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CVS pathophysiology > Valvular Heart disease therapy > Flashcards

Valvular Heart disease therapy Flashcards

1
Q

What is cardiac isachemia?

A
  • lack of BF/O2 to the cardiac muscle

- artery can be blocked narrowed for short period of time

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2
Q

State the causes of cardiac isachemia

A
  • atherosclerosis
  • embolism
  • coronary thrombosis
  • aortic dissection ( injury to T.intima which allows BF to occur between the layers. T intima and T.adevenia seperate )
  • arteritis
  • congenital
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3
Q

What conditions can IHD lead to?

A
  • angina
  • MI
  • arrythmia
  • chronic HF
  • sudden death
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4
Q

State patterns of CAD

A
  • left main stem(CA) stenosis
  • 3 vessel coronary artery disease (the left anterior descending, right coronary and circumflex arteries have blockages from atherosclerotic plaques.)
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5
Q

State indications for coronary artery bypass grafting (CABG)

A
  • if symptomatic ( of any CAD pattern)

- prognostic (LMSS, 3VCAD)

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6
Q

Criterieas of patients for CABG

A

Adequate:

  • LF
  • MF
  • HF
  • ascending aorta OK
  • distal coronary targets OK
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7
Q

State conduits for CABG

A
  • reversed saphenous vein
  • internal mammary arteries
  • radial arteries

Sternotomy required to gain access to middle mediastinum

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8
Q

Reversed saphenous vein CABG

A
  • reversed to ensure the BF of the blood is operating in the right direction.
  • valves
  • long saphenous vein
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9
Q

Explain the CABG procedure + the CPB

A

CABG

  • graft vessel used to replace a narrowed artery ( coronary)
  • Internal mammary artery is preferred as it doesn’t narrow over time unlike others.
  • After graft vessels removed, sternoctomy performed to gain access to heart. Blood is rerouted to a heart-lung bypass machine(CPB), which pumps blood and O2 through body.
  • Heart is temporarily stopped using medication as new graft attachments are made.
  • After grafts made, controlled electrical shocks to start the heart
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10
Q

State sternocotomy related problems

A
  • wire infection
  • painful wires
  • sternal dehiscence ( when wires press into RV > haemorrage)
  • sternal malunion ( when sternum heals abnormally)
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11
Q

Post op problems in cardiac surgery

A
  • cardiac tamponade ( when pericardial fluid builds resuting in comptrssion of heart)
  • death
  • stroke
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12
Q

Clinical symptoms of cardiac tamponade + Treatment

A

Primary features
-high CVP, HR, low BP

Secondary features
-oliguria, increased O2 requirements, metabolic acidosis

Treatment
-chest re opening

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13
Q

Surgery for valvular HD in adult and paediatrics

A

Adult Cardiac surgery
-aortic and mitral valve surgery

Paediatric cardiac surgery
-all 4 vales operated with equal frequency

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14
Q

State causes of valvular HD in ADULTS

A
  • degenerative
  • congenital
  • infective
  • inflammatory
  • LV/RV dilation
  • trauma
  • neoplastic
  • paraneoplastic
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15
Q

Most common valve problems requiring cardiac surgery in Abdn

A
  • senile tricuspid AS
  • Bicuspid AS
  • degenerative MR
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16
Q

What is rheumatic fever and what is it caused by?

A
  • relapsing illness caused by streptococcal infections
  • hallmark pathology is pancarditis ( inflammation of whole heart including pericardium and heart walls)
  • sydenham’s chorea
17
Q

Treatment of rheumatic fever

A
  • antibiotics after treatment to prevent steptococcal infections(penicillin sensitive)
  • aspirin + bed rest
18
Q

Test for rheumatic fever

A

ASO titre

- blood test to measure antibodies against streptolysin O ( produced by Grp A strept bacteria)

19
Q

What is chronic rhemuatic HD

A
  • progressive mitral valve disease and/or aortic valve disease
  • major cause of death in pregnancy ; cardiac surgery
20
Q

Endocarditis pathogens

A
  • streptococcus viridans
  • staphylococus aureus ( most aggressive)
  • can be diseased/normal beforehand
21
Q

State indications for surgery in endocarditis

A
  • if severe valvular regurgitation
  • large vegetations
  • pyrexia(fever)
  • progressive renal failure
22
Q

Treatment of endocarditis

A

-IV for 6 weeks post operatively

23
Q

Presentation of aortic stenosis

A
  • HF, angina, syncopal episodes(faint), asymptomatic incidental finding
  • murmur easily heard
  • AVR recommended for severe AS
24
Q

Describe heart sounds of aortic stenosis vs aortic sclerosis

A

-no aortic S2 ( differentiates it from aortic sclerosis)

25
Q

Presentation of aortic regurgitation

A

-HF, angina, or asymptomatic incidental finding
-murmur difficult to hear
-the louder, more severe AR
-AVR recommended for severe especially with LV dilatiion
-

26
Q

Presentation of mitral stenosis

A
  • mumur difficult to hear. The louder, more severe
  • patient excercise in order to hear
  • surgery recommended if MVA on echo is <1.5cm2
27
Q

Presentation of mitral regurgitation

A
  • easily heard
  • severe assoc with LV and LA dilation, onset AF and pulmonary hypertension
  • MVR recommended if severe
  • if severe, on ECHO systolic BF reversal in pulmonary veins
28
Q

Explain cardiopulmonary bypass surgery

A
  • blood drained from RA and returned to ascending aorta?
  • heart and lung function taken over by CPG machine
  • induced hypothermia
  • non pulsatile flow during CPG
29
Q

Types of valves and explain difference

A

Biological valve
-no warfarin required but wears out > 15 yrs

Mechanical valve
-warfarin required for life. Valve lasts for >40yrs

-Sometimes repair>replacement for mitral valve once complete valve competence is restored,

30
Q

What is coronary angioplasty? Compare benefits/limitations of this and CABG

A
  • alternative to CABG
  • procedure that widens arteries
  • a small catheter with balloon attached at end(deflated) and reaches narrowed artery (guided by Xray). Balloon is inflated to push artery open and a stent(metal tube) is inserted to help keep artery open.
  • less invasive to CABPG but higher chance it needs to be repeated. Not used when multiple coronary arteries is blocked / abnormal vessel structure surrounding heart abnormal

CVS pathophysiology (23 decks)

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