Valvular heart disease - Therapy

Question 1

what requirements does a patient have to fulfill if they are to undergo CABG

Answer 1

1. adequate lung function
2. adequate mental function
3. adequate hepatic function
4. ascending aorta OK
5. distal coronary targets OK
6. LV ejection fraction >20%

Question 2

what can be a major complication following IHD surgery

Answer 2

cardiac tamponade

stroke

Question 3

what are symptoms of cardiac tamponade

Answer 3

low BP
raised HR
raised central venous pressure

Question 4

In adults, what valves are usually operated on in cardiac surgery

Answer 4

aortic and mitral

Question 5

in paediatrics, what valves are usually operated on in cardiac surgery

Answer 5

all four valves operated in roughly equal frequency

Question 6

when would you consider AVR (aortic valve replacement) in Aortic stenosis

Answer 6

if sever stenosis present

patient considered well enough to undergo surgery

Question 7

when would you consider AVR in a patient with Aortic regurgitation

Answer 7

AVR recommended for severe AR especially with LV dilatation

Question 8

when is mitral valve replacement (MVR) recommended for mitral regurgitation

Answer 8

MVR recommended on basis of severe MR being present

Question 9

what investigation would be suitable to detect MR

Answer 9

echo

Question 10

what are the strengths and weaknesses of a Biological valve

Answer 10

no warfarin required

valve wears out after 15 yrs

Question 11

what are the strengths and weaknesses of a mechanical valve

Answer 11

requires warfarin

can last for 40 yrs

Question 12

what are the 2 types of prosthetic heart valves available

Answer 12

biological- made of animal tissue

mechanical- synthetic material

Question 13

If infective endocarditis occurs at a native valve what treatment option would be used and why

Answer 13

antibiotics

there is a 90% cure rate with Ab alone

Question 14

if infective endocarditis occurs at a prosthetic valve would Ab be suitable treatment

Answer 14

possibly-50% chance of cure with Ab alone

Question 15

what are the indications for surgery in infective endocarditis

Answer 15

severe valvular regurgitation
large vegetation
persistent pyrexia
progressive renal failure

Question 16

after an operation for infective endocarditis, how long would antibiotics be given for

Answer 16

6 weeks

Question 17

what are causes of cardiac ischaemia

Answer 17

ebolism
congenital 
atherosclerosis
coronary thrombosis
aortic dissection

Question 18

what are the long term outcomes post CABG

Answer 18

50% non cardiac problems 10 years later

50% only have minor problem 10 years later