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Cardiovascular System > Surgical intervention of Ischaemic and Valvular Heart Disease > Flashcards

Surgical intervention of Ischaemic and Valvular Heart Disease Flashcards

1
Q

Ischaemia

A

Inadequate blood supply to organ or part of the body

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2
Q

Ischaemic heart disease

A

Heart problems caused by narrowed coronary arteries that supply blood to heart muscle

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3
Q

Aetiology of ischaemic heart disease

A 
Atherosclerosis 
Embolism
Coronary thrombus
Congenital
Arteritides
Aortic dissection
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4
Q

Manifestations of ischaemic heart disease

A 
Angina
MI
Arrhythmia
Chronic heart failure
Sudden death
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5
Q

Dangerous patterns of coronary heart disease

A

Left main stem stenosis

3 vessel coronary artery disease - proximal

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6
Q

Symptomatic coronary artery bypass grafting

A

Stops symptoms but doesn’t increase life expectancy

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7
Q

Prognostic coronary artery bypass grafting

A

Gets rid of angina and increase life expectancy

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8
Q

Symptomatic bypass grafting is performed for which coronary artery disease patterns

A

All

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9
Q

Prognostic bypass grafting is performed for which coronary artery disease patterns

A

Left main stem stenosis

3 vessel coronary artery disease

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10
Q

Selection of patients for coronary artery bypass grafting depends on

A

Adequate lung, mental and hepatic function
Ascending aorta and distal coronary targets are okay
Left ventricular ejection fraction > 20%

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11
Q

Conduits for coronary artery bypass grafting

A

Reversed saphenous vein
Left internal mammary arteries
Radial arteries

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12
Q

Sternotomy related problems

A

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion

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13
Q

Post-operation problems in cardiac surgery

A

Cardiac tamponade
Death
Stroke

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14
Q

Cardiac tamponade

A

Accumulation of fluid in the pericardial space resulting in reduced filling of heart

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15
Q

Primary features of cardiac tamponade

A

Raised central venous pressure
Raised heart rate
Low blood pressure

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16
Q

Secondary features of cardiac tamponade

A

Oliguria (low urine)
Increased oxygen requirements
Metabolic acidosis

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17
Q

Treatment of cardiac tamponade

A

Chest re-opening

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18
Q

Percentage of coronary artery bypass grafting patients that have no further cardiac problems 10 years later

A

50%

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19
Q

Percentage of coronary artery bypass grafting patients who may require repeat or stent

A

5-10%

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20
Q

What valves are operated on in adult cardiac surgery

A

Mainly aortic and mitral

21
Q

What valves are operated on in paediatric cardiac surgery

A

All 4

22
Q

Causes of valvular heart disease in the adult

A 
Degenerative
Congenital
Infective 
Inflammatory
Ventricular dilation
Trauma 
Neoplastic 
Paraneoplastic
23
Q

3 commonest valve problems requiring surgery in Aberdeen

A

Senile tricuspid aortic stenosis
Bicuspid aortic stenosis
Degenerative mitral regurgitation

24
Q

Rheumatic fever

A

Inflammatory disease that develops after a streptococcal throat infection

25
Q

Symptoms of rheumatic fever

A

Skin rashes
Joint pain
St Vitus’ Dance

26
Q

Treatment for rheumatic fever

A

Aspirin and bed rest

27
Q

ASO titre

A

Blood test to measure antibodies against streptolysin produced by streptococcus

28
Q

Chronic rheumatic heart disease

A

Gradually progressive mitral valve disease and/or aortic valve disease

29
Q

What is the commonest heart problem worldwide

A

Chronic rheumatic heart disease

30
Q

Endocarditis

A

Infection of endocardium of heart

31
Q

Organism that gives rise to subacute bacterial endocarditis

A

Strep viridans

32
Q

Organism that gives rise to acute bacterial endocarditis

A

Staph aureus

33
Q

Indications for surgery in endocarditis

A

Severe valvular regurgitation
Large vegetations
Persistent pyrexia (raised body temp)
Progressive renal failure

34
Q

Endocarditis post-op management

A

IV antibiotics for 6 weeks

35
Q

Surgical management for severe aortic stenosis

A

Aortic valve replacement

36
Q

Surgical management for severe aortic regurgitation

A

Aortic valve replacement

37
Q

Mitral stenosis surgery is only carried out if the size of the mitral valve annulus on ECHO is less than

A

1.5cm2

38
Q

Surgical management for mitral regurgitation

A

Mitral valve replacement for severe or repair for degenerative

39
Q

Cardiopulmonary bypass

A

Machine that takes over heart and lung function during surgery

40
Q

How does cardiopulmonary bypass work

A

Blood is drained from the right atrium and returned to the ascending aorta
Also induced hypothermia

41
Q

Cardiopulmonary bypass requires

A

Systemic anticoagulation

42
Q

During cardiopulmonary bypass flow is

A

Non-pulstatile

43
Q

Max time limit for cardiopulmonary bypass

A

12 hours

44
Q

Max cardiac ischaemic time

A

6 hours

45
Q

Common problem of cardiopulmonary bypass

A

Coagulopathy

46
Q

Advantage of closed cardiac operation like coronary artery bypass grafting over open cardiac surgical procedures like valve replacement

A

Air embolisms are less common

47
Q

Biological valve

A

Lasts only 15 years but no warfarin required

48
Q

Mechanical valve

A

Lasts for over 40 years but warfarin required for life

49
Q

Warfarin

A

Anticoagulant

Cardiovascular System (27 decks)

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