Valvular and IHD Therapy Flashcards
What are 5 different causes of cardiac ischaemia?
Atheroscelrosis Embolism Coronary thrombosis Aortic dissection Arteritides Congenital
What is arteritides?
Inflammation of an artery
What are commissures?
The places where the cusps of the valves meet
What is aortic dissection?
The intima and media of the aorta are ripped apart and blood enters the space
What are the manifestations of ischaemic heart diseases?
Angina MI Arrythmias Chronic heart failure Sudden death
What are two dangerous patterns of coronary artery disease?
L main stem stenosis
3 vessel coronary artery disease (LAD, L circumflex, RCA)
What are indications for coronary artery bypass grafting (CABG)?
Symptomatic (any CAD pattern)
Prognostic (left main stem stenosis, 3 vessel coronary artery disease)
What are requirements for CABG?
Adequate:
Lung function
Hepatic function
Mental function
Ascending aorta OK
Distal coronary arteries OK
LV EF>20%
What are the potential conduits used for CABG?
Reversed saphenous vein
Internal mammary arteries
Radial arteries
Name 3 post-op problems in cardiac surgery
Cardiac tamponade
Death
Stroke
What is a cardiac tamponade?
Build up of fluid or blood in the pericardial space
What are the primary features of cardiac tamponade (following cardiac surgery)?
Raised CVP
Raised heart rate
Low BP
What are the secondary features of cardiac tamponade following cardiac surgery?
Oliguria (low urine output)
Increased O2 demand
Metabolic acidosis
What can cardiac tamponade lead to if it becomes too severe?
Cardiac arrest
Which valves are most commonly operated on in adults?
Aortic and mitral
Which valves are most commonly operated on in children?
All four valves
List the causes of valvular heart disease in adults
Degenerative valves Congenital Infective Inflammatory LV or RV dilatation Trauma Neoplastic Paraneoplastic
What is rheumatic fever?
Cardiac inflammation and scarring triggered by streptococcal infections
It manifests into pancarditis, involving inflammation of the myocardium, endocardium, and epicardium
What is the clinical presentation of pancarditis?
Friction rub
Skin rash
Acute renal failure
St Vitus’ Dance
How is pancarditis treated?
Aspirin and bed rest
Which organism give rise to subacute bacterial endocarditis?
Strep viridians
Which organism give rise to acute bacterial endocarditis?
Staph aureus
Is endocarditis caused by staph. aureas or strep. viridans more likely to be cured?
Higher chance with strep viridian’s
What is the chance of survival of natural valve endocarditis with antibiotics alone?
90%
What is the chance of survival of prosthetic valve endocarditis with antibiotics alone?
50%
What are the indications for surgery in endocarditis?
Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure
What is given post-operatively in endocarditis?
IV antibiotics for 6 weeks
How does aortic stenosis typically present?
Heart failure
Angina
Syncopal episodes
Asymptomatic incidental finding
How is aortic stenosis differentiated from aortic sclerosis?
Loss of S2 heart sound due to murmur
What is the recommended treatment for severe aortic stenosis?
Aortic valve replacement
What does aortic regurgitation typically present as?
Heart failure
Angina
Asymptomatic incidental finding
What type of murmur is heard with aortic regurgitation?
Diastolic - usually hard to hear
What treatment is recommended for severe aortic regurgitation?
Aortic valve replacement - especial with LV dilation
When is surgery recommended for mitral stenosis?
Orifice on ECHO <1.5cm2
Why is mitral stenosis hard to hear?
It is diastolic - may have to exercise to hear
What is severe mitral regurgitation associated with?
LV and LA dilations causing AF and pulmonary HPT
What treatment is recommended for severe mitral regurgitation?
Mitral valve replacement
How does an ECHO characterise mitral regurgitation?
Systolic blood flow reversal in the pulmonary veins
What is the function the cardiopulmonary bypass machine?
Drains deoxygenated blood from RA, oxygenates it, and returned it to the ascending aorta
What is required when using a cardiopulmonary bypass machine?
Systemic anticoagulation
Induced hypothermia
What are rules of CBP?
Max time 12hrs
Max cardiac ischaemia time 6hrs
What are complications of CBP?
Coagulopathy
Air embolism
What is the advantage and disadvantage of a biological valve choice for heart valve prosthesis?
No warfarin
Wears out after 15yrs
What is the advantage and disadvantage of a mechanical valve choice for heart valve prosthesis?
Warfarin for life
Lasts > 40 yrs
