Valvular and Ischemic Heart Disease - Therapy Flashcards by Jane Wu

What are some causes of cardiac ischaemia?

Atherosclerosis

Embolism

Coronary thrombosis

Airtuc dussection

Arteritides

Congenital

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What is aortic dissection?

Tear in the wall of the aorta

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What is a tear in the wall of the aorta called?

Aortic dissection

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What are some manifestations of ischaemic heart disease?

Angina

Myocardial infarction

Arrythmias

Chronic heart failure

Death

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What is arrythmias?

Irregular heart beat

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What is irregular heart beat called?

Arrythmias

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What are indications for coronary artery bypass grafting (CABG)?

Symptomatic

Prognostic

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What does CABG stand for?

Coronary artery bypass grafting

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What is coronary artery bypass grafting (CABG)?

Surgical procedure used to treat coronary heart disease by diverting blood around a narrowed or clogged part of arteries to improve blood flow to the heart

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What is a surgical procedure used to treat coronary heart disease by diverting blood around a narrowed or clogged part of arteries to improve blood flow to the heart called?

Coronary artery bypass grafting (CABG)

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What is used for the seleciton of patients for CABG?

Adequate lung function

Adequate mental function

Adequate hepatic function

Descending aorta okay

Distal coronary targets okay

Left ventricle ejection fraction (LV EF) > 20%

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What does LV EF stand for?

Left ventricle ejection fraction

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What are contraindications for CABG?

Reversed suphenous vein

Internal mammary arteries

Radial arteries

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What is sternotomy?

Surgical procedure in which a verticle incision is made along the sternum, after the sternum itself is divided

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What is the surgical procedure in which a verticle incision is made along the sternum, after the sternum itself is divided called?

Sternotomy

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What are sternotomy related problems?

Wire infections

Painful wires

Sternal dehiscence

Sternal malunion

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What is sternal dehiscence?

Process of seperation of the body sternum

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What is the process of seperation of the body sternum called?

Sternal dehiscence

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What is sternal malunion?

Sternal pain with clicking and/or instability for more than 6 months in the absence of infection

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What is sternal pain with clicking and/or instability for more than 6 months in the absence of infection called?

Sternal malunion

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What are some possible post-operative problems in cardiac surgery?

Cardiac tamponade

Death

Stroke

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What is cardiac tamponade?

Clinical syndrome caused by the accumulation of fluid in the pericardial space resulting in reduced ventricular filling

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What is a clinical syndrome caused by the accumulation of fluid in the pericardial space resulting in reduced ventricular filling?

Cardiac tamponade

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What are the primary features of cardiac tamponade?

Raised central venous pressure

Raised heart rate

Low blood pressure

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What are the secondary features of cardiac tamponade?

Oliguria Increased oxygen requirements Metabolic acidosis

What is oliguria?

Urine output less than: 1mL/kg/hr in infants 0.5mL/kg/hr in children 400 or 500ml/24 hours in adults

What is the treatment of tamponade?

Chest re-opening

What are the long term outcomes post CABG?

50% have no further cardiac problems 10 years later 5% may require a repeat CABG

What is the most common valve surgery in adults?

Mitral and aortic

What is the most common valve surgery in children?

All 4

What are some causes of valvular heart disease in adults?

Degenerative Congenital Infective Inflammatory Left ventricle or right ventricle dilation Trauma Neoplastic Paraneoplastic

What are 3 common valve problems requiring surgery?

Senile tricuspid aortic stenosis Bicuspid aortic stenosis Degenerative mitral regurgitation

What is rheumatic fever related to?

Steptococcal infection

What does rheumatic fever lead to?

Pancarditis

What is the treatment of rheumatic fever?

Aspirin and bed rest

What is the most common heart problem worldwide?

Rheumatic heart disease

What is endocarditis?

Infection of the endocardium

What is infection of the endocardium called?

Endocarditis

What are the 2 most common organisms to cause endocarditis?

1) Strep virdans 2) Staph aureus

What gives rise to subacute bacterial endocarditis?

Strep virdans

What gives rise to acute bacterial endocarditis?

Staph aureus

Is the chances of curing endocarditis higher with antibiotics when it is caused by strep virdans or staph aureus?

Strep virdans

What are indications for surgery in endocarditis?

Severe vavular regurgitation Large vegetations Persistance pyrexia Progressive renal failure

What is to be given after surgery for endocarditis?

Antibiotics by IV for 6 weeks post-operatively

What is aortic stenosis?

Narrowing of the aortic valve opening

What does aortic stenosis typically present in?

Heart failure Angina Syncope epidoses Asymptomatic incidental finding

What is the murmur like in aortic stenosis?

Easily heard

What investigations are done for aortic stenosis?

ECG ECHO

What treatment is done for severe aortic stenosis?

Aortic valve replacement

What is aortic regurgitation?

Leaky aortic valve causing backflow of blood

What does aortic regurgiation present as?

Heart failure Angina Asymptomatic incidental finding

What is the murmur due to aortic regurgitation like?

Hard to hear

What is the relationship between the severity of aortic regurgitation and the loudness of the murmur?

The louder the mumur the more severe the aortic regurgitation

What is the treatment for severe aortic valve regurgitation?

Aortic valve replacement

What is mitral stenosis?

Narrowing of the mitral valve

What is the murmur due to mitral stenosis like?

Hard to hear

What may the patient have to do to hear the murmur due to mitral steonsis?

Exercise

When is surgery used to treat mitral stenosis?

When mitral valve area is less than 1.5cm² on ECHO

What is mitral regurgitation?

Leaking of the mitral valve causing backflow of blood

What is severe mitral regurgitation associated with?

Left ventricular and left atrial dilation Onset of atrial fibrillation Pulmonary hypertension

What is the treatment for severe mitral regurgitation?

Mitral valve replacement

What is severe mitral regurgitation on ECHO characterised by?

Blood flow reversal in pulmonary veins

What is a cardiopulmonary bypass?

Technique in which a machine takes over the function of the heart and lungs during surgery

What is a technique in which a machine takes over the function of the heart and lungs during surgery?

Cardiopulmonary bypass

What happens during a caridopulmonary bypass?

Blood drained from right atrium and returned to the ascending aorta

What is the maximum time of cardiopulmonary bypass?

12 hours

What is a common problem with cardiopulmonary bypass?

Coagulopathy

What are different choices of heart valve replacements?

Biological valve Mechanical valve

What is the advantage and disadvantage of a biological valve replacement?

No warfarin required but the valve wears out after 15 years

What is the advantage and disadvantage of mechanical valve replacement?

Warfarin required for life but valve lasts for more than 40 years

When is repair of the valve better than replacement?

For the mitral valve