Ischaemic Heart Disease and Valvular Heart Disease

Question 1

Which patterns of coronary artery disease is operated on?

Answer 1

Left main stem stenosis

3 vessel coronary artery disease

Question 2

What are some problems related to a strenotomy?

Answer 2

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion

Question 3

What are the postoperative problems of cardiac surgery?

Answer 3

Cardiac tamponade
Death
Stroke

Question 4

What are the primary features of cardiac tamponade?

Answer 4

Raised cardiovascular pressure
Raised heart rate
Low blood pressure

Question 5

What are the secondary features of cardiac tamponade?

Answer 5

Oliguria
Increased oxygen requirements
Metabolic acidosis

Question 6

What is the treatment of cardiac tamponade?

Answer 6

Chest re-opening

Question 7

What are the possible manifestation of ischaemic heart disease?

Answer 7

Angina 
MI 
Arrhythmias 
Chronic heart failure 
Sudden death

Question 8

What is considered when selecting patients for coronary artery bypass grafting?

Answer 8

Adequate lung function
Adequate mental function
Adequate hepatic function
Ascending aorta OK
Distal coronary targets OK
LV EF > 20%

Question 9

What are the possible conduits for CABG?

Answer 9

Reversed saphenous vein
Internal mammary arteries
Radial arteries

Question 10

What is operated on in adult cardiac surgery?

Answer 10

Mainly aortic and mitral valves

Question 11

What is operated on in paediatric cardiac surgery?

Answer 11

All 4 heart valves operated on with roughly equal frequency

Question 12

What are the manifestations of ischaemic heart disease?

Answer 12

Angina 
MI 
Arrhythmia 
Chronic heart failure 
Sudden death

Question 13

What is considered when selecting patients for CABG?

Answer 13

Adequate lung function 
Adequate mental function 
Adequate hepatic function 
Ascending aorta ok 
Distal coronary targets ok 
LV ejection fraction >20%

Question 14

What is cardiac tamponade?

Answer 14

Fluid in the pericardium builds up and compresses the heart

Question 15

What are the long term outcomes of CABG?

Answer 15

50% - completely fine
5% - may require repeat CABG
Of the other 45% most have minor problems

Question 16

What does the adult cardiac surgery for valvular heart disease involve?

Answer 16

Mainly aortic and mitral valve surgery

Question 17

What does the paediatric cardiac surgery for valvular heart disease involve?

Answer 17

All four heart valves operated on with roughly equal frequency

Question 18

What are the possible causes of valvular heart disease in adults?

Answer 18

Degenerative 
Congenital 
Infective 
Inflammatory 
LV or RV dilatation 
Trauma 
Neoplastic 
Paraneoplastic

Question 19

What is rheumatic fever?

Answer 19

A relapsing illness related to streptococcal infection

Question 20

How is rheumatic fever treated?

Answer 20

With aspirin and bed rest

Question 21

What does rheumatic fever normally cause?

Answer 21

Pancarditis

Question 22

What does chronic rheumatic heart disease cause?

Answer 22

Gradually progressive mitral valve disease and/or aortic valve disease

Question 23

What are the first and second most common organisms that cause endocarditis?

Answer 23

1. Strep viridians

2. Staph aureus

Question 24

What is endocarditis?

Answer 24

Infection of the endocardium

Question 25

What is the chance of curing native valve endocarditis with antibiotics?

Answer 25

90%

Question 26

What is the chance of curing prosthetic valve endocarditis with antibiotics?

Answer 26

50%

Question 27

Which of the two most common types of endocarditis is easier to cure?

Answer 27

Strep viridians endocarditis

Question 28

What are the indication for surgery in endocarditis?

Answer 28

Severe valvular regurgitation
Large vegetations
Persistant pyrexia
Progressive renal failure

Question 29

What is given after surgery for endocarditis?

Answer 29

IV antibiotics for 6 weeks

Question 30

What differentiates aortic stenosis from aortic sclerosis?

Answer 30

Loss of aortic S2 in aortic stenosis

Question 31

How is severe aortic stenosis treated?

Answer 31

Aortic valve replacement

Question 32

How can you tell how severe the aortic regurgitation is?

Answer 32

The louder the murmur, the more severe the aortic regurgitation

Question 33

When is aortic valve replacement done for aortic regurgitation?

Answer 33

When there is severe aortic regurgitation, especially with left ventricular dilatation

Question 34

When is surgery recommended for mitral stenosis?

Answer 34

When the mitral valve area on echo is less than 1.5cm2

Question 35

What is severe mitral regurgitation associated with?

Answer 35

Left vertical and right ventricle dilatation, onset of atrial fibrillation and pulmonary hypertension

Question 36

How is severe mitral regurgitation characterised on ECHO?

Answer 36

Reversal of systolic blood flow in the pulmonary veins

Question 37

What is done in a cardiopulmonary bypass?

Answer 37

Blood is drained from the right atrium and returned to the ascending aorta

Question 38

What happens to heart and lung function during cardiopulmonary bypass?

Answer 38

It is taken over by a machine and there is non-pulsatile flow

Question 39

What is necessary during CPB?

Answer 39

Systemic anticoagulation

Question 40

What is the maximum time limit on cardiopulmonary bypass?

Answer 40

12 hours

Question 41

Who operates the CPB machine?

Answer 41

a perfusionist

Question 42

What are the pros and cons of a biological valve?

Answer 42

No warfarin required

Valve wears out after 15 years

Question 43

What are the pros and cons of a mechanical valve?

Answer 43

Warfarin required for life

Valve lasts for more than 40 years

Question 44

When is mitral valve repair possible?

Answer 44

In many cases of degenerative mitral regurgitation