Valvular heart disease therapy Flashcards
What is the aetiology of cardiac ischaemia?
Atherosclerosis Embolism Coronary thrombosis Aortic dissection Arteritides Congenital
What are the symptoms of ischaemic heart disease?
Angina MI Arrythmias Chronic heart failure Sudden death
What are dangerous patterns and indications of coronary artery disease?
Left main stem stenosis
3 vessel coronary artery disease
What are the reasons for coronary artery bypass grafting?
Symptomatic (to get rid of angina only) and prognostic ( get rid of angina and also loner life)
What are factors that help you select patients for CABG
Adequate lung function Adequate mental function Adequate hepatic function Ascending aorta OK Distal coronary targets OK LV EF > 20%
What arteries are usually used for CABG (grafting)?
Reversed saphenous vein
Internal mammary arteries
Radial arteries
What are sternotomy related problems?
Wire infection
Painful wires
Sternal dehiscence
Sternal malunion
What are post op problems in cardiac surgery?
Cardiac Tamponade
Death
Stroke
What are the primary and secondary signs and treatment for cardiac tamponade?
Primary features – Raised CVP, raised heart rate, low BP
Secondary features – Oliguria, increased oxygen requirements, metabolic acidosis
Treatment – chest re-opening
What are some statistical outcomes of post CABG
50% have no further cardiac problems 10 years later
Of the 50% who do have a problem, the majority are minor and easily controlled with medication
5% of patients may require repeat CABG
Aeitiology of cardiac heart disease
Degenerative – thickening and calcification +70
Congenital – bicuspid aortic valve so instead of 3 you get 2 so therefore aortic stenosis
Infective – endocarditis = not having antibiotics during dental procedure or having heart problems.
Inflam – rheumatic = antibody that is produced against strep also affects the tissue of the body. Can affect myocardium or pericardium
Dilation – heart enlarges and causes leaflets to no longer meet during systole and causes regurgitation
Trauma – Big car crash so aorta can get squashed and cause leaflets to rupture
Neoplastic – unusual and therefore need to operate on valve to remove it
Paraneoplastic – malignant tumour occur in gut and metasosis to the liver and causes something to be produced that affects the heart and requires the valves to be replaced. Diarrohea and flushing!
Can rehumatic fever replase?
Yes
Which infection is rheumatic fever related to?
Steptococcal Group A
What is the diagnostic test for rheumatic fever?
ASO titre to measure antibody content in body
What is a common cause for maternal/pregnancy death?
Chronic rheumatic heart disease
