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Cardiovascular > Surgery for IHD and VHD > Flashcards

Surgery for IHD and VHD Flashcards

1
Q

What are some common causes for cardiac ischaemia?

A

Atherosclerosis
Embolism
Coronary thrombosis
Aortic dissection
Arteritides
Congenital

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2
Q

What are some manifestations of ischaemic heart disease?

A

Angina, MI, arrhythmias, chronic heart failure and sudden death

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3
Q

What are the dangerous patterns of coronary artery disease?

A

Left main stem stenosis
3 vessel coronary artery disease

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4
Q

What are the indications for coronary artery bypass grafting?

A

Symptomatic - any cardiac pattern
Prognostic - LMSS, 3VDx

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5
Q

What is included in selection of patients for CABG?

A

Adequate lung function, mental function, hepatic function, ascending aorta is okay, distal coronary targets and LVEF>20%

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6
Q

What conduits for CABG?

A

Reversed saphenous vein
Internal mammary arteries
Radial arteries

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7
Q

Describe a sternotomy

A

Procedure to separate your sternum (breastbone). Cardiac surgeons frequently use it to access your heart and aortic arch during surgery

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8
Q

When is radial artery used in CABG?

A

If problem with varicose veins

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9
Q

What are some related problems to a sternotomy?

A

Wire infection, painful wires, sternal malunion and sternal dehiscence (muscle on wound breaks down)

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10
Q

What are some post-op problems in cardiac surgery?

A

Cardiac tamponade, death and stroke

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11
Q

What are the primary features of cardiac tamponade following cardiac surgery?

A

Raised CVP, raised heart rate and low BP

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12
Q

What are the secondary features of cardiac tamponade following cardiac surgery?

A

oliguria, increased oxygen requirements and metabolic acidosis

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13
Q

What is the treatment of cardiac tamponade?

A

Chest re-opening

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14
Q

What are the long term outcomes post CABG?

A

50% have no further cardiac problems 10 years later
Majority of problems are minor and fixed with meds
Only 5% may need repeat CABG

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15
Q

What are the surgeries for valvular heart disease?

A

Adult cardiac surgery - mainly aortic and mitral valves
Paediatric Cardiac surgery - all 4 heart valves operated on in equal frequency

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16
Q

What are some causes of valvular heart disease in adults?

A

Degenerative, congenital, infective, inflammatory, LV or RV dilatation, trauma, neoplastic and paraneoplastic

17
Q

What are the most common problems requiring cardiac valve surgery?

A

Senile tricuspid AS
Bicuspid AS
Degenerative MR

18
Q

Explain Rheumatic fever

A

Is a relapsing illness and is related to streptococcal infections. ASO titre
Hallmark pathology is pericarditis
Skin and joint manifestations are usual
Sydenham’s chorea/ St Vitus’ dance

19
Q

What is rheumatic fever treated with?

A

Aspirin and bed rest

20
Q

Explain chronic rheumatic heart disease

A

Gradually progressive MVDx and maybe AVDx
Is most common heart problem and major cause of death in pregnancy

21
Q

What are common organisms that can give rise to endocarditis?

A

Strep viridans is most common - subacute bacterial endocarditis
Straph aureus is also common - acute bacterial endocarditis

22
Q

Explain chances of cure and endocarditis

A

NVE - 90% chance of cure with antibiotics alone
PVE - 50% chance of cure with antibiotics alone
Chances of cure much higher with strep viridans endocarditis than strep. aureus

23
Q

What are the indication for surgery in endocarditis?

A

Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure

24
Q

How long are antibiotics given post-op after surgery for endocarditis?

A

Given by IV for 6 weeks

25
Q

What are the typical presentations for aortic stenosis?

A

Heart failure, angina, syncopal episodes or as an asymptomatic incidental finding
Murmur usually easily heard
Loss of aortic S2 differentiates it from aortic stenosis

26
Q

What is recommended for severe AS?

A

Aortic valve replacement (AVR)

27
Q

Describe the murmur in mitral stenosis?

A

Usually difficult to hear
Easily heard if stenosis is severe
May need to exercise the patient to hear the murmur

28
Q

When is surgery recommended in patients with mitral stenosis/

A

If MVA on echo is <1.5 cm2

29
Q

Describe the murmur in mitral regurgitation

A

Murmur is usually easy to hear and if loud then usually severe

30
Q

What is severe MR associated with?

A

LV and LA dilatation, onset of AF and pulmonary hypertension

31
Q

What is Severe MR on echo characterised by?

A

Systolic blood flow reversal in the pulmonary veins

32
Q

Describe cardiopulmonary bypass

A

Blood is drained from RA and returned to the ascending aorta
Heart and lung function taken over by CPB machine
Systemic anticoagulation necessary - heparin
Induced hypothermia and non-pulsatile flow during CPB

33
Q

What is the max. time limit for CPB machine?

A

12 hours

34
Q

What are the two types of heart valve prosthetics?

A

Biological valve and mechanical valves (need warfarin)

Cardiovascular (33 decks)

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