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ZA - Cardio Diseases > Surgical Treatment for IHD and Valve Replacement > Flashcards

Surgical Treatment for IHD and Valve Replacement Flashcards

1
Q

What causes ischaemic heart disease?

A 
Atherosclerosis
Thrombosis
Embolism
Aortic dissection
Congenital
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2
Q

How does IHD manifest?

A 
Stable/unstable angina
MI -NSTEMI/STEMI
Sudden cardiac ceath
Chronic heart failure
Arrhythmias
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3
Q

What are the most dangerous types/patterns of IHD?

A

Left main stem stenosis

3 vessel CAD - narrowing near the origin of the coronary artery cuts off supply to all branches

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4
Q

When would a CABG be considered?

A

If symptomatic and the IHD symptoms get worse

If they have the dangerous patterns

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5
Q

What patients are suitable for a CABG?

A

Must have adequate lung, mental and hepatic function

Health ascending aorta and distal coronary arteries

LV ejection fraction must be >20%

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6
Q

What vessels are used in a CABG? How are they used?

A

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

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7
Q

What is a sternotomy?

A

Opening of chest and sternum to get into the thoracic cavity

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8
Q

Problems of a sternotomy

A

Wire infections
Painful wires

Sternal malunion - a healed fracture in a bad position

Sternal dehisence - wound rupture

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9
Q

Other post op CABG issues?

A

Cardiac tamponade
Stroke
Death

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10
Q

What is a cardiac tamponade?

A

Compression of the heart by an accumulation of fluid (blood) in the pericardial sac

This prevents atria filling properly

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11
Q

Signs of a cardiac tamponade?

A

Raised central venous pressure, HR

Low BP

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12
Q

Treatment for a cardiac tamponade?

A

Need to reopen chest

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13
Q

What are the common adult valve surgeries?

A

Aortic and mitral?

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14
Q

Common paeds valve surgeries?

A

All 4 valves roughly equal

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15
Q

Causes of valve disease?

A 
Degenerative
Congenital
Infective
Inflammatory 
LV/RV dilatation
Trauma
Neoplastic
Para-neoplastic
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16
Q

What is a neoplasm?

A

New and abnormal growth of tissue

17
Q

How does AS present?

A

Heart failure
Angina
Syncopal episodes

Asymptomatic and found incidentally sometimes

18
Q

Murmur of AS?

A

Ejection systolic murmur
Easily heard
Loss of S2 differentiates it from aortic sclerosis

19
Q

What will an echo see in AS?

A

LVH

AV-pressure gradient above 50mmHg

20
Q

How does AR present?

A

Heart failure
Angina

Incidental finding

21
Q

Describe the murmur for AR

A

High pitched early diastolic murmur
Soft - difficult to hear

Louder it is more severe it is

22
Q

When is surgery recommended for MS?

A

If the MV area is less than 1.5cm^2 on an echo

23
Q

Describe the murmur of MS

A

Low rumbling diastolic murmur

Best heard on expiration

24
Q

How is severe MR seen?

A

LV and RV dilatation

Onset of A-fib and pulmonary hypertension

25
Q

What will a severe MR look like on a echo?

A

Systolic blood will be seen flowing backwards into pulmonary vein

26
Q

How does the murmur of MR sound?

A

Pan-systolic
Easy to hear
Louder - more severe

27
Q

How does a cardiopulmonary bypass machine work, what does it do and what’s its major problem?

A

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

28
Q

What is the pos and neg of a bio valve?

A

No warfarin is needed

Valve wears out after 15 years

29
Q

What are the pos and neg of a mechanical valve?

A

Valve lasts a good 40 years

Warfarin needed for life

30
Q

Mitral Valve - is replacement or repair better?

A

Repair is better than replacement

ZA - Cardio Diseases (36 decks)

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