Ischaemic Heart Disease and Valvular Heart Disease Flashcards
Which patterns of coronary artery disease is operated on?
Left main stem stenosis
3 vessel coronary artery disease
What are some problems related to a strenotomy?
Wire infection
Painful wires
Sternal dehiscence
Sternal malunion
What are the postoperative problems of cardiac surgery?
Cardiac tamponade
Death
Stroke
What are the primary features of cardiac tamponade?
Raised cardiovascular pressure
Raised heart rate
Low blood pressure
What are the secondary features of cardiac tamponade?
Oliguria
Increased oxygen requirements
Metabolic acidosis
What is the treatment of cardiac tamponade?
Chest re-opening
What are the possible manifestation of ischaemic heart disease?
Angina MI Arrhythmias Chronic heart failure Sudden death
What is considered when selecting patients for coronary artery bypass grafting?
Adequate lung function Adequate mental function Adequate hepatic function Ascending aorta OK Distal coronary targets OK LV EF > 20%
What are the possible conduits for CABG?
Reversed saphenous vein
Internal mammary arteries
Radial arteries
What is operated on in adult cardiac surgery?
Mainly aortic and mitral valves
What is operated on in paediatric cardiac surgery?
All 4 heart valves operated on with roughly equal frequency
What are the manifestations of ischaemic heart disease?
Angina MI Arrhythmia Chronic heart failure Sudden death
What is considered when selecting patients for CABG?
Adequate lung function Adequate mental function Adequate hepatic function Ascending aorta ok Distal coronary targets ok LV ejection fraction >20%
What is cardiac tamponade?
Fluid in the pericardium builds up and compresses the heart
What are the long term outcomes of CABG?
50% - completely fine
5% - may require repeat CABG
Of the other 45% most have minor problems
What does the adult cardiac surgery for valvular heart disease involve?
Mainly aortic and mitral valve surgery
What does the paediatric cardiac surgery for valvular heart disease involve?
All four heart valves operated on with roughly equal frequency
What are the possible causes of valvular heart disease in adults?
Degenerative Congenital Infective Inflammatory LV or RV dilatation Trauma Neoplastic Paraneoplastic
What is rheumatic fever?
A relapsing illness related to streptococcal infection
How is rheumatic fever treated?
With aspirin and bed rest
What does rheumatic fever normally cause?
Pancarditis
What does chronic rheumatic heart disease cause?
Gradually progressive mitral valve disease and/or aortic valve disease
What are the first and second most common organisms that cause endocarditis?
- Strep viridians
2. Staph aureus
What is endocarditis?
Infection of the endocardium
What is the chance of curing native valve endocarditis with antibiotics?
90%
What is the chance of curing prosthetic valve endocarditis with antibiotics?
50%
Which of the two most common types of endocarditis is easier to cure?
Strep viridians endocarditis
What are the indication for surgery in endocarditis?
Severe valvular regurgitation
Large vegetations
Persistant pyrexia
Progressive renal failure
What is given after surgery for endocarditis?
IV antibiotics for 6 weeks
What differentiates aortic stenosis from aortic sclerosis?
Loss of aortic S2 in aortic stenosis
How is severe aortic stenosis treated?
Aortic valve replacement
How can you tell how severe the aortic regurgitation is?
The louder the murmur, the more severe the aortic regurgitation
When is aortic valve replacement done for aortic regurgitation?
When there is severe aortic regurgitation, especially with left ventricular dilatation
When is surgery recommended for mitral stenosis?
When the mitral valve area on echo is less than 1.5cm2
What is severe mitral regurgitation associated with?
Left vertical and right ventricle dilatation, onset of atrial fibrillation and pulmonary hypertension
How is severe mitral regurgitation characterised on ECHO?
Reversal of systolic blood flow in the pulmonary veins
What is done in a cardiopulmonary bypass?
Blood is drained from the right atrium and returned to the ascending aorta
What happens to heart and lung function during cardiopulmonary bypass?
It is taken over by a machine and there is non-pulsatile flow
What is necessary during CPB?
Systemic anticoagulation
What is the maximum time limit on cardiopulmonary bypass?
12 hours
Who operates the CPB machine?
a perfusionist
What are the pros and cons of a biological valve?
No warfarin required
Valve wears out after 15 years
What are the pros and cons of a mechanical valve?
Warfarin required for life
Valve lasts for more than 40 years
When is mitral valve repair possible?
In many cases of degenerative mitral regurgitation
