Valvular Heart Disease- Therapy

Question 1

What is the difference between Type A and B aortic dissection?

Answer 1

Type A- involves the ascending aorta
Type B- does not involve the ascending aorta

Question 2

What is meant by arteritides?

Answer 2

Inflammation of the arteries

Question 3

What are some of the causes of ischaemic heart disease?

Answer 3

-Atherosclerosis
-Embolism
-Coronary thrombosis
-Aortic dissection
-Arteritides
-Congenital

Question 4

What are some of the manifestations of coronary heart disease?

Answer 4

Angina
MI
Arrythmias
Chronic heart failure
Sudden death

Question 5

What are the two groups of indications for CABG?

Answer 5

Symptomatic
Prognostic

Question 6

What considerations need to be made when assessing whether a patient is suitable for a CABG?

Answer 6

-Adequate lung function
-Adequate mental function
-Adequate hepatic function
-Ascending aorta OK
-Distal coronary targets OK
-LV EF > 20%

Question 7

Sometimes a saphenous vein from the leg is used in combination with a mammary artery for a CABG.
What is important to remember about the saphenous vein?

Answer 7

It contains valves so needs to be connected the right way or there would be no blood flow

Question 8

Which two vessels are commonly used in combination for a CABG?

Answer 8

Mammary artery
Saphenous veins

Question 9

Occasionally, which artery can be used in CABG?

Answer 9

Radial artery

Question 10

What are some issues which may arise in sternotomy surgery?

Answer 10

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion

Question 11

Name three post-op risks of cardiac surgery.

Answer 11

Cardiac Tamponade
Death
Stroke

Question 12

What are some of the primary features suggesting cardiac tamponade?

Answer 12

Raised CVP
Raised HR
Low BP

Question 13

What are some of the secondary features suggesting cardiac tamponade?

Answer 13

Oliguria (reduced urine output), increased oxygen requirements, metabolic acidosis

Question 14

What is the treatment for cardiac tamponade following cardiac surgery?

Answer 14

Reopening the chest

Question 15

What are the two valves which more commonly require surgery?

Answer 15

Aortic and mitral valves

Question 16

In Aberdeen, what are the three most common valve problems requiring surgery?

Answer 16

Senile Tricuspid AS
Bicuspid AS
Degenerative MR

Question 17

What is rheumatic fever linked to?

Answer 17

Streptococcal infections

Question 18

How is rheumatoid fever treated?

Answer 18

Aspirin and bed rest

Question 19

What can rheumatic fever be an indication of?

Answer 19

Heart valve disease

Question 20

Worldwide, what is the most common heart problem?

Answer 20

Chronic Rheumatic Heart Disease

Question 21

How can you differentiate aortic stenosis and aortic sclerosis?

Answer 21

Aortic stenosis= loss of aortic S2

Question 22

In those with mitral stenosis, when is surgery recommended?

Answer 22

When mitral valve area on ECHO is < 1.5cm2

Question 23

In which condition is the murmur more easily heard- mitral stenosis or mitral regurgitation?

Answer 23

Mitral regurgitation

Question 24

What happens is a cardiopulmonary bypass?

Answer 24

Blood drained from the RA and returned to the ascending aorta

Question 25

What drugs are needed before a cardiopulmonary bypass can take place?

Answer 25

Anticoagulants

Question 26

What are the two types of valve choice in valve replacement?

Answer 26

Biological valves
Mechanical valves

Question 27

Given an example of a biological valve.

Answer 27

Pig valve

Question 28

Describe the pros and cons of a biological valve.

Answer 28

No warfarin required but the valve wears out after 15 years

Question 29

Describe the pros and cons of a mechanical valve.

Answer 29

Warfarin required for life. Valve lasts for > 40 years