Ischaemic and Valvular HD surgery

Question 1

Causes of cardiac ischaemia?

Answer 1

Atheroslerosis
Embolism
Coronary thrombosis
Aortic dissection
Arteritis
Congenital
Demand ischaemia

Question 2

Manifestations of IHD

Answer 2

Angina
MI
Arrhythmias
HF
Sudden death

Question 3

Indications for CABG

Answer 3

Symptomatic coronary artery disease
Prognostic
- 3Vessel disease
- Left main stem stenosis

Question 4

Requirements for CABG

Answer 4

Lung function
Mental function
Liver function
Ascending aorta normal
Distal targets okay
LV EF>20%

Question 5

Conduits for CABG

Answer 5

Reversed saphenous vein
Internal mammary arteries
Radial arteries

Question 6

What must check in possible CABG conduits?

Answer 6

Patency
Valve direction (veins)

Question 7

Sternotomy related problems

Answer 7

Wire infections
Wire pain
Sternal dehiscence/malunion

Question 8

Common post-cardiac surgery problems?

Answer 8

Cardiac tamponade
Death
Stroke

Question 9

Signs of cardiac tamponade

Answer 9

Raised JVP
Tachycardia
Low BP
Metabolic acidosis

Question 10

Treatment of cardiac tamponade post surgery?

Answer 10

Re-opening chest

Question 11

Causes of valvular heart disease?

Answer 11

Degenerative
Congenital
Infective
Inflammatory
Ventricular dilation
Trauma
Paraneoplastic

Question 12

Most common valve problems requiring surgery?

Answer 12

Senile AS
Bicuspid AS
Degenerative MR

Question 13

Test for Rheumatic fever?

Answer 13

ASO titre

Streptolycin antibody

Question 14

Hallmark pathology of Rheumatic fever?

Answer 14

Pancarditis
Skin/joint issues
Renal failure
St Vitus’ dance

Question 15

Chronic rheumatic heart disease

Answer 15

Progressive MVD

Major CoD in pregnancy

Question 16

Most common organism gives rise to what?

Answer 16

Strep viridans

Subacute bacterial endocarditis

Question 17

What common organism gives rise to what?

Answer 17

Staph aureus

Acute bacterial endocarditis

Question 18

Indications for surgery in endocarditis?

Answer 18

Severe valvular regurge
Large vegitations
Persistent pyrexia
Progressive renal failure

Question 19

How is aortic stenosis differentiated from aortic sclerosis?

Answer 19

Loss of Aortic S2

Question 20

AV gradient of what is suggestive of aortic stenosis?

Answer 20

gradient >50mmHg

Question 21

Typical presentations of aortic regurgitation?

Answer 21

Heart Failure
Angina
Asymptomatic

Question 22

When is surgery indicated for AR?

Answer 22

Severe AR with LV dilation

Question 23

How is severe MR characterised on an ECHO?

Answer 23

Pulmonary Vein systolic blood flow reversal

Question 24

How is blood flow transferred in Cardiopulmonary bypass?

Answer 24

Heart & lung function taken over by machine

Drained from RA, returned to ascending aorta

Question 25

Therapy needed alongside Cardiopulmonary bypass?

Answer 25

Systemic anticoagulation

Induced hypothermia

Question 26

Time limit for CPB?

Answer 26

12 hours

Question 27

Biological valve

Answer 27

No warfarin

Only lasts ~15 years

Question 28

Mechanical valve

Answer 28

Warfarin for life

Lasts >40 years