ischaemic heart disease and valvular disease Flashcards
what are the causes of cardiac ischaemia?
Atherosclerosis Embolism Coronary thrombosis Aortic dissection Arteritides Congenital
what are manifestations of ischaemic heart disease
Angina MI Arrythmias Chronic heart failure Sudden death
what are the dangerous patterns of coronary artery disease?
Left main stem stenosis
3 vessel coronary artery disease
what are indications for coronary artery bypass grafting (CABC)
Symptomatic (any CAD pattern)
Prognostic (LMSS, 3VDx)
what are the selection of patients for
Adequate lung function Adequate mental function Adequate hepatic function Ascending aorta OK Distal coronary targets OK LV EF > 20%
conduits for CABC
Reversed saphenous vein
Internal mammary arteries
Radial arteries
what are sternomoty related problems?
Wire infection
Painful wires
Sternal dehiscence
Sternal malunion
what are examples of post op problems in cardiac surgery?
Cardiac Tamponade
Death
Stroke
what are pimary features of cardiac tamponade following cardiac surgery?
Raised CVP, raised heart rate, low BP
what are secondary features of cardiac tamponade following cardiac surgery?
Oliguria, increased oxygen requirements, metabolic acidosis
what is treatment of cardiac tamponade following cardiac surgery?
chest re-opening
for an adult with valvular heart disease, how would you perform sugery on them?
Mainly aortic and mitral valve surgery
for a child with valvular heart disease, how would you perform sugery on them?
All four heart valves operated with roughly equal frequency
what are the causes of valvular heart disease in the adult?
Degenerative Congenital Infective Inflammatory LV or RV dilatation Trauma Neoplastic Paraneoplastic
what are the three commonest valve problems requiring cardiac surgery in aberdeen?
Senile Tricuspid AS
Bicuspid AS
Degenerative MR
what is rheumatic fever?
a complication of untreated strep throat
Rheumatic fever can damage body tissues by causing them to swell, but its greatest danger lies in the damage it can do to your heart.
what is rheumatic fever treated with?
aspirin and bed rest
whats the most common heart problem world wide?
Chronic Rheumatic Heart Disease
whats the most common organism in endocarditis?
strep viridans
gives subacute bacterial endocarditis
whats the second most common organism in endocarditis?
steph aureus
gives rise to acute bacterial endocarditis
what are indications for surgery in endocarditis?
Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure
what s given after operation of endocarditis?
antibiotics are given IV for 6 weeks
what are the presentations of aortic stenosis?
heart failure, angina, syncopal episodes or as an asymptomatic incidental finding
what are presentations of aortic regurgitation
heart failure, angina or as an asymptomatic incidental finding
is a murmur easier to hear in aortic stenosis or aortic regurgitation?
stenosis
how would you be able to hear the murmur more easily for mitral stenosis?
may have to exercise the patient to hear it
when is a surgery recommended for mitral stenosis?
if MVA on ECHO is <1.5cm2
are murmurs easier to hear in mitral regurgitation?
yeah
what is severe MR associated with?
LV and LA dilation onset of AF and pulmonary hypertension
what is Cardiopulmonary Bypass
technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient’s body.
what are the two types of heart valve prothesis?
biological and mechanical valve
what are the positives and negatives for biological valve?
No warfarin required but the valve wears out after 15 years
what are the positives and negatives for mechanical valve?
Warfarin required for life. Valve lasts for > 40 years
