Valvular Heart Disease Therapy Flashcards
What are the main causes of cardiac ischaemia?
Atherosclerosis Embolism Coronary thrombosis Aortic dissection Arteritides Congenital
What are the commonest manifestations of ischaemic heart disease?
Angina MI Arrhythmia Chronic heart failure Sudden death
What are the most dangerous patterns of coronary artery disease?
Left main stem stenosis
3 vessel coronary artery disease
What are the indications for coronary artery bypass grafting?
Symptomatic - any CAD pattern
Prognostic - LMSS, 3VDx
What is necessary in patients when selecting them for CABG?
Adequate lung function Adequate mental function Adequate hepatic function Ascending aorta OK Distal coronary targets OK LV ejection fraction > 20%
What are the potential sternotomy-related problems?
Wire infection
Painful wires
Sternal dehiscence
Sternal malunion
What are the major post-operative problems in cardiac surgery?
Cardiac tamponade
Stroke
Death
What are the features of cardiac tamponade following cardiac surgery?
Primary
- Raised CVP
- Raised HR
- Low BP
Secondary
- Oliguria
- Increased oxygen requirement
- Metabolic acidosis
What is the treatment of cardiac tamponade following cardiac surgery?
Chest re-opening
What are the long term outcomes post-CABG?
50% have no further cardiac problems in 10 years
Of the 50% who do have a problem, most are minor and easily controlled with medication
5% of patients may require a repeat CABG
What are the possible conduits used in CABG?
Reversed saphenous vein
Internal mammary arteries
Radial arteries
How does cardiopulmonary bypass work?
Blood drained from right atrium and returned to the ascending aorta
Heart and lung function taken over by CPB machine
Systemic anticoagulation necessary
Induced hypothermia
What is the maximum time limit of CPB?
12 hours
What is the maximum cardiac ischaemia time in CPB?
6 hours
What are the potential causes of valvular heart disease in adults?
Degenerative Congenital Infective Inflammatory LV or RV dilatation Trauma Neoplastic Paraneoplastic
What is the typical presentation of aortic stenosis?
Heart failure Angina Syncopal episodes Or as an asymptomatic finding Murmur usually easily heart
When is aortic valve replacement recommended in aortic stenosis?
In severe AS
What differentiates aortic stenosis from aortic sclerosis?
Loss of aortic S2
What is the typical presentation of aortic regurgitation?
Heart failure
Angina
Or as an asymptomatic incidental finding
Louder the murmur, the more severe the regurgitation
When is aortic valve replacement recommended in aortic regurgitation?
In severe AR, especially with left ventricular dilatation
What does an easily heard murmur suggest in mitral stenosis?
That stenosis is severe
When is surgery recommended in mitral stenosis?
If MVA on echo is < 1.52cm
What does a loud murmur suggest in mitral regurgitation?
Severe MR
What is severe mitral regurgitation associated with?
LV and LA dilatation
Onset of atrial fibrillation
Pulmonary hypertension
When is surgery recommended in mitral regurgitation?
On basis of severe mitral regurgitation being present
What are the valve types in common use in replacement?
Biological
Mechanical
What are the advantages and disadvantages of biological valves?
No warfarin required but valve wears out after 15 years
What are the advantages and disadvantages of mechanical valves?
Warfarin required for life but valves last > 40 years
What are the indications for surgery in infective endocarditis?
Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure
