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CARD - 1 > Ischaemic and Valvular Heart Disease - Cardio Surgery > Flashcards

Ischaemic and Valvular Heart Disease - Cardio Surgery Flashcards

1
Q

What are the main causes of cardiac ischaemia?

A 
Atherosclerosis
Embolism
Coronary thrombosis
Aortic dissection 
Arteritides
Congenital
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2
Q

What are the main manifestations of ischaemic heart disease?

A 
Angina
MI
Arrythmias
Chronic heart failure
Sudden death
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3
Q

What are the two most dangerous patterns of coronary artery disease?

A

Left main stem stenosis

3 vessel coronary artery disease

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4
Q

For what two reasons would you opt patients for a coronary artery bypass?

A

Symptomatic or prognostic reasons.

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5
Q

What are the requirements for CABG patients?

A

Adequate lung, mental and hepatic function and an okay ascending aorta and distal coronary targets. LV EF >20%.

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6
Q

What are the possible conduits for CABG?

A

Reversed saphenous vein, internal mammary arteries, radial arteries.

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7
Q

What are some problems that may occur related to sternotomy?

A

Wire infection, painful wires, sternal dehiscence, sternal malunion.

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8
Q

What are some examples of post-op problems in cardiac surgery?

A

Cardiac tamponade - fluid in pericardium builds up and puts pressure on the heart.
Death
Stroke

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9
Q

What are the primary features of cardiac tamponade following cardiac surgery?

A

Beck’s triad - hypotension, raised JVP, muffled heart sounds

Others - SoB, tachycardia, absent Y descent on JVP, pulsus paradoxus
Kussmaul’s sign
ECG - electrical alternans

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10
Q

What are the secondary features of cardiac tamponade following cardiac surgery?

A

Oliguria, increased oxygen requirements, metabolic acidosis.

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11
Q

How is cardiac tamponade treated?

A

Urgent pericardiocentesis

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12
Q

What are the long term outcomes of patients post CABG?

A

50% have no further cardiac problems 10 years later.
Of the other half who have a problem, most are minor and easily controlled with medication.
5% may require repeat CABG.

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13
Q

What are the main valves affected in adult valvular heart disease?

A

Mainly aortic and mitral surgery takes place in adults.

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14
Q

What are the main valves operated on in paediatrics?

A

All four equally.

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15
Q

What are the causes of valvular heart disease in adults? (8)

A 
Degenerative
Congenital 
Infective
Inflammatory
LV or RV dilation 
Trauma
Neoplastic
Paraneoplastic
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16
Q

What commonly happens to heart valves in the elderly (degenerative)?

A

Leaflet tissue becomes affected by atheroma, thickens and calcifies leading to trileaflet aortic stenosis.

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17
Q

What are the three most common valve problems requiring cardiac surgery in Aberdeen?

A

Senie tricupsid aortic stenosis
bicupsid aortic stenosis
denegerative mitral regurgitation

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18
Q

What is rheumatic fever?

A

A condition that develops following an immunological reaction to recent (2-6w ago) strep pyogenes infection n

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19
Q

How is rheumatic fever diagnosed?

A

Evidence of recent strep infection + 2 major criteria or 1 major + 2 minor

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20
Q

What disorder is common in rheumatic fever patients?

A

Sydenham’s chorea/St Vitus’ Dance - uncoordinated jerking movements, especially in the face, hands and feet.

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21
Q

How is rheumatic fever treated?

A

Aspirin and bed rest.

22
Q

What characterises chronic rheumatic heart disease?

A

Gradually progressive MVD with or without ADV. Commonest heart problem WW. WW major cause of death in pregnancy (in Uk still sometimes a reason to do cardiac surgery on pregnant.

23
Q

What is endocarditis?

A

Inflammation of inner heart layer and heart valves.

24
Q

What are the most common endocarditis causing organisms?

A

commonest - Strep viridian’s gives rise to subacute bacterial endocarditis.
2nd commonest - Staph aureus gives rise to acute bacterial endocarditis.

25
Q

What condition does the heart valves need to be in order for endocarditis to happen?

A

Infected valves may have been diseased beforehand or may have been healthy.

26
Q

How does cure rate differ in endocarditis between native valve endocarditis and artificial valve endocarditis?

A

90% chance of cure with antibiotics alone in NVE.

50% chance of cure with antibiotics alone in AVE.

27
Q

With which organism is the chances of cure much higher in endocarditis?

A

Strep viridian’s compared to staph aureus.

28
Q

What would be indications for surgery in endocarditis?

A

Severe valvular regurgitation, large vegetations (bits breaking off and can cause big stroke), persistent pyrexia (can’t control infection and die from lack of temp control and loss of appetite), progressive renal failure (due to inflammation of glomeruli (irreversible damage).

29
Q

What post-operative measures are taken following surgery for endocarditis?

A

Antibiotics IV for 6 weeks.

30
Q

How does aortic stenosis typically present?

A

Heart failure, angina, syncopal episodes or as an asymptomatic incidental finding. Murmur is usually easily heard. Loss of aortic S2 differentiated it from aortic sclerosis.

31
Q

Is aortic stenosis recommended for aortic stenosis?

A

Only if severe.

32
Q

How does aortic regurgitation typically present?

A

As heart failure, angina or as an asymptomatic incidental finding.

33
Q

Is an aortic regurgitation murmurs usually easy to hear?

A

Usually difficult to hear. A louder murmur indicates a more severe AR.

34
Q

When would AVR be recommended for aortic regurgitation?

A

In severe AR esp. with LV dilatation.

35
Q

How is severity of aortic regurgitation assessed?

A

In severe AR entire LV is filled with contrast after one diastolic interval during aortography.

36
Q

How easy is it to hear a murmur from mitral stenosis?

A

Usually difficult, if you can hear it means stenosis is severe. May have to exercise patient to hear the murmur.

Presystolic accentuation may be present.

37
Q

When would surgery be indicated in mitral stenosis?

A

if MVA on ECHO is <1.5cm2.

38
Q

How easy is it to hear a murmur in mitral regurgitation?

A

Usually easy to hear.

If loud indicates MR is usually severe

39
Q

What is a severe mitral regurgitation associated with?

A

LV and LA dilatation, onset of AP and pulmonary hypertension.

40
Q

When is mitral valve replacement recommended?

A

With severe MR.

41
Q

How do you distinguish severity of mitral regurgitation?

A

Severe MR on ECHO characterised by systolic blood flow reversal in pulmonary veins.

42
Q

How does a cardiopulmonary bypass machine work?

A

Blood is drained from the RA and returned to ascending aorta. Heart and lung function taken over by CPB machine. Systemic anticoagulation necessary and induced hypothermia. Non-pulsatile flow during CPB.

43
Q

What is the max time patients can be on the CPB machine?

A

12 hours.

Max cardiac ischaemic time - 6hrs.

44
Q

Who operates the CPB machine?

A

Perfusionists.

45
Q

When is air embolism more common?

A

In open cardiac surgical procedures e.g. valve replacement as compared to closed cardiac operations, e.g. CABG.

46
Q

What are the two different types of valves that can be used for replacement?

A

Biological valve - no warfarin required but valve wares out after 15 years.
Mechanical valve - warfarin required for life, valve lasts for 40 years.

47
Q

What valve may be able to be repaired?

A

Mitral valve, this is possible in many cases of degenerative MR. When complete valve competence is restored, repair is better than replacement for MV.

48
Q

What are the major criteria in rheumatic fever?

A 
Erythema maginatum
Sydenham's chorea (late features) 
Polyarthritis
Carditis and valvulitis (pancarditis)
S/c nodules
49
Q

What are the minor criteria in rheumatic fever?

A

Raised ESR/CRP
Pyrexia
Arthalgia
Prolonged PR interval

50
Q

What counts as evidence of a recent strep infection for diagnosing rheumatic fever?

A

Raised/rising strep antibodies
Positive throat swab
Positive rapid group A strep antigen test

CARD - 1 (28 decks)

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