Valvular and Ischaemic Heart Disease Flashcards
Causes of Cardiac Ischaemia (6)
- Atherosclerosis
- Embolism
- Coronary thrombosis
- Aortic dissection
- Arteritides- rheumatic arteritis generalized inflammation of arterioles and arterial capillaries occurring in rheumatic fever
- Congenital
Manifestations of IHDx (5)
- Angina
- MI
- Arrythmias
- Chronic heart failure
- Sudden death
Dangerous patterns of coronary artery disease (2)
- Left main stem stenosis
* 3-vessel coronary artery disease
Indications for coronary artery bypass grafting (2)
- Symptomatic (any CAD pattern)
* Prognostic (LMSS, 3VDx) Left main stem
Selection of patients for CABG (6)
- Adequate lung function
- Adequate mental function
- Adequate hepatic function
- Ascending aorta OK
- Distal coronary targets OK
- LV EF >20%
Conduits for CABG
- Reversed saphenous vein (lower leg)
- Internal mammary arteries (thorax)
- Radial arteries (arm)
What is a sternotomy
vertical inline incision is made along the sternum after which the sternum itself is
divided or cracked
Problems related to sternotomy (4)
- Wire infection
- Painful wires
- Sternal dehiscence
- Sternal malunion
Post-op problems in cardiac surgery (3)
Cardiac tamponade
Death
Stroke
Primary features of tamponade (3)
Raised CVP
Raised HR
Low BP
Secondary features of tamponade (3)
Oliguria
Increased oxygen requirements
Metabolic acidosis
Treatment for tamponade
Re-opening chest
Valvular heart disease in adults is mainly
Aortic and mitral valve surgery
Valvular disease in children is
All four valves operated with equal frequency
Causes of Valvular Heart Disease in Adults (8)
- Degenerative
- Congenital
- Infective
- Inflammatory
- LV or RV dilatation
- Trauma
- Neoplastic
- Paraneoplastic
Rheumatic fever is related to what organism
Streptococcal infection
What is the hallmark pathology of rheumatic fever
Pancarditis
Signs of rheumatic fever (3)
ASO titre- blood test to measure antibodies against streptolysin O, a substance produced by group A streptococcus bacteria
Skin and joint manifestations
Sydenham’s chorea/ St Vitus’ dance
What is rheumatic fever treated with
Aspirin and bed rest
What is the commonest cause of IE
Strep viridans
What is the second commonest cause of IE
Staph aureua
What is more easier to treat with antibiotics NVE or PVE
NVE
Which infection has a higher chance of being cure Staph. viridans or Staph. aureus
Staph viridans
Indications for surgery in endocarditis (4)
• Severe valvular regurgitation • Large vegetations • Persistent pyrexia • Progressive renal failure •
What is the treatment for endocarditis post-operatively
Antibiotics given IV for 6 weeks post-operatively
Aortic stenosis typically presents as (4)
Heart failure
Angina
Syncopal episodes
Incidental
Murmur in aortic stenosis
Usually heard
What differentiates aortic stenosis from aortic sclerosis
Loss of aortic S2 sound
Aortic regurgitation typically presents with (4)
Heart failure
Angina
Syncopal episodes
Incidental
Murmur in aortic regurgitation is
difficult to hear
What is severe MR associated with
LV and LA dilatation
Onset AF
Pulmonary hypertension
What can be seen in the ECHO during mR
Systolic blood flow reversal in the pulmonary veins
Features of a Cardiopulmonary Bypass
Blood drained from RA and returned to ascending aorta
Max time for CPB
12 hours
Maximum cardiac ischaemic time
6 hours
Common problems with CPB machines
Coagulopathy
Air embolism
Biological valve
no warfarin requires but the valve wears out after 15 years
Mechanical
warfarin required for life. Valve lasts for >40 years
What is better replacement or repair of valve for mitral valve
Repair
