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Cardiovascular System > Ischaemic heart disease and valvular heart disease - surgeon approach > Flashcards

Ischaemic heart disease and valvular heart disease - surgeon approach Flashcards

1
Q

What are causes of cardiac ischaemia?

A
  • Atherosclerosis
  • Embolism
  • Coronary thrombosis
  • Aortic dissection
  • Arteritides
  • Congenital
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2
Q

Manifestations of ischaemic heart disease

A
  • Angina
  • MI
  • Arrythmias
  • Chronic heart failure
  • Sudden death
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3
Q

Dangerous patterns for coronary artery disease

A
  • Left main stem stenosis

3 vessel coronary artery disease

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4
Q

Indications for coronary artery bypass grafting

A
  • Symptomatic (any CAD pattern)

- Prognostic (LMSS, 3VDx)

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5
Q

Features required for selection of patients for CABG (coronary artery bypass grafting)

A
  • Adequate lung function
  • Adequate mental function
  • Adequate hepatic function
  • Ascending aorta OK
  • Distal coronary targets OK
  • LV EF>20%
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6
Q

Conduits for CABG

A
  • Reversed saphenous vein
  • Internal mammary arteries
  • Radial arteries
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7
Q

What is median sternotomy?

A

It is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided.
- This procedure provides access to the heart and lungs.

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8
Q

What are sternotomy related problems?

A
  • Wire infection
  • Painful wires
  • Sternal dehiscence
  • Sternal malunion
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9
Q

Post-operation problems in cardiac surgery

A
  • Cardiac tamponade
  • Death
  • Stroke
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10
Q

Features of cardiac tamponade following cardiac surgery

A
  • Primary features: raised CVP, raised heart rate, low BP

- Secondary features: oliguria, increased oxygen requirements, metabolic acidosis

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11
Q

Treatment for cardiac tamponade

A

Chest re-opening

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12
Q

Cardiac surgery for valvular heart disease in adults and children

A

Adult cardiac surgery- mainly aortic and mitral valve surgery.

Paediatric cardiac surgery - all four heart valves operated with roughly equal frequency.

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13
Q

Causes of valvular heart disease in adults

A
  • Degenerative
  • Congenital
  • Infective
  • Inflammatory
  • LV or RV dilatation
  • Trauma
  • Neoplastic
  • Paraneoplastic
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14
Q

What are the 3 commonest valve problems requiring cardiac surgery in Aberdeen?

A
  • Senile Tricuspid AS
  • Bicuspid AS
  • Degenerative MR
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15
Q

Features of Rheumatic fever

A
  • A relapsing illness
  • Related to streptococcal infections
  • ASO titre (type of blood test)
  • The hallmark pathology is pancarditis
  • Skin and joint manifestations are usual
  • Syndenham’s chorea/ St Vitus’ Dance
  • Treated with aspirin and bed rest
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16
Q

Primary prevention of rheumatic fever

A

Primary prevention of acute rheumatic fever requires adequate antibiotic treatment of streptococcal throat infections

17
Q

Features of chronic rheumatic heart disease

A
  • Gradually progressive MVDx +/- AVDx
  • Worldwide is the commonest heart problem
  • Worldwide is a major cause of death in pregnancy
18
Q

Which organisms give rise to Endocarditis?

A
  • Strep viridans is the commonest organism: gives rise to subacute bacterial endocarditis
  • Staph aureus is the second commonest organism: gives rise to acute bacterial endocarditis

Infected heart valve may have been diseased beforehand or may have been normal

19
Q

Chances of cure for NVE (native valve endocarditis) and PVE (prosthetic valve endocarditis)

A

NVE - 90% chance of cure with antibiotics alone

PVE - 50% chance of cure with antibiotics alone

20
Q

Which organism gives a higher cure chance?

A

Chances of cure much higher with strep viridans endocarditis than with staph aureus

21
Q

What are indications for surgery in endocarditis?

A
  • Severe valvular regurgitation
  • Large vegetations
  • Persistent pyrexia
  • Progressive renal failure
22
Q

How long are antibiotics given for post-operatively for endocarditis?

A

Antibiotics are given IV for 6 weeks post-operatively

23
Q

Features of aortic stenosis

A
  • Typically presents as heart failure, angina, syncopal episodes or as an asymptomatic incidental finding.
  • The murmur is usually easily heard.
  • Loss of aortic S2 differentiates it from aortic sclerosis.
  • ECG/ECHO- LVH.AV gradient > 50mmHg
  • AVR recommended for severe aortic stenosis.
24
Q

Features of mitral stenosis

A
  • Murmur is usually difficult to hear
  • If easily heard then the stenosis is severe
  • May have to exercise the patient to hear the murmur
  • Presystolic accentuation may be present
  • Surgery recommended if MVA on ECHO is < 1.5cm2
25
Q

Features of aortic regurgitation

A
  • Typically presents as heart failure, angina or as an asymptomatic incidental finding
  • The murmur is usually difficult to hear
  • The louder the murmur the more severe the aortic regurgitation
26
Q

What is recommended for severe aortic regurgitation?

A

Aortic valve replacement recommended for severe aortic regurgitation especially with left ventricular dilatation.

  • In severe AR the entire LV is filled with contrast after one diastolic interval during aortography
27
Q

Features of Mitral regurgitation

A
  • Murmur is usually easy to hear
  • If murmur is loud, MR is usually severe.
  • Severe MR on ECHO characterised by systolic blood flow reversal in the pulmonary veins.
28
Q

What is severe Mitral regurgitation associated with and what is recommended for it?

A

It is associated with LV and LA dilatation, onset of AF and pulmonary hypertension.

MVR recommended on the basis of severe MR being present.

29
Q

How is a Cardiopulmonary Bypass carried out?

A
  • Blood drained from the RA and returned to the ascending aorta.
  • Heart and lung function taken over by CPB machine.
  • Systemic anticoagulation necessary
  • Induced hypothermia
  • Non-pulsatile flow during CPB.
30
Q

What is the maximum cardiopulmonary bypass time limit?

A

12 hours

  • Maximum cardiac ischaemic time is 6 hours.
31
Q

What are common problems in cardiopulmonary bypass?

A
  • Coagulopathy

- Air embolism

32
Q

What is coagulopathy?

A

A condition in which the blood’s ability to coagulate (form clots) is impaired.
- This condition can cause a tendency toward prolonged or excessive bleeding (bleeding diathesis).

33
Q

Warfarin and valve wear for choice of heart valve prosthesis

A

Biological valve - no warfarin required but the valve wears out after 15 years.

Mechanical valve - warfarin required for life. Valve lasts for > 40 years.

Cardiovascular System (36 decks)

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