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Cardio 5 > Ischemic and valvular heart disease - srgical look > Flashcards

Ischemic and valvular heart disease - srgical look Flashcards

1
Q

What are the sinus of valsalva?

A

It is the bulgy part of the aorta just as it leaves the left atrium

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2
Q

What is the sino-tubular junction

A

The junction between the sinus of walsalva and the ascending aortar (when it goes from bulby structure to a tube

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3
Q

Where is ostial stenosis?

A

It is stenosis when it occurs near the orifices (entrance/opening) of the coronary arteries(near the sinus of valsalva)

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4
Q

Type A vs Type B Aortic disection worse?

A

Type A- as type A includes the ascending aorta (vvvv flexiable and elastic) and can often lead to cardiac tamponade (as the blood finds its way into the pericardium) and death within a week.

Type B - (does NOT include the ascending aorta) has rougher descending aorta outerlayer and doesn’t include ascending aorta and so won’t lead to blood filling the pericardium)

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5
Q

What is Arteritides?

A

Inflammation of the arteries, If happens to aorta, can lead to occlusion or partial occlusion of the coronary arteries and this can present itself as angina

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6
Q

What surgical treatment options are there for ischaemic heart disease and what are the potential complications of surgery?

A

Stenting or CABG.

Complications of CABG include cardiac tapenade, death or Stroke

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7
Q

What valvular defects are suitable for surgery?

A

All of them are, but more common for adults to have aortic/mitral whereas paedriatric cardiac surgery all 4 valves are operated on with equal frequency.

Most common reasons in Aberdeen are Senile Tricuspid Aortic Stenosis, Bicuspid Aortic Stenosis and ergenartative Mitral Regurgitation

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8
Q

When would you have a valve replacement?

A

If you have severe Mitral regurgitation, Aortic Regurgitation, Aortric Stenosis or MVA (Mitral stenosis) on echo of less than 1.5cm2.

ALKso in Endocarditis with Severe regurfitations, laarge vegitations, persistent pyrexia or progressive renal failure

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9
Q

What prosthetic valves are in common use?

A

Biological valves (no need for warfrin but wears out within 15 years)

Mechanical valves - needs warfrin for life but valve can last up to 40 years+

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10
Q

How is endocarditis treated? Any surgery?

A

Antibiotics - most common bug is strp. Veridans, which is killed with penicillin, so has higher chance of cure than eg staph aureus.

Less chance if prosthetic heart valve of being cured with antibiotics alone.

Indications of surgery include:
-severe regurgitation
-large vegitations
-persistant pyrexia
-progressive renal failure
After surgery antibiotics are given IV for 6 weeks
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11
Q

What is the aortic root marked by?

A

Insertion of valve leaflets to sinotubular junction

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12
Q

What are the causes of Cardiac Ischemia?

A
  • Atherosclerosis
  • Embolism/coronary thrombosis
  • Aortic dissection (when the aorta starts to split off and parts can cover the coronary sinuses?)
  • Arteridides (inflammation of the arteries)
  • Congenital defects eg coronary arteries not actually attached to the aorta or attched to pulmonary trunk instead)
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13
Q

What does Cardiac Iscaemia lead to?

A
  • Angina
  • Arrythmias
  • MI
  • Chronic Heart Failure
  • Sudden Death
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14
Q

Why can diabetic patients present with heart failure due to coronary artery disease but without any angina symptoms?

A

Due to autonomic neuropathy - neurons that usually convey angina sensation don’t work

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15
Q

What are the 2 dangerous patterns of Coronary Artery Disease?

A

If there is atherosclerosis or narrowing proximally of the 3 main coronary arteries

OR

Left Main Stem Stenosis

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16
Q

When would you operate for Prognostic reasons?

A

If the coronary anatomy is life threatening (3 coronary arteries stenosed/left main stem stenosed) to improve outcome/survival

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17
Q

When would you operate for Symptomatic reasons?

A

To relieve symptoms and to improve QOL

18
Q

What are the requirements for CABG?

A
  • Good lung fction (FEV1 at least 1L and at least 50% of predicted FEV1 and transfer factor)
  • Good mental State (won’t run out/attack surgeon)
  • Good liver function (no chirrosis)
  • OK ascending aorta and distal coronary targets
  • Left Ventricular Ejection Fraction at least 20% (although some grey area, some surgeons may do is lower depending on co morbidities)
19
Q

What do liver/kidneys filter out? What effect does this have?

A

Liver filters our lipid soluble toxins and the kidneys filter our water soluble toxins.

In tissue breakdown a lot of lipid soluble toxins are released so liver function needs to be good)

20
Q

Wht can be used for a CABG?

A 
Saphenous Vein (must be inverted so that the valves don't block the blood flow!)
If varicose veins then the radial artery may be used
Alternatively the internal mammary arteries may be used.
21
Q

Sternotomy issues

A

Wire infection (osteomyelitis or granuloma of inflection)
Painful wires
Sternal dehiscence (snapped wire/cuts through bone)
Bad alignment of sternum

22
Q

Post op. problesms after cardiac surgery eg cabg?

A

Stroke
Cardiad Tamponade
Death

23
Q

What are the characteristics of Cardiac Tamponade and treatment following cardiac surgery

A

Raised CVP (central venous pressure) raised HR, low BP

May also have increased O2 requirements, metabolic acidosis and oliguria (low amounts of urine)

24
Q

Vaso vagal attack (fainting/blackout) clinical features

A

Low HR and low BP

25
Q

10 year Outcomes for CABG

A

50% no cardiac problems
of other 50% most is controlled with medication and are minor
5% have another CABG

26
Q

Adult vs peadriatric valvular surgery which vaves?

A

Adult = Aortic or Mitral mainly

Paedriatrics = all in eaqual measure

27
Q

Mitral valve - which leaflet bigger?

A

Anterior leaflet (aortic leaflet) bigger than posterior (mural) leaflet

28
Q

What is the “junction point”

A

Part between anterior and posterior valve leaflets, have lateral and medial

29
Q

Long vs short axis of the left ventricle

A

Long axis is from apex to valves, short axis is acrossventricle wall to ventricle wall on the other side

30
Q

What are the causes of valvular Heart disease in the adult?

A
  • degenarative
  • congenital
  • infective
  • inflammatory
  • Diltation of left/right venreicles
  • Trauma
  • Neoplastic
  • Paraneoplastic
31
Q

Most common valve problems opeated on in ABz

A

Senile Tricuspid Aortic Stenosis
Bicuspid Aortic Stenosis
Degenarative Mitral Regurgitation

32
Q

What does Rheumatic Fever have to do with it?

A 
It is the most common cause of valvular disease in the world. 
Relapsing illness (usually Streptococcal infections) causing pancarditis and treated with asprin and bed rest.

Can lead to Mitral and Aortic valve degenaration. Can be a reason for cardiac surgery while pregnant.

33
Q

Endocarditis organisms and popularity

A

Strep. Veridans is most common, then Staph Aureus ,

34
Q

When would you operate in endocarditis?

A

With Svere Valvular regurgitation
Persistent Pyrexia
Large vegitations
Progressive renal failure

35
Q

Aortic stenosis symptoms and presentation

A

Heart failure, angina, syncope.

Can be found incidentally

Loud systolic murmour with loss of S2. With S2 is Aortic Sclerosis.

On ECG/Echo with have Left ventricular Hypertrophy and Atria-ventricular pressure gradient greater than 50mmHg

36
Q

Aortic regurgitation presentations

A

Heart Failure, angina caa be asymptomatic

Murmour can be hard to hear esp if early stage.

If Left Ventricle also dilated then valve replacement is recommended.

37
Q

What about Mitral stenosis

A

Usually hard to hear stenosis (if easy then is severe), may have to exercise patient to hear and presystolic accentuation may be present.

If MVA on echop is less than 1.5cm2 then surgery recommended

38
Q

Mitral refurgitation

A

Usually easy to hear murmour
Causes dilatation of Left vent and atrium
If loud then severe, can can be classified on ECHO by systolic blood flow reversal in pulmonary veins

39
Q

What is the time limit for cardio pulmonary bypass and maximum time before cardiac ischemia?

A

12 hours for operation and 6 hours for cardiac ischaemia

40
Q

Biological vs mechanical valve

A

Biological doesn’t require warfrin but weears out sooner (within 15 years), Mechanical valve lasts longer but requires lifelong warfrin

Cardio 5 (7 decks)

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