Surgical Treatment for IHD and Valve Replacement Flashcards
What causes ischaemic heart disease?
Atherosclerosis Thrombosis Embolism Aortic dissection Congenital
How does IHD manifest?
Stable/unstable angina MI -NSTEMI/STEMI Sudden cardiac ceath Chronic heart failure Arrhythmias
What are the most dangerous types/patterns of IHD?
Left main stem stenosis
3 vessel CAD - narrowing near the origin of the coronary artery cuts off supply to all branches
When would a CABG be considered?
If symptomatic and the IHD symptoms get worse
If they have the dangerous patterns
What patients are suitable for a CABG?
Must have adequate lung, mental and hepatic function
Health ascending aorta and distal coronary arteries
LV ejection fraction must be >20%
What vessels are used in a CABG? How are they used?
Long saphenous vein taken from leg and reversed - attached to aorta and coronary artery distal to occlusion
Internal mammary arteries - left one redirected to heart away from breasts/chest wall
Radial artery - easier to remove than ulnar
What is a sternotomy?
Opening of chest and sternum to get into the thoracic cavity
Problems of a sternotomy
Wire infections
Painful wires
Sternal malunion - a healed fracture in a bad position
Sternal dehisence - wound rupture
Other post op CABG issues?
Cardiac tamponade
Stroke
Death
What is a cardiac tamponade?
Compression of the heart by an accumulation of fluid (blood) in the pericardial sac
This prevents atria filling properly
Signs of a cardiac tamponade?
Raised central venous pressure, HR
Low BP
Treatment for a cardiac tamponade?
Need to reopen chest
What are the common adult valve surgeries?
Aortic and mitral?
Common paeds valve surgeries?
All 4 valves roughly equal
Causes of valve disease?
Degenerative Congenital Infective Inflammatory LV/RV dilatation Trauma Neoplastic Para-neoplastic
What is a neoplasm?
New and abnormal growth of tissue
How does AS present?
Heart failure
Angina
Syncopal episodes
Asymptomatic and found incidentally sometimes
Murmur of AS?
Ejection systolic murmur
Easily heard
Loss of S2 differentiates it from aortic sclerosis
What will an echo see in AS?
LVH
AV-pressure gradient above 50mmHg
How does AR present?
Heart failure
Angina
Incidental finding
Describe the murmur for AR
High pitched early diastolic murmur
Soft - difficult to hear
Louder it is more severe it is
When is surgery recommended for MS?
If the MV area is less than 1.5cm^2 on an echo
Describe the murmur of MS
Low rumbling diastolic murmur
Best heard on expiration
How is severe MR seen?
LV and RV dilatation
Onset of A-fib and pulmonary hypertension
What will a severe MR look like on a echo?
Systolic blood will be seen flowing backwards into pulmonary vein
How does the murmur of MR sound?
Pan-systolic
Easy to hear
Louder - more severe
How does a cardiopulmonary bypass machine work, what does it do and what’s its major problem?
Directs blood from RA to aorta bypassing pulmonary circulation
This takes over the heart and lung function
Main problem is systemic anticoagulation is needed as it can cause coagulopathy
What is the pos and neg of a bio valve?
No warfarin is needed
Valve wears out after 15 years
What are the pos and neg of a mechanical valve?
Valve lasts a good 40 years
Warfarin needed for life
Mitral Valve - is replacement or repair better?
Repair is better than replacement
