EXAM ONE Flashcards
NY Heart Association Functional Classification
Functional Class I-IV
Functional Class II
Slight limitation of physical activity. Ordinary activity results in fatigue, palpitations, dyspnea, or angina pain
Functional III
Marked limitation of physical activity. Less than ordinary activity causes fatigue, palpitations, dyspnea or angina pain.
Functional Class IV
Inability to carry out any physical activity without discomfort, symptoms maybe present at rest
Functional Class I
No Limitation of Physical Activity (people dont even know that they have any problems
CAD?
Coronary Artery Disease
CAD (coronary artery disease) results from…..?
From Progressive blockage by atherothrombotic disease
Myocardial Revascularization
Taking LIMA or LITA and using it as a graft
Myocardial revascularization: Coronary Artery bypass grafts (CABG) Patency Rates???
Saphenous Vein Graft: 10-15% occlusion within one month (thrombotic occlusion) and 10 year follow up is 50% occlusion
Internal Mammary Graft Patency rate?
10 year follow up with only 10% occlusion
10-15% occlusion (patency rate) within one month is for what type of occlusion?
A saphenous vein graft and its a thrombotic occlusion
Off-pump revascularization ?
OPCAB: Off-pump coronary artery bypass
Percutaneous coronary intervention
PCI-is a non-surgical procedure that uses a catheter to place a small structure called a stent to open yo the vessels in the heart that have been narrowed by plaque buildup (atherosclerosis)
Other interventions for coronary artery disease: Percutaneous
- PTCA: Percutaneous transluminal coronary angioplasty
- Transluminal stent {bare metal vs. drug-eluding}
- Percutaneous atherectomy
PTCA?
Percutaneous Transluminal Coronary Angioplasty: minimally invasive procedure to open up blocked coronary arteries which allows blood to circulate unobstructed to the heart muscle.
Other Interventions for CAD
MIDCAB: minimally invasive direct coronary artery bypass
TECAB: robotic/totally endoscopic coronary artery bypass
TMR: Transmyocardial revascularization
MIDCAB???
Minimally invasive direct coronary artery bypass
TECAB
Robotic/totally endoscopic coronary artery bypass
TMR
Transmyocardial revascularization
Complications Ischemic Heart Disease
Left Ventricular aneurysm
Post-infarction ventricular septal rupture
Ischemic mitral regurgitation
Left Ventricual Aneurysm
Coronary occlusion may produce extensive transmutation necrosis
Converses muscle into thin scar tissue
Left Ventricular Aneurysm (linear closure)
Teflon felt is used to close up the ventricle
Left Ventricular Aneurysm (patch)
Purse-string sutures is used
Ventricular Septal Rupture
Usually occurs within 1st week of infarct
Symptoms: pulmonary edema, and cardiogenic shock
Emergency surgery indicated for nearly all (surgical mortality is 30%)
Heart Valves
Stenosis: the opening of the valve becomes smaller thus allowing less blood to flow through
Regurgitation/insufficiency (leaky valve): the valve does not close properly and allows blood to flow backward as well as forward in the heart.
Stenosis
The opening of the valve becomes smaller, thus allowing less blood to flow through
Regurgitation/insufficiency (leaky valve)
The valve does not close properly and it allows blood to flow backwards as well as forwards in the heart
Heart Valve Surgery
Aortic valve replacement
Mitral valve replacement/repair
Tricuspid valve replacement/repair
Surgery for endocarditis
Aortic valve replacement
Mechanical vs. Tissue
Scented vs. Stentless {xenografts-autografts-homografts}
Ross Procedure
Cut out the bad aortic valve and cut out the pulmonary autograft than replace aortic with pulmonary and place cryopreserved pulmonary homograft at the pulmonary
Bentall Procedure
Clamp the aortic anuresym ends then cut open and replace
Other methods of Aortic valve Replacements
Transfemoral/transaortic and transapical
Percutaneous Aortic valve
Transfemoral or transapical
3 types of TAVR
Transfemoral
Transapical
Transaortic (TA0)
Open Heart Surgery
AVR (Aortic Valve Replacement)
Minimal Incision Valve Surgery (MIVS)
Can be used for an Aortic valve replacement
Mitral Valve Replacement or repair (leaflets, chords, annulus) 3 types…
Annuloplasty
Valvuloplasty
Commissurotomy
Know the tricuspid valve repair
Repair when blood is leaking back into r. Atrium (regurgitation)
Heart Valve Surgery
Surgery for endocarditis: excision of infected tissue/repair or replace valve
Intravenous Drug Use (image)
Pulmonic regurgitation, tricuspid regurgitation, septic emboli, pneumonia, high incidence of tricuspid bacterial endocarditis with IV drug use
Aortic Surgery
- Dissection
- Aneurysm
Dissection 2types
Type A all over the head
Type B defending aorta
Aneurysm (4 types)
- aortic root Aneurysm
- ascending aortic aneurysm
- aortic arch aneurysm
- descending aortic aneurysm
Aortic Surgery
- aortic root surgery (valve/conduit combination)
- aortic arch surgery (cerebral protection)
- throacoabdominal (spinal cord protection)
- Bypass vs. percutaneous
Crawford classification of Thoracoabdominal aneurysms
I
II
III
IV
Percutaneous aortic surgery
TEVAR:Thoracic Endovascular Aortic repair
Miscellaneous
- Atrial Fibrillation
- Pericardial Disease
- Cardiac tumors
Atrial Fibrillation:
You use Maze III procedure; cryoablation, radiofrequency, and high-freq. ultrasound
Pericardial Disease: Pericardial restriction/tampnade
Cardiac tumors: primary vs. secondary benign vs. malignant
Atrial Fibrillation
Maze III procedure (cox-maze iii)
Cryoalbation
Radiofrequency and high freq. ultrasound
Pericardial Disease
Pericardial restriction/tamponade
…. specimens taken via incision in the 5th left intercostal space
Cardiac tumors (TWO types)
Primary and Secondary
Benign and Malignant
Primary Cardiac Tumors
Benign: 75% of cardiac tumors
Respond well to surgical resection
Malignant: 25% of cardiac tumors
Almost all incurable
2types of cardiac tumors that are BENIGN
Myxoma
Lipoma, fibroelastoma and rhabdomyoma
Myxoma
Benign cardiac tumor: 41% of benign primary tumors in adults 15% in children More common in women Age range of 30 to 60 75% originates in the left atrium
Lipoma, fibroelastoma, rhabdomyoma
59% of benign primary tumors
Equal occurrence
Malignant cardiac tumor
Almost all sarcomas (considers transplants)
Angiosarcoma and rhabdomyosarcoma
2 types of cardiac malignant tumors that are Sarcoma….
Angiosarcoma
Rhabdomyosarcoma
Angiosarcoma
More common in men
Most arise from the right atrium or pericardium
Very vascular
Rhabdomyosarcoma
Arise all areas of the heart
Slight male predominance
Cardiac Tumors Secondary
Metastatic
30x more common than primary
10-12% of patients with widely metastatic tumors have cardiac involvement
Surgery palliative-mainly for recurrent pericardial effusions
Surgery for Trauma (4types)
Blunt aortic trauma
Blunt cardiac trauma
Penetrating mediastinal trauma
Penetration cardiac trauma
Blunt aortic trauma (surgery)
80% to 90% die at the scene
50% of remaining die within 48hours if not properly treated
Blunt Cardiac trauma
Involved in up to 20% of all MVA deaths (motor vehicle accidents)
Surgery for trauma: penetrating mediastinal trauma
Rare that major structures avoided
Penetrating cardiac trauma
Fatality rates of 70-80%
Patients who survive usually do so because of pericardial tamponade
Transplants
Heart
Lungs
Heart-Lung
Congenital Defects (14 total)
ASD Vent. Septal defect Atrioventricular septal defect Patient ductus arteriosus Tricuspid atresia Pulmonary atresia with intact ventricular septum Tetralogy of fallot Hypoplastic left heart Transposition of the great arteries Double outlet right ventricle Truncus arteriosus Interrupted aortic arch Coarctation of the aorta Total anomalous pulmonary venous connection
Total CPB Time (minutes)
ASD/VSD
CABGx1/CABGx2
CABGx3
20to 60 mins (ASD/VSD)
30-60
90-180
Total CPB Time (mins)
Single Valve
Multiple Procedures
Tumor Removal
60-120
120-180
30-90 *estimated times based on average clinical experiences
CPB Time(minutes)
Trauma
Root Replacement w/valve
Aortic Repair
Trauma 60-120
>= 120 (root replacement w/valve)
>=240-300 (aortic repair)
CPB time
Thoracoabdominal repair
Congenital defect repair
> = 300 hours
Varies greatly on kid
Top 10 causes of death 2015
- Ischemic heart attack
- Stroke
- Lower respira.
- Chronic obstructive
- Trachea
- Diabetes
- Alzheimer disease
- Diarrheal disease
9 TB
10 road injury
