Ischaemic Heart Disease and Valvular Heart Disease – The Cardiac Surgeon’s approach Flashcards
What is the causes of ischaemic heart disease
Atherosclerosis Embolism Coronary thrombosis Aortic dissection (tear allows blood to leak in) Arteritis Congenital
What is the possible manifestations of ischaemic heart disease
Angina MI Arrythmias Chronic heart failure Sudden death
What are two examples of dangerous pattens to CAD that require surgery intervention
Left main stem stenosis
3 vessel coronary artery disease
What is the selection critique for coronary by pass grafting
Adequate lung function Adequate mental function Adequate hepatic function Ascending aorta OK Distal coronary targets OK LV EF > 20%
What is the three different conduits used for CABG
Reversed saphenous vein
Internal mammary arteries
Radial arteries
Why is the saphenous vein reversed
so the valves are facing the right ways to allow blood flow to not flow back from the heart
What is the possible post operative problems in cardiac surgery
Cardiac Tamponade
Death
Stroke
What is cardiac tamponade
Excessive collection of blood in the pericardial sac that is under pressure and prevent the filling stages of the heart
What is the primary features of cardiac tamponade
Raised Central venous pressure,
raised heart rate,
low BP
What is the secondary features of cardiac tamponade
Oliguria - abnormally small amounts of urine
increased oxygen requirements,
metabolic acidosis
What is the treatment of cardiac tamponade
chest re-opening and drain
What is the difference between adult and paediatric cardiac surgery on heart valves
Adult is mainly aortic and mitral valve surgery where
Paediatric Cardiac Surgery is all four heart valves operated with roughly equal frequency
What is the causes of valvular heart disease
Degenerative Congenital Infective Inflammatory LV or RV dilatation Trauma Neoplastic Paraneoplastic
What is the main cause of valvular heart disease
Degenerative
What affect does degenerative have on the aortic valves
Causes aortic valve stenosis due to calcification
What affect does degenerative have on mitral valves
Causes mitral regurgitation possible due to a force on the chordae tendae resulting in them snapping
What is an example of a congenital heart valve problem
Bicuspid valve of the aortic
What is examples of three common valve problems requiring cardiac surgery
Senile Tricuspid Aortic Stenosis
Bicuspid Aortic Stenosis
Degenerative Mitral Regurgitation
What is examples of infections resulting in heart valve problems
Rheumatic heart disease
Endocarditis
Rheumatic heart disease is a relapsing illness causes by what type of infection
streptococcal infections
What is the blood test to measure rheumatic heart disease antibodys against strep
ASO titre
What is rheumatic heart disease treated with
Aspirin and bed rest
What bacterial infection results in acute endocarditis
Staph aureus the second commonest organism – gives rise to acute bacterial endocarditis
What bacterial infection results in subacute endocarditis
Strep viridans the commonest organism – gives rise to subacute bacterial endocarditis
What infection in endocarditis has a much higher cure rate with anitibiotics treatment alone
Native vascular endocarditis - strep. viridans in subacute endocarditis (90%)
What endocarditis infection needs immediate treatment
acute endocarditis
What is the indications for surgery in endocarditis
Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure
What is the treatment plan post operative endocarditis
Antibiotics are given IV for 6 weeks
What is the recommended for severe aortic stenosis/regurgitation
aortic valve replacement
What is the process Cardiopulmonary Bypass and what does this allow
Blood drained from the RA and returned to the ascending aorta allowing Heart and lung function taken over by CPB machine
What medical intervention is needed during Cardiopulmonary Bypass
Systemic anticoagulation
What can Cardiopulmonary Bypass induce
Hypothermia
What is the flow like in Cardiopulmonary Bypass
Non-pulsatile
What is a common problem in cardiopulmonary bypass
Coagulopathy - a condition in which the blood’s ability to clot is impaired. This condition can cause prolonged or excessive bleeding
In what kind of cardiac surgery procedures is air embolism more likely to occur
valve replacement than in closed cardiac operations such as CABG
What is two types of valves used in valvular replacement
Biological
Mechanical
What is the advantage and disadvantage to biological valve replacement
Adv- Don’t have to take warfarin
Dis - Wears out after 15 years
What is the advantage and disadvantage to mechanical valve replacement
Adv- Last for over 40 years
Dis - have to take warfarin
What is the best treatment for mitral valve
repair is better than replacement
