Therapy for valvular heart disease Flashcards
What can cause cardiac ischaemia?
Atherosclerosis Embolism Coronary thrombosis Aortic dissection Arteritides (inflammed artery) Congenital
How can cardiac ischaemia manifest?
Angina MI Arrhythmias CHF Sudden death
Name the two most dangerous forms of CAD
Left main stem stenosis
3 vessel coronary artery disease
Name the indications for CABG
Symptomatic (any CAD pattern)
Prognostic (left main stem/3 vessel disease)
What is required of patients to undergo CABG?
Adequate lung function Adequate mental function Adequate liver function Ascending aorta is healthy Distal coronary artery targets are healthy LV ejection fraction >20%
What can be used to replace damaged vessels in CABG?
Reversed saphenous vein
internal mammary arteries
radial arteries
What procedure provides access to the heart and lungs?
Median sternotomy
What is a median sternotomy called if it is being reperformed for another surgery?
Resternotomy
State some sternotomy related problems
Wire infections
Painful wires
Sternal dehiscence (splitting)
Sternal malunion
What are some possible post-op complications in cardiac surgery?
Cardiac tamponade
Death
Stroke
What is cardiac tamponade?
Fluid build up in pericardium leading to compression of the heart
What are some symptoms of cardiac tamponade?
Cariogenic shock SOB Weakness Lightheadedness Cough
What can cause cardiac tamponade?
Cancer Kidney failure Chest trauma Pericarditis Connective tissue disease Hypothyroidism Aortic rupture Following chest surgery
What are some clinical features of cardiac tamponade?
Raised JVP Increased HR Low BP Quiet heart sounds Oliguria (low urine output) Increased O2 demand Metabolic acidosis
How do you treat cardiac tamponade?
Open chest and drain via pericardiocentesis
Which valves are more likely to be operated on in children?
All 4, as they are likely to be affected by a congenital abnormality
Which valves are more likely to be operated on in adults?
Mitral or aortic, most affected by ageing and degeneration
What can cause valve disease in adults?
Degenerative Congenital Infective Inflammatory LV or RV dilatation Trauma Neoplasm Paraneoplastic
What are the 3 most common valve problems operated on in Aberdeen?
Senile tricuspid AS
Bicuspid AS
Degenerative MR
What causes Rheumatic fever?
Group A Streptococcul infections
What test is used for diagnosing rheumatic fever?
Anti-streptolysin O (ASO) titre - measures levels of antibodies for streptomycin O in the blood, a substance produced by group A streptococcus
What is the hallmark signs of rheumatic fever?
Pancarditis (inflammation of the heart)
Skin and joint manifestations as well
Syndehams chorea/St Vitus’ dance
What is the most common organism causing infective endocarditis?
Strep viridans
What is the second most common organism causing infective endocarditis
Staph aureus
When is surgery indicated in those with IE?
Severe valvular regurgitation Large vegetations Persistent pyrexia Progressive renal failure Following full 6 week course of Abx
What procedure is used to temporarily take over the function of the heart and lungs during surgery?
Cardiopulmonary bypass (CPB) pump, often called a heart-lung machine. Non-pulsatile flow, anticoagulation used throughout, induced hypothermia
Where does a CPB take the blood out of the body?
Right atrium
Where does a CPB return blood to the body?
Ascending aorta
What are the pros and cons of a biological valve replacement versus a mechanical valve replacement?
Bio - no warfarin but lasts 15 years
Mech - lifetime warfarin but lasts >40 years
