Acquired Heart Disease

Question 0

Patient with wide pulse pressure and blowing diastolic heart murmur. Suspected diagnosis? Type of surgery? Surgery when?

Answer 0

Chronic aortic insufficiency

Valve replacement
#ECHO evidence of left ventricular dilation

Question 1

Elderly patient presents with harsh, mid systolic murmur. Likely diagnosis? Initial test? Type of surgery? Surgery when?

Answer 1

Aortic stenosis; ECHO

Valve replacement
#upon detection of 50+ mm Hg gradient between the valve
#First sign of CHF, angina, syncope

Question 2

Young adult who suddenly developed congestive heart failure. Has loud diastolic murmur at right intercostal space. Likely diagnosis? Likely etiology? Surgery when?

Answer 2

Endocarditis; IV drug use

Emergency valve replacement

Question 3

Natural history of mitral stenosis?

Answer 3

1. Asymptomatic for years
2. Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, hemoptysis
   #3. Patient becomes thin, cachectic, and develops a atrial fibrillation

Question 4

Surgery for mitral stenosis?

Answer 4

Surgical commissurotomy or balloon valvuloplasty

Question 5

Mitral regurgitation is most commonly caused by? When surgery? Treatment options? (Preferred?)

Answer 5

Mitral valve prolapse

Surgery when patient develops exertional dyspnea, orthopnea, or atrial fibrillation

Annuloplasty (repair of valve) preferred over prosthetic replacement

Question 6

Patient presents with suspected coronary disease – when to intervene? When to do surgery?

Answer 6

Progressive, unstable, disabling angina

Intervention with 70% + stenosis and good distal vessel

Surgery over angioplasty with more complex problems (I.e. Treat single vessel disease with angioplasty; treat triple vessel disease with coronary bypass)

Question 7

Most important vessel for coronary bypass?

Answer 7

Internal mammary

Question 8

Goal of care for postoperative heart surgery patients? How to evaluate?

Answer 8

Optimize cardiac output

If output is normal (5 L/min or cardiac index of 3), measure wedge pressure

#If wedge pressure under three, suggests hypovolemia
#If wedge pressure over 20, suggests ventricular failure

Question 9

Signs of chronic constrictive pericarditis? Cardiac catheterization shows this sign? Treatment?

Answer 9

Dyspnea, hepatomegaly, ascites

Square root sign

Surgery