Ischaemic and Valvular HD surgery Flashcards
Causes of cardiac ischaemia?
Atheroslerosis Embolism Coronary thrombosis Aortic dissection Arteritis Congenital Demand ischaemia
Manifestations of IHD
Angina MI Arrhythmias HF Sudden death
Indications for CABG
Symptomatic coronary artery disease
Prognostic
- 3Vessel disease
- Left main stem stenosis
Requirements for CABG
Lung function Mental function Liver function Ascending aorta normal Distal targets okay LV EF>20%
Conduits for CABG
Reversed saphenous vein
Internal mammary arteries
Radial arteries
What must check in possible CABG conduits?
Patency Valve direction (veins)
Sternotomy related problems
Wire infections
Wire pain
Sternal dehiscence/malunion
Common post-cardiac surgery problems?
Cardiac tamponade
Death
Stroke
Signs of cardiac tamponade
Raised JVP
Tachycardia
Low BP
Metabolic acidosis
Treatment of cardiac tamponade post surgery?
Re-opening chest
Causes of valvular heart disease?
Degenerative Congenital Infective Inflammatory Ventricular dilation Trauma Paraneoplastic
Most common valve problems requiring surgery?
Senile AS
Bicuspid AS
Degenerative MR
Test for Rheumatic fever?
ASO titre
Streptolycin antibody
Hallmark pathology of Rheumatic fever?
Pancarditis
Skin/joint issues
Renal failure
St Vitus’ dance
Chronic rheumatic heart disease
Progressive MVD
Major CoD in pregnancy
Most common organism gives rise to what?
Strep viridans
Subacute bacterial endocarditis
What common organism gives rise to what?
Staph aureus
Acute bacterial endocarditis
Indications for surgery in endocarditis?
Severe valvular regurge
Large vegitations
Persistent pyrexia
Progressive renal failure
How is aortic stenosis differentiated from aortic sclerosis?
Loss of Aortic S2
AV gradient of what is suggestive of aortic stenosis?
gradient >50mmHg
Typical presentations of aortic regurgitation?
Heart Failure
Angina
Asymptomatic
When is surgery indicated for AR?
Severe AR with LV dilation
How is severe MR characterised on an ECHO?
Pulmonary Vein systolic blood flow reversal
How is blood flow transferred in Cardiopulmonary bypass?
Heart & lung function taken over by machine
Drained from RA, returned to ascending aorta
