Cardio-Chapter 22 (Exam-Review Questions)

What is "cardiac cycle"?

"Events taking place during a single heartbeat" Includes all pathological actions that occur during a single heartbeat. Each cardiac cycle pressure change occurs as the atria + ventricles contract and relax, and blood flows from areas of higher pressure to those of lower pressure.

What's ventricular septal defect?

(hole between the right and left ventricles) A ventricular septal defect (VSD) is a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart. The ventricular septum consists of an inferior muscular and superior membranous portion and is extensively innervated with conducting cardiomyocytes. The membranous portion, which is close to the atrioventricular node, is most commonly affected in adults and older children in the United States.It is also the type that will most commonly require surgical intervention, comprising over 80% of cases. Membranous ventricular septal defects are more common than muscular ventricular septal defects, and are the most common congenital cardiac anomaly

Thoracoscopy

- Endoscopic procedure - Minimally invasive !

Sternum

- Manubrium - Body - Xyphoid process

Arterial + Venous Cannulation

--> Tourniquette around

Foley catheter

-> to drain + landmark / up to 2 hours normal adult = 16 French Pediatric = 8/10 French

Normal healthy adult, "blood-pressure" ?

120/60-80 (systole/diastole) "RR = Riva Rocci"

Sizes of: Chest tubes

16-34 French

Parathyroids

2

Thyroids

2

What is the name for the last two ribs + what numbers are these ribs?

2 Floating Ribs / Number 11 + 12

How many ribs exist?

2 pairs of 12 = 24 ribs

What's the name for ribs 8-12?

3 FALSE Ribs

When does the fetal heart begin developing? Fetal development of heart:

3rd Week Fetal development: The first trimester Fetal development begins soon after conception. Find out how your baby grows and develops during the first trimester. Week 6: The neural tube closes Fetal development four weeks after conception Growth is rapid this week. Just four weeks after conception, the neural tube along your baby's back is closing and your baby's heart is pumping blood.

How many pulmonary veins do exist?

4 (2 on right + 2 on left) One pulmonary vein for each lung lobe although in humans the veins from the upper and middle right lobes merge before entering the heart so there are 5 lobes and 4 pulmonary veins

How many Vertebrosternal Ribs + the name?

7 True Ribs

Left coronary artery

90% Heart attacks

Pectus Carinatum

= "Pigeon chest") where the front part of the chest appears to protrude or 'stick out'. Researchers are not sure what triggers the deformity, but it is thought to be caused by abnormal or excessive growth of rib cartilage. This causes the cartilage to buckle, pushing the sternum inward or outward.

Pectus Excavatum

= "Sunken chest syndrome" or "funnel chest") is an abnormality of the chest wall in which the front ribs and breast bone (sternum) appear indented and sunken toward the spine.

Human donor (heart valve)

= Allograft or Homograft

Own tissue

= Autograft / Ross procedure

Chordae Tendineae

= Heart strings Little hairlike fibrous cord-like tendons that connect the papillary muscles to the tricuspid valve and the mitral valve in the heart. Chordae tendineae are approximately 80% collagen, while the remaining 20% is made up of elastin and endothelial cells.

Animal tissue

= Xenograft ~PORCINE

Bovine pericardium

= from COW / Animal tissue (= Xenograft)

Porcine pericardium

= from PIG / Animal tissue (= Xenograft)

Different types of congenital defects

A congenital anomaly (congenital abnormality, congenital malformation, birth defect) is a condition which is present at the time of birth which varies from the standard presentation. It is a type of congenital disorder which is primarily structural in nature. Types A limb anomaly is called a dysmelia. These include all forms of limbs anomalies, such as amelia, ectrodactyly, phocomelia, polymelia, polydactyly, syndactyly, polysyndactyly, oligodactyly, brachydactyly, achondroplasia, congenital aplasia or hypoplasia, amniotic band syndrome, and cleidocranial dysostosis. Congenital anomalies of the heart include patent ductus arteriosus, atrial septal defect, ventricular septal defect, and tetralogy of fallot. Helen Taussig has been a major force in research on congenital anomalies of the heart. Congenital anomalies of the nervous system include neural tube defects such as spina bifida, meningocele, meningomyelocele, encephalocele and anencephaly. Other congenital anomalies of the nervous system include the Arnold-Chiari malformation, the Dandy-Walker malformation, hydrocephalus, microencephaly, megencephaly, lissencephaly, polymicrogyria, holoprosencephaly, and agenesis of the corpus callosum. Congenital anomalies of the gastrointestinal system include numerous forms of stenosis and atresia, and imperforate.

Cyanotic defects include?

A cyanotic heart defect is a group-type of congenital heart defects (CHDs). The patient appears blue (cyanotic), due to deoxygenated blood bypassing the lungs and entering the systemic circulation. This can be caused by right-to-left or bidirectional shunting, or malposition of the great arteries. =Tetralogy of Fallot,... (EXCEPT: Coarctation of the aorta (may cause cyanosis in some cases) Atrial septal defect Ventricular septal defect Double outlet left/right ventricle

AAA

Abdominal Aortic Aneurysm common symptom = back pain

What are "alveolar ducts"?

Alveolar ducts are tiny ducts connect the respiratory bronchioles to alveolar sacs, each of which contain a bunch of alveoli (the balls). They are tiny end ducts of the branching airways that fill the lungs. Each lung holds approximately 1.5 to 2 million of them. The tubules divide into two or three alveolar sacs at the distal end. They are formed from the confluence openings of several alveoli. Distal terminations of alveolar ducts are atria which then end in alveolar sacs. In human anatomy, respiratory bronchioles exists proximal to the alveolar ducts. The epithelial lining consists of smooth muscle knobs covered by nonciliated, simple cuboidal cells. The smooth muscle constricts under parasympathetic innervation and relax under sympathetic innervation.

What is "alveolar" / plural: "Alveoli"

Composed of simples squamous epithelium which exchanges oxygen + carbon dioxide

CABG

Coronary Artery Bypass Graft

CABG-EVH

Coronary Artery Bypass Graft - Endoscopic Vessel Harvesting Nr 1 Vein on Chest = Saphenous Vein Nr 1 Artery = Right Coronary Artery

CAD

Coronary Artery Disease

CABG

Coronary artery bypass grafting (CABG) = a type of surgery that improves blood flow to the heart. Over time, plaque can harden or rupture (break open). A waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. --> Bypass into, MOST COMMONLY used: Saphenous vein or Internal Mammary artery

Tetralagy of Fallot

Cyanotic Heart Defect Tetralogy of Fallot (TOF) is a congenital heart defect which is classically understood to involve 4 anatomical abnormalities (although only 3 of them are always present). It is the most common cyanotic heart defect, and the most common cause of blue baby syndrome. It was described in 1672 by Niels Stensen, in 1773 by Edward Sandifort, and in 1888 by the French physician Étienne-Louis Arthur Fallot, after whom it is named.

EKG / ECG

Electro Cardio Gram 4 leads (small EKG) / 12 leads (big EKG)

Cardiac cathterization, occur mostly on ___

Femoral artery

What artery supplies to the Left Ventricle?

LAD = Left Anterior Descending Artery

What artery supplies to the Left Atrium?

LCX = Left Circumflex Coronary Artery

What procedes oxygenated blood?

Left Atrium (oxygenated blood = Pulmonary Vein !!!)

Mechanical Heart Valves

Made of: Synthetic materials, which are designed to last many years. Blood tends to stick to mechanical valves + create blood clots. If you have a mechanical valve, you'll need to take: Blood-thinning medicines (anticoagulants) for life.

MVR

Mitral Valve Replacement

Biological Heart Valves

Most used in older patients.

What is referred to as a pacemaker of the heart?

SA-node = Sinoatrial Node The pacemaker of the heart is a bundle of cells that tells the heart when to beat. These cells are connected to the rest of the cells of the heart and communicate with them through electrical signals. The pacemaker cells set the pace (or rate) of the heartbeat. The actual structure that serves as the heart's primary pacemaker is called the sinoatrial node (SA node). As described above, the SA node is a little bundle of cells located in the wall of the right atrium, the small upper chamber on the right side of the heart.

What is "hilium"?

Slight concave portion on medial side of each lung where the bronchus and other structures enter

Cigarette questions

Smoking cigarettes is known to cause coronary heart disease, stroke, narrowing of the blood vessels, and abdominal aortic aneurysms.....so, q uit as soon as possible if not , that artery replacement will fill with plaque.

Decortication

Stripping of Pleura --> removal of: yellow, sticky fat (for:Asthma, emphysema...)

Positioning of a patient for Cardiothoracic surgery?

Supine

Most Specimen are sent away with what?

Telfa

Rastelli procedure?

The Rastelli procedure is an open heart surgical procedure developed by Italian physician and cardiac surgery researcher, Giancarlo Rastelli, which is used to correct certain combinations of congenital heart defects (CHDs) A teflon patern being used to close the ventricular septal defect. The middle pulmonary artery is transected and a channel is placed from the right ventricular outflow to the pulmonary artery.

Where do coronary veins empty?

The coronary sinus is a collection of veins joined together that collect blood from the myocardium. The coronary sinus empties into the Right Atrium.

The space between ribs are called?

The intercostal space (ICS) is the space between two ribs (Lat. costa). Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it.

Swan-Ganz catheterization

The passing of a thin tube (catheter) into the right side of the heart and the arteries leading to the lungs to monitor the heart's function and blood flow, usually in persons who are very ill.

Pericardial window

for draining excess fluid around the pericard

Circumfrench

goes around

Arterial line

goes in the : Radial artery

Pacemakers / location,, put into?

located in the wall of the: RIGHT Atrium. The contraction of heart (cardiac) muscle in all animals with hearts is initiated by chemical impulses. The rate at which these impulses fire controls the heart rate. The cells that create these rhythmical impulses are called pacemaker cells, and they directly control the heart rate. In humans, and occasionally in other animals, a mechanical device called an artificial pacemaker (or simply "pacemaker") may be used after damage to the body's intrinsic conduction system to produce these impulses synthetically.

Different types of aneurysms 1,2,3,+4,

Aortic Dissections: By definition, a dissection is a tear in the intimal layer of the aorta with dissection along the media proximally or distally. Dissections may be classified according to two well accepted systems: Debakey Classification: Type 1 Intimal tear in the ascending aorta and dissection anywhere along the aorta. Type 2 Intimal tear in the ascending aorta but dissection is limited to the ascending aorta and arch only. Type 3 Intimal tear in the descending aorta distal to the left subclavian artery and limited to the descending aorta. Stanford Classification: Type A Intimal tear in the ascending aorta but limited to the ascending aorta and arch only. Type B Intimal tear in the descending aorta disal to the left subclavian artery and limited to the descending aorta.

2 Atrioventricular (AV) valves?

Are between the Atria + the Ventricles= - the Mitral valve (also called: Bicuspid valve) - the Tricuspid valve Valvular disease --> mainly from: Mitral valve

2 Semilunar (SL) valves

Are in the Arteries leaving the heart: - the Aortic valve - the Pulmonary valve. A form of heart disease occurs when a valve malfunction allows some blood to flow in the wrong direction. This is called: Regurgitation !!!

Malignant lesion, percentages

Benign The most common primary tumor of the heart is the myxoma. In surgical series, the myxoma makes up as much as 77% of all primary tumors of the heart.[1] Less common tumors of the heart include lipoma and cystic tumor of the atrioventricular nodal region. [edit]Malignant About 20 percent of primary tumors of the heart are malignant in nature.[1] Malignant tumors of the heart include rhabdomyosarcomas, angiosarcomas, myxosarcomas, fibrosarcomas, leiomyosarcomas, reticulum cell sarcomas, desmoplastic small round cell tumor,and liposarcomas. The cardiac sarcomas may occur at any age, but are more commonly seen in individuals in their 20s to 40s. They occur equally in males and females. [edit]Valvular A subset of the primary tumors of the heart are tumors that are found on the valves of the heart. Tumors that affect the valves of the heart are found in an equal distribution among the four heart valves.The vast majority of these are papillary fibroelastomas. Primary tumors of the valves of the heart are more likely to occur in males. While most primary tumors of the valves of the heart are not malignant, they are more likely to have symptoms related to the valve, including neurologic symptoms and (in a few cases) sudden cardiac death.

Aorta

Biggest Artery

Vena Cava

Biggest Vein

Pectus Excavatum & Pectus Carinatum Repair

Nuss procedure = Minimally invasive surgery where small 1 inch incisions are made on each side of the rib cage. A curved, custom-shaped, stainless steel pectus bar is guided through the rib cage and beneath the sternum. Once in place the rod is rotated, turning the curved portion against the chest wall, pushing the ribs and sternum out. The procedure works in much the same that orthodontic braces remodel teeth. In the majority of cases, cartilage or bone is not removed. The bar is secured to the ribs under the skin with stitches and is left in place for two to three years. The correction of the chest deformity is immediate. The recovery time for the traditional and minimally invasive approaches is similar with a 3 to 5 day stay in the hospital. However, patients and families often prefer the Nuss procedure to traditional surgery because the operation is shorter, has less blood loss, and uses smaller incisions resulting in less scar. Removal of the bar requires a short procedure that can be performed in the outpatient surgery center.

PTCA Pre-OP tests...and where you put lines

Percutaneous transluminal coronary angioplasty (PTCA) = Minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. --> Forgarty catheter Pre-Operative Testing Prior to urgery, patients will undergo a number of tests to ensure they can withstand the operation, and to gauge their recovery time. These include: Blood tests Urinalysis Electrocardiogram (EKG) Chest x-ray Pulmonary (lung) function test or PFT Optional Tests Several other tests may be ordered. These include: Bone scan CT-Scan MRI (magnetic resonance image) V/Q scan (a type of lung scan)

What is "diastole"?

Phase of relaxation It is the period of time when the heart refills with blood after systole (contraction).

Nr 1 Suture, Heart Surgery

Prolene (blue suture)

Pericardium

Protects the heart Fibrous = outer layer, fits loosely Serous = inner layer

Heart-lung machine

Pump oxygenator

Thoracentesis

Puncture of the Thorax

What procedes unoxygenated blood?

Right Atrium (UNoxygenated blood= Pulmonary Artery!!!)

Into which portion of the heart is the cannula placed to achieve venous cannulation for cardiopulmonary bypass?

Right atrium

Arteries

Thick walled / HIGH pressure have NO valves / blood flow = 2 ways

Veins

Thin walled / LOW pressure have Valves

What's between the alveolar + bronchi?

Trachea & Bifurcation of Bronchi

What are heart valves?

Valves are flap-like structures that allow blood to flow in one direction. The heart has two kinds of valves, atrioventricular and semilunar valves. The atrioventricular valves are thin structures that are composed of endocardium and connective tissue. They are located between the atria and the ventricles. !!! Valve Replacement = !!! - Infection - Heart Disease - Rheumatic Fever - Congenial (=born with it) - Arteriosclerosis

VATS

Video-Assisted Thoracic Surgery

What's atrial septal defect?

trial septal defect (ASD) is a form of congenital heart defect that enables blood flow between the left and right atria via the interatrial septum. The interatrial septum is the tissue that divides the right and left atria. Without this septum, or if there is a defect in this septum, it is possible for blood to travel from the left side of the heart to the right side of the heart, or vice versa.[1] This results in the mixing of arterial and venous blood, which may or may not be clinically significant. This mixture of blood may or may not result in what is known as a "shunt". The amount of shunting present, if any, dictates hemodynamic significance (see Pathophysiology below). A "right-to-left-shunt" typically poses the more dangerous scenario (see Pathophysiology below).