Surgery: Heart

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two conditions associated with hemoptysis (one cardiac, one pulmonary): mitral stenosis
pulmonary infarction
pulsus alterans is sign of...: left ventricular failure
pusus parvus et tardus may be seen with: aortic stenosis
Differential of cardiac arrest (6): Myocardial depressants (anesthetics, antiarrhythmics, digitalis)
Conduction disturbances
coronary thrombosis
anoxia
vagotonic maneuvers
electrolyte disturbances
(MC CAVE)
Brain injury results after ... minutes of dec. perfusion: 3-4
Drug therapy for cardiac arrest includes the following- epinephrine for... calcium for... sodium bicarb for... vasopressors for... atropine for...: epi for cardiotonic effect
calcium for cardiotonic effect
sodium bicarb to tx acidosis
vasopressors to increase BP
Atropine to reverse bradycardia
during extracorporeal ciculation, how is the mycoardium protected from ischemia (2): hypothermia and cardioplegia
name five pathophysiologic effects of extracorporeal circulation: 1. inflammatory response (coag cascade, complement activation, fibrolysis, kallikrein-kinin)
2. vasoactive substances released (epi, norepi, H2, bradykinin)
3. Na and H2O retention
4. RBC/platelet trauma
5. respiratory insufficiency
___ valves do not require long-term anticoagulation but have 10-30% failure at 10 years ___ valves are durable for a long time but require anticoagulation ___ vavles don't require anticoagulation and have 92% durability at 10 years: porcine tissue valves

mechanical valves

human allograft (cryoperserved)
Presenting symptoms of aortic stenosis: dyspnea
angina
syncope
for aortic stenosis... chest x-ray shows ekg shows echo shows cardiac cath shows: chest x-ray shows nl heart size
ekg shows LVH
echo estimates degree of stenosis
cardiac cath measures pressure gradient across valve (tx if >50)
water-hammer pulses (2): aortic insufficiency
PDA
x-ray of aortic insufficiency: left ventricular dilation
class triad of mitral stenosis: patient is thin/cachectic with
1. opening snap
2. apical diastolic rumble
3. loud S1
normal cross-sectional area of mitral valve... with mild stenosis... moderate stenosis... severe stenosis: nl 4-6 cm2
mild 2-2.5
mod 1.5-2
sev 1-1.5
x-ray of mitral stenosis... ekg... echo... cardiac cath: enlarged pulmonary vasculature;may show double density right heart border;
lateral decubitus with barium swallow may show left atrial enlargement

ekg may show abnl p-waves

echo evaluates valve function

cath evaluates pressure gradient and cross-sectional area
instead of valve replacement, what can be offered to a patient with mitral stenosis with fusion of commissures and minimal calcification: closed or open mitral valve commissurotomy
four causes of mitral insufficiency: myxomatous degeneration
papillary muscle dysfunction
bacterial endocarditis
rheumatic fever
x-ray for mitral insufficiency... ekg...: x-ray shows enlarged left atrium and ventrilce

ekg show LVH (50% of the time)
Three classes of drugs used for medical tx of mitral insufficinecy: digitalis
diuretics
vasodilators
what two options are sought before mitral valve replacement is done: annuloplasty and valve repair
which is more common, functional tricuspid insufficiency (from pulmonary hypertension or right ventricul dilation) or organic tricupsid valve disease (from rheumatic fever): functional insufficiency
carcinoid syndrome may effect which valves: pulmonic (stenosis)
tricuspid insufficiency
Four, that's right, four causes of CAD: atherosclerosis
vasculitis
trauma
radiation injury
a coronary artery obstruction is considered clinically significant when diameter is narrowed ...%: 50%
Two indications for coronary artery bypass. Which vessel is usualyy used: 1. intractable or unstable angina pectoris
2. angina with (a) triple vessel disease (b) left main coronary artery obstruction (c) proximal LADA obstruction
alternative to coronary bypass: PTCA- percutaneous transluminal coronary antioplasty
10 year patency for Internal mammary artery grafts? saphenous vein grafts?: >90%

50%

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Deck Info

Number of cards 28