Pericardial tamponade
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- Pericardial tamponade causes haemodynamic compromise with symptoms like acute dyspnea, tachycardia, and low or undetectable blood pressure. - Key physical exam findings include elevated jugular venous pressure, muffled heart sounds, and pulsus paradoxus (an abnormally large fall in systolic blood pressure during inspiration). - Diagnosis is supported by echocardiography showing a large pericardial collection and swings in ventricular filling during respiration. Treatment involves pericardiocentesis or creation of a pericardial window by surgery to drain fluid from the pericardial sac.
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This document provides an overview of cyanotic heart disease in newborns. It discusses the causes, types, and approach to evaluating and managing cyanosis. Key points include:
- Cyanosis is a bluish discoloration of the skin from low oxygen levels in the blood. It is detectable at oxygen saturations below 85%.
- Cardiac causes of cyanosis include decreased or increased pulmonary blood flow from conditions like tetralogy of Fallot or transposition of the great arteries.
- Evaluation involves history, physical exam, chest X-ray, ECG, pulse oximetry, blood gases and hyperoxic challenge test, and echocardiogram.
- Management focuses on maintaining ductus arter
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A 57-year-old male with a history of coronary artery disease and prior stent placement presented for a routine follow-up. His clinical exam and echocardiogram were normal. His ECG showed an abnormality, with possible diagnoses including myocardial infarction, early repolarization, left ventricular hypertrophy, and others. However, pulse tapping on the ECG electrodes was identified as the likely cause of the changes seen, known as pulse tapping artifact. This phenomenon can occur due to the tapping of arterial pulses on electrodes and has been reported before in patients after percutaneous coronary interventions.
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Invasive hemodynamics of constrictive pericarditis
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1) Key events and innovations in the development of CABG, including the first successful procedures in the USSR, US, and Bulgaria.
2) Indications for CABG based on the number and location of diseased vessels and patient characteristics, as outlined in European and US guidelines.
3) Considerations for conduit choice, preoperative evaluation, and risk stratification prior to CABG.
4) An overview of how CABG differs from percutaneous coronary intervention (PCI) in treating both present and future coronary lesions due to the placement of bypass grafts in the mid coronary arteries.
Acute aortic syndrome
Acute aortic syndrome (AAS) refers to life-threatening pathologies of the thoracic aorta including aortic dissection, penetrating aortic ulcer, intramural hematoma, and leaking aortic aneurysm. Management of AAS involves surgery for ascending aorta pathologies and medical management or potential intervention for descending aorta issues depending on complications. Investigation options include TEE, CTA, MRI, and aortography but have limitations. Surgical and endovascular options aim to prevent complications like rupture but have significant mortality and morbidity risks.
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Surgery has a long history, with the earliest known surgeries dating back over 7,000 years to trepanation procedures in Ukraine. Significant developments include ancient Egyptian brain surgery, Sushruta's pioneering of plastic surgery techniques in India in 600 BC, and advances made by Greek physicians like Hippocrates and Galen. In medieval times, surgery declined but was practiced by barbers and monks. Key historical figures helped establish modern surgical principles like controlling bleeding (Pare), understanding anatomy (Vesalius), anesthesia (Morton), antisepsis (Lister), and advances in multiple surgical specialties in the late 19th/early 20th centuries. Major 20th century developments include antibiotics, trans
Transplantology ( Basic terms & common drug regimens )
This document provides an overview of transplant surgery principles and history. It discusses how in ancient times, limb replacement was performed. In the 1950s, the first successful kidney transplant occurred between identical twins without immunosuppression. In the following decades, drugs like azathioprine and cyclosporine were discovered that allowed transplantation of other organs by preventing rejection. The document also describes the types of graft rejection, principles of immunosuppression therapy, complications of infection and malignancy, and definitions relevant to transplantation.
Surgical oncology ( malignancies )
Malignant tumors can be classified based on their cell of origin and include carcinomas, sarcomas, and germ cell tumors. They are characterized by uncontrolled growth, invasion of surrounding tissues, and spread through lymphatics or bloodstream. Diagnosis is confirmed through biopsy and histopathological examination showing features of malignancy. While some genetic and environmental factors are known to increase cancer risk, the exact causes remain unclear. Staging systems help determine prognosis and appropriate treatment.
Surgical oncology 1 ( Benign tumors)
This document provides information on benign tumors, including their definition, differences between benign and malignant tumors, and descriptions of specific benign tumor types. Some key points:
- Benign tumors are slow-growing and do not invade other structures or spread to other parts of the body, while malignant tumors are rapidly growing and can invade nearby tissues and spread via lymphatics or bloodstream.
- Common benign tumor types described include lipomas, fibromas, papillomas, neurofibromas, and pigmented nevi. Specific features and classifications of lipomas and neurofibromas are outlined.
- Treatment options for benign tumors typically involve surgical excision to address cosmetic concerns or prevent complications from
Tricuspid valve disease
The document discusses tricuspid valve disease, including causes of tricuspid regurgitation and stenosis. It describes how tricuspid regurgitation and stenosis are quantified by echocardiography. Surgical options for tricuspid valve annular dilatation are presented, including bicuspidization/plication, De Vega annuloplasty, and ring annuloplasty techniques. Risks of tricuspid valve surgery include damaging structures located in the triangle of Koch.
Cardiopulmonary bypass
1. Cardiopulmonary bypass (CPB) was first successfully used by John Gibbon in 1953 and has since revolutionized cardiac surgery by allowing temporary replacement of heart and lung function.
2. CPB involves cannulating major vessels to establish bypass between the cardiopulmonary bypass machine and the patient, allowing the heart to be isolated from circulation.
3. Myocardial protection techniques like cardioplegic arrest and hypothermia are used during CPB to protect the heart from ischemic damage while it is stopped.
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This document discusses several types of cyanotic congenital heart disease, including tetralogy of Fallot, transposition of the great arteries, total anomalous pulmonary venous connection, and Eisenmenger syndrome. It provides details on the pathophysiology, clinical presentation, diagnostic workup, and surgical treatment options for each condition. The standard of care has shifted from palliative procedures to complete anatomical repairs performed earlier in life to improve long-term outcomes.
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This document discusses congenital heart disease (CHD), which are abnormalities in heart structure present from birth. CHDs arise during gestation and are the most common birth defect. While many CHDs cause increased blood flow to the lungs, some cause obstruction of blood flow. CHDs are classified as cyanotic if they involve deoxygenated blood in the arteries, or acyanotic. Common acyanotic defects include patent ductus arteriosus, atrial septal defect, and ventricular septal defect. Tetralogy of Fallot is a common cyanotic defect involving a right-to-left shunt.
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1. Coronary artery disease is caused by atherosclerosis developing in three stages, culminating in plaque rupture and thrombosis.
2. Risk factors for atherosclerosis and CAD include smoking, hyperlipidemia, hypertension, diabetes, male gender, increasing age, and family history.
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This document provides information on congenital heart disease. It discusses various types of acyanotic heart defects including atrial septal defects (ASD), ventricular septal defects (VSD), patent ductus arteriosus (PDA), and coarctation of the aorta (CoA). For each condition, it describes the pathophysiology, clinical presentation, diagnostic evaluation, and treatment options including surgical repair. Common anatomical variations are defined for different subtypes of each condition.
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Covid 19 & cardiac surgery
Cardiac surgery departments and providers face significant challenges in treating patients during the COVID-19 pandemic. Patients undergoing cardiac surgery are often older with pre-existing health conditions, putting them at high risk for severe COVID-19 infections before and after procedures. While emergency cardiac surgeries and interventions should continue following strict safety protocols, elective procedures may need to be postponed to avoid risks to patients and conserve critical care resources that may be needed to treat COVID-19 patients. Cardiac surgery teams also need to take precautions to avoid exposure given the risk of working with intubated COVID-19 patients. The long term impacts of the pandemic on cardiac surgery capabilities and the healthcare system remain uncertain.
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Pericardial tamponade
- 1. HRISTO RAHMAN 03/04/20 PERICARDIAL TAMPONADE DEPARTMENT OF CARDIAC AND VASCULAR SURGERY MEDICAL UNIVERSITY PLOVDIV
- 2. HRISTO RAHMAN 03/04/20 • HAEMODYNAMIC COMPROMISE WITH ACUTE DYSPNOEA AND TACHYPNOEA • LOW PULSE VOLUME WITH PULSUS PARADOXUS • LOW OR UNDETECTABLE BLOOD PRESSURE • RAISED JUGULAR VENOUS PULSE ( JVP ) WITH PROMINENT X DESCENT BUT NO Y DESCENT • KUSSMAUL’S SIGN ( INSPIRATORY RISE OF JVP ) IS NOT COMMON • MUFFLED HEART SOUNDS • OLIGURIA OR ANURIA PERICARDIAL TAMPONADE: CLINICAL FEATURES
- 3. BECK TRIAD
- 4. HRISTO RAHMAN 03/04/20 • DEFINED AS ABNORMALLY EXCESSIVE FALL IN SYSTOLIC BLOOD PRESSURE ON INSPIRATION >10 MMHG • NORMALLY ON INSPIRATION THERE IS SLIGHT FALL IN SYSTOLIC BLOOD PRESSURE ( < 5 MMHG ) • IN CARDIAC TAMPONADE, INCREASED VENOUS RETURN OCCURING ON INSPIRATION CAUSES FILLING OF RIGHT HEART , THEREBY DISPLACING INTERVENTRICULAR SEPTUM TO THE LEFT ( RIGID BOX WITH TAMPONADE ), RESULTING IN LESS FILLING POSSIBLE IN THE LEFT HEART PRODUCING REDUCED CARDIAC OUTPUT AND SYSTEMIC BLOOD PRESSURE • OTHER CAUSES OF PULSUS PARADOXUS INCLUDE: • -1. CONSTRICTIVE PERICARDITIS; • -2. STATUS ASTHMATICUS WHAT IS PULSUS PARADOXUS ?
- 7. HRISTO RAHMAN 03/04/20 • ECG: • - LOW VOLTAGE QRS COMPLEXES, ELECTRIC ALTERNANS ( DUE TO HEART MOVING WITHIN FLUID-FILLED SAC ) • CXR: • - SYMMETRICAL GLOBULAR ENLARGEMENT OF THE HEART • ECHOCARDIOGRAPHY: • - LARGE PERICARDIAL COLLECTION; • - HEART SWINGING FREELY WITHIN PERICARDIAL SAC; • - EARLY DISTOLIC COLLAPSE OF RIGHT VENTRICLE; • - LATE DIASTOLIC COLLAPSE OF RIGHT ATRIUM; • - MARKED RESPIRATORY TRICUSPID VALVE (>40%) AND MITRAL VALVE (>25%) INFLOW VARIATION TYPICAL FINDINGS ON INVESTIGATIONS WITH PERICARDIAL TAMPONADE
- 8. HRISTO RAHMAN 03/04/20 • DEPENDING ON STABILITY OF THE PATIENT AND UNDERLYING CAUSE: • PARAXIPHOID PERICARDIOCENTHESIS; • SUBXIPHOID DRAINAGE OF PERICARDIAL COLLECTION; • ANTEROLATERAL ( LEFT OR RIGHT ) THORACOTOMY DRAINAGE OF PERICARDIAL COLLECTION WITH PERICARDIAL WINDOW; • RE-OPENING OF MEDIAN STERNOTOMY • OTHER ( CARDIAC TRAUMA ) TREATMENT OF PERICARDIAL TAMPONADE