually have associated Mitral regurg** |
|
|
Term
|
Definition
idiopathic hypertrophic subaortic stenosis
-give sufficient volume
-BBLK vs HR (allows LV filling and stretching of outflow tract)
**avoid inotropes** |
|
|
Term
|
Definition
30%
-lowest in body
-high O2 extraction by myocardium |
|
|
Term
Pt coming of pump, now with dark aortic root vent blood but red perfusion cannula blood.
-tx? |
|
Definition
|
|
Term
| indication for re-op after cardiac surgery based on mediastinal output? |
|
Definition
1. 500 cc over 1st hour
2. >250 cc/4hr |
|
|
Term
|
Definition
-obesity
-use of bilateral internal mammary art
-DM
-inc blood transfusion |
|
|
Term
Postpericardiotomy syndrome
sxs
EKG findings
MC cause
tx |
|
Definition
-pericard frinction rub, fever, chest pain, sob, left pleural effusion
-diffuse ST ele (pericarditis)
-MC after CABG
-Tx NSAIDs, steroids |
|
|
Term
Pt with severe carotid stenosis in need of CABG
-general recommendation? |
|
Definition
1. Asympt >80% or sxs > 70%?
-CEA first. CABG 4 wk later
2. Unstable angina or severe left main dz?
-combined CEA/CABG (CEA first)
*combined procedure stroke risk is higher (6% vs 3% if staged) |
|
|
Term
Coarctation
-MC location
-mc assoc condition
-common exam finding
-tx? |
|
Definition
-just distal to left SCA
-a/w Turners syndrome
-rib notching from IMA/intercostal collats
-All need repair to prevent CHF
->rsxn and re-anastamosis |
|
|
Term
Vascular rings
-MC manifestation
-pres
-tx |
|
Definition
double aortic arch
-p/w recurrent pulm infxns, dysphagia
-divide smaller arch via left thora |
|
|
Term
Transposition of great vessels
-type of shunt/where it shunts through?
-medical Tx options |
|
Definition
-R to L, MC via ASD
-medical: goal = allow mixing
- balloon atrial septostomy (atrial mixing).
-PGE1 to keep PDA open |
|
|
Term
Transposition
-timing of operation |
|
Definition
No VSD-->1-2 weeks
VSD--> 1-2 months |
|
|
Term
Truncus arteriosus
-shunt type
-sxs |
|
Definition
R->L
CHF
*has VSD that allows mixing* |
|
|
Term
Truncus arteriosus
-shunt type |
|
Definition
|
|
Term
Hypoplastic left heart
-procedure to repair? |
|
Definition
|
|
Term
Tricuspid atreisa
-procedure to repair? |
|
Definition
|
|
