Term
| blood supply of the heart |
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Definition
left main artery branches into LAD and LCX.
considered right dominant if it arises from the RCA. left dominant if it arises from the LCX
LAD supplies anterior LV, apex of heart, intraventricular septum and part of the RV (AKA widowmaker).
LCX has marginal vessels that supply the LV.
RCA supplies the lateral portion of RV. |
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Term
| Posterior Descending Artery |
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Definition
| PDA arises from the RCA and supplies AV node |
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Term
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Definition
| between LV and aorta, has 3 leaflets |
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Term
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Definition
| between LA and LV, has 2 leaflets |
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Term
| this attaches the valve leaflets to the papillary muscles, tethering the leaflets to the ventricle wall |
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Definition
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Term
| common cause of mortality in the US |
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Definition
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Term
| risk factors for coronary artery disease |
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Definition
| HTN, +FHx, hypercholesterolemia, smoking, obesity, diabetes, physical inactivity |
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Term
| this population has increased risk of mortality after CABG |
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Definition
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Term
| leading cause of death in women in the US |
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Definition
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Term
| _______ is an independent risk factor for survival after CABG |
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Definition
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Term
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Definition
| cardiac catheterization (diagnostic and therapeutic), coronary artery bypass graft (CABG) |
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Term
| complications following CABG |
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Definition
| Q wave infarction, non-Q wave infarction, myocardial stunning, ventricular dysfunction, severe dysnfunction in high risk patients |
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Term
| medical management of CAD |
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Definition
| CCB, ACEI, lipid lowering agents, lifestyle changes |
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Term
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Definition
| greater saphenous vein, lesser/short saphenous vein, internal mammary artery, radial artery |
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Term
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Definition
| greater saphenous vein, lesser/short saphenous vein, internal mammary artery, radial artery, ulnar artery, popliteal vein/artery, anterior tibial vein/artery, peroneal vein/artery, cephalic vein |
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Term
| how do you dx acquired valvular heart disease? |
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Definition
echo - assess severity of stenosis, regurg, and valve anatomy.
transthoracic echo - non-invasive.
transesophageal echo - definition of aortic and mitral valve anatomy |
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Term
| what may be necessary to confirm the dx of acquired valvular heart disease? |
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Definition
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Term
| common cause of left ventricular outflow obstruction |
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Definition
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Term
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Definition
| angina, syncope, and heart failure, occasionally sudden death. |
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Term
| where is the murmur of aortic stenosis heard best? |
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Definition
| systolic murmur best heard at the base, radiating to the carotid arteries |
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Term
| how do you dx aortic stenosis? |
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Definition
| ECG (LVH, LAE), xray (calcification), echo, cardiac cath |
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Term
| only effective therapy for aortic stenosis |
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Definition
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Term
| tx of congenital aortic stenosis |
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Definition
| almost all undergo balloon aortic valvotomy. mechanical prosthesis can be considered in childhood |
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Term
| disease of valve leaflets, prolapse of the valve --> a central leak. may be sx free for long periods, eventually LV dysfunction manifests |
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Definition
| aortic insufficiency (regurg) |
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Term
| characterized by a wide pulse pressure, and high frequency crescendo-decrescendo diastolic murmur |
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Definition
| aortic insufficiency (regurg) |
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Term
| how do you dx aortic insufficiency? |
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Definition
| CXR (enlarged cardiac silhouette), ECG (LVH, LAE), doppler echo to confirm dx, cardiac cath (to determine severeity) |
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Term
| treatment of aortic insufficiency |
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Definition
| nifedipine, ACEI, symptomatic aortic insufficiency requires elective surgical therapy (aortic valve replacement) before the left ventricle has irreversibly dilated. |
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Term
| etiology of mitral stenosis |
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Definition
rheumatic fever, SLE, RA
mitral apparatus becomes defoemed and scarred during healing --> stenosis |
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Term
| describe the murmur of MS |
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Definition
| rumbling, diastolic murmur best heart at the apex, decreased with inspiration, preceded by an opening snap |
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Term
| how do you dx mital stenosis? |
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Definition
| xray (LAE/calcification), echo is gold standard |
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Term
| treatment of a symptom free pt with mitral stenosis |
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Definition
| only bacterial endocarditis prophylaxis |
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Term
| treatment for a symptomatic pt with mitral stenosis |
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Definition
med: diuretics, BB/CCB, digoxin (for afib), warfarin.
surgical indications: pulmonary HTn, mitral valve reduced to 1cm, systemic emoblization, endocarditis.
Surgical options: balloon mitral valvuloplasty, open surgical mitral valvuloplasty, mirtal valve replacement |
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Term
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Definition
| abnormalities of the mitral valve, chordal rupture, endocarditis, rheumatic fever, mitral valve prolapse, papillary muscle infarction |
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Term
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Definition
| SOB, dyspnea on exertion, orthopnea, pulmonary edema, diminished exercise tolerance |
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Term
| describe the murmur of MR |
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Definition
| holosystolic murmur heard best at the apex, radiating to the axilla and left scapular region. Pulm exam may reveal rales |
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Term
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Definition
| ECG (LAE, afib), xray (LAE, cardiomegaly) |
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Term
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Definition
| diuresis, ACEI (afterload reduction), heart failure from acute MR = IV vasodilators (nitroprusside) |
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Term
| surgical indications for MR |
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Definition
symptomatic despite medical management, severe MR in the presence of an identified structural abnormality (rupture chordae tendinea, pulmonary HTN, deteriorating LV contractile function).
Surgical options = Mitral valve replacement, mitral valve repair |
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Term
| compression of the subclavian vessels and nerves (brachial plexus) in the region of the thoracic inlet |
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Definition
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Term
| pt inspires maximally while the neck is extended and the head turned toward the affected side, loss of ipsilateral radial pulse = + test |
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Definition
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Term
| how do you dx thoracic outlet syndrome? |
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Definition
| chest and c-spine radiography (CT, MRI, or myelogram), doppler studies, nerve conduction velocities |
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Term
| treatment of thoracic outlet syndrome |
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Definition
| nonsurgical behavior modifications, operation for failed conservative tx is complete removal of the first rib. |
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Term
| peri-operative risks of lung surgery |
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Definition
| comorbidities associated with increased risk = smoking, increased age, COPD, asthma, obesity |
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Term
| how can you minimize post-op morbidity from lung surgery? |
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Definition
| adequate pain control = IV analgesics (PCA, thoracic epidural catheter, intercostal nerve blocks after thoracotomy), pulmonary exercises to expand the lungs (incentive spirometry, and mobilization within 24 hrs) |
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Term
| MC thoracotomy approach used |
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Definition
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Term
| curvilinear incision underneath the inferior border of the pectoralis major muscle |
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Definition
| anterior or anterolateral thoracotomy |
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Term
| vertical incision from the sternal notch to the xiphoid, followed by sternal saw |
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Definition
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Term
| when is a transverse sternotomy (clamshell) used? |
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Definition
| large mediastinal tumors, hilar dissections, lung transplantation |
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Term
| minimally invasive procedure for pneumothorax, open lung biopsy, and staging of thoracic malignancies |
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Definition
| video assisted surgery (VATS) |
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Term
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Definition
| often present in late stages: hoarseness, chest wall pain, horner's syndrome, dysphagia |
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Term
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Definition
| often present in late stages: hoarseness, chest wall pain, horner's syndrome, dysphagia, pleural effusion, phrenic nerve paralysis |
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Term
| sxs of a very large lung cancer |
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Definition
| hemoptysis, dyspnea, obstruction, pain |
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Term
| how do you dx lung cancer? |
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Definition
| cytologic exam of sputum, CXR, fiberoptic bronchoscopy, FNA, CT of the chest |
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Term
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Definition
stage dependent:
surgery for localized disease,
chemo for mets disease,
RT for local control in pts whose condition is not amenable to surgery |
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Term
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Definition
primary isloated mets = surgery/radiation.
extraregional mets = systemic chemo.
RT can be used to tx or palliate the local effects of mets disease. |
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Term
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Definition
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Term
| rare malignant lesion derived from the visceral pleura |
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Definition
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Term
| risk factors for mesothelioma |
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Definition
| asbestos, cigarette smoking |
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Term
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Definition
| chest pain, dyspnea, fever, decreased breath sounds from pleural effusion |
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Term
| how do you dx mesothelioma? |
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Definition
| CXR (pleural effusion), thoracentesis (bloody fluid - cytology = malignant cells), pleuroscopy and biopsy |
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Term
| treatment of mesothelioma |
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Definition
survival > 2 yrs = rare.
extrapleural pneumonectomy (entire lung and pleura), chemo and RT = expiramental |
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Term
| occurs when air enters the space between the visceral and parietal pleura |
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Definition
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|
Term
| defect in the chest wall allows continuous entry of air from outside the body |
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Definition
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|
Term
| defect in the visceral pleura allows ait to enter the space but not escape |
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Definition
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Term
| who does a spontaneous pneumothorax occur in? |
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Definition
| tall, thin, young males or those with bullous emphysema or mechanical ventilation, with placement of central venous catheters, infection (TB or pneumocystis carinii) |
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Term
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Definition
| Asx, sudden pleuritic chest pain and dyspnea, decreased breath sounds, hyperresonance, dispalced trachea with tension pneumo |
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|
Term
| how do you dx pneumothorax? |
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Definition
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Term
| treatment of pneumothorax? |
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Definition
< 20% deflation = watchful observation with oxygen.
chest tube (thoracostomy).
reapir of an open chest wall defect. |
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Term
| what type of pneumo is a surgical emergency? |
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Definition
| tension pneumo, requires STAT needle thoracotomy at the MCL, 2nd intercostal space on the affected size to decompress the chest. |
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