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Hi, everyone just to check. Can people hear me? Ok. Is there any issues just mention on the shot? Um, or if if you just put it on, um, you're still on presenter mode at the moment? I mhm. Is that ok? Hi, everyone. Um, thank you for joining us today. My name is Bianca and I'm one of the chairs at sector. Um, this week we are going to be focusing on cardiothoracic surgery and we're excited to have you all with us today. I'm joined by AA who will guide you through um, the cardiothoracic surgery session. And um fa is a third year medical student from vacuum. Um, so to make this session as engaging as possible or even be asking you questions throughout, um, these just answer these questions in the chat using the chat function. And if you have any questions during the session, please pop them in the chat and we'll do our best to address them at the end of the session, we will be releasing some full questions as well for you to have a go at. We'll also set, share a feedback form at the end of the session. And if you complete this. You will receive a certificate of attendance and exclusive discount codes for teach me surgery and the MRC S. Um The session will be recorded and the recording of SL will be shared on our me page a couple of hours after. So be sure to keep an eye out for that. We're also excited to share that we have an exclusive question bank and other resources that will soon be available on our learning portal. So be sure to check out our website to assess to access them. And if you, if you create a free membership account with us, you'll automatically receive a discount code for 10% of all the medics, anatomy, flash cards, surgery, flash cards, and knowledge bundle. Finally, before we begin, we'd like to thank our partners, the Royal College of Surgeons EK Medics MDU more than Skin deep me, teach me surgery and pass the M Yes. Um Thank you so much and I'll hand over to AA. Uh So hi everyone. My name is Aa Qureshi. I'm a third year medical student um at the University of Buckingham. But currently I'm doing my placement at Buckinghamshire Healthcare Trust, which is in Elsbury. Um So today I'm gonna be talking about cardiothoracic surgery, but specifically valvular heart disease and uh coronary artery disease. Um I'll be, I'll try to ask a couple of questions throughout the session just to see if you guys are able to recall what I've um what I, what I've said and you can put your answers in the chart and the coordinator, um, will look through them and then let me know what's said in the chart as I can't see it. Um, ok, so let's get started. So the learning objectives for today are I'm just gonna be going over basic anatomy of the heart, um, and its clinical significance a little bit about the electrical conduction of the heart. Um And then specifically going into the most important valvular heart diseases that you need to know. Um and their coinciding murmurs, presentations and risk factors for coronary artery disease and a little bit about the pathophysiology. Um And finally, uh talking about ACS acute Coronary syndrome management and a little bit about um the surgical options that are available including PC and cabin. If you guys have any questions throughout, you can put them in the chart and I'll um try to get to them. Ok. So, anatomy of the heart, um there are four chambers as most of you already probably know there's a right atrium, the right ventricle, the left atrium and the left ventricle. Um and these four chambers are where the blood flows through. So there's, there's a pathway of the blood that flows to the heart, um which I've included over here. So, again, the deoxygenated blood from the body comes to the IVC and the CBC, which is the inferior vena cava and superior vena cava. Um and then it goes through into the right atrium and then through there it goes through the tricuspid valve into the right ventricle. And then through, from the right le from the right ventricle, it goes through the pulmonic valve through the pulmonary artery into the lungs where it gets oxygenated and then it comes back to the heart through the pulmonary veins. So there's the four different veins and then it goes into the left atrium and then through into the left ventricle to the mitral valve, and then out through the aortic valve into the aorta and then to the rest of the body. So then the branches of the aorta then go to the head, the limbs, the upper limbs and the lower limbs and the rest of the body. So, one thing that we need to start off when we're talking about anatomy is the layers of the heart. Um So I'm gonna go from inside to outside. So the the innermost layer um is called the endocardium. So the endocardium is this portion right here. And the importance of it is that it helps in eating with like the electrical activity and right, it lines the heart and it, it regulates the contractions that are happening. Um and it's made up of loose connective tissue. Then after the endocardium, you have the myocardium. So your myocardium is basically the muscle layer of the heart which helps in contraction of the heart. Um And it has your cardiac muscle type. And then after the myocardium, then you have the pericardium. So the pericardium has, has different layers. Um it has a visceral layer, a space in between and then a parietal layer outside. Um the visceral layer, basically, it protects the heart muscle because it's right after the myocardium and it uh creates the pericardial fluid which is within the pericardial space. The pericardial fluid is really important for um lubrication of the heart and outside of the pericardial space. Then you have the parietal pericardium and then outside of the parietal pericardium, you have the fibrous pericardium and that's um the fibrous pericardium is important to protect the whole heart as a whole and it prevents it from overfilling. So it prevents cardiac tampon from happening, which is when you get a buildup of fluid uh outside of the heart and that compresses the heart and that can prevent um blood flow from, from going to the rest of the body. So now that I've talked a little bit about the layers of the heart, I wanna go into specific detail about um inflammation or infection that you can get of each of the layers of the heart. So again, we start from the inside. So, endocardium inflammation would be infective endocarditis. Um and it's basically caused by various different um bacterial bacteria like staphylococcus, aureus, streptococcus, viridans, staphylococcus epidermis. So it just, it depends on the patient demographic, which organism is going to cause endocarditis. Um, there are like three cardinal signs that they love to ask in questions. Um I haven't really seen it in real life but they are asked widely is the splinter hemorrhages, the Osler's nodes and the Janeway lesions. Um, so splinter hemorrhages will be like these little lines that you see going through the nail and then Osler's nose and J lesions will be found on like the palmar surface of your hand. Um And when you do like cardio examinations, you'll see people talking about whether they can see these signs or not. Um They are kind of like indicative of infective endocarditis. Other things that they might, that patients might present with are fever chills, um chest pain, muscle aches, just feeling unwell in general. Um and they may present with the aortic regurgitation murmur. I'm gonna go in detail as to what that sounds like. Um In the next couple of slides, the diagnosis for endocarditis is done using the modified do criteria. It's, it's a very confusing criteria. But what I think you guys should know is that one, you have to have done three blood cultures from different areas of the body and they all have to be positive for a specific organism. Um in order to say that the patient has infective endocarditis, and then they also are looking for like cardinal signs like the splinter hemorrhage lesions, Osler's nose. Um in order to say 100% whether they have infective endocarditis. Another test, they like to use an echocardiogram because they want, they want to see if there's any um basically lesions on the valves.