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Systems: Cardiovascualar AB > Valvular+ IHD- Therapy > Flashcards

Valvular+ IHD- Therapy Flashcards

1
Q

What are the causes of cardiac ischaemia?

A
  • Atherosclerosis
  • Embolism
  • Coronary thrombosis
  • Aortic dissection
  • Arteritides
  • Congenital
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2
Q

What is arteritides?

A

Inflammation of the arteries

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3
Q

How can IHD manifest itself?

A
  • Angina
  • MI
  • Arrhythmias
  • Chronic Heart Failure
  • Sudden death
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4
Q

What are the 2 major dangerous patterns of coronary artery disease?

A
  • Left main stem stenosis

- 3 vessel coronary artery disease

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5
Q

What are the indications for CABG?

A
  • Symptomatic (any CAD pattern)

- Prognostic (LMSS, 3VDx)

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6
Q

What is the criteria for selection of patients for CABG?

A
  • Adequate lung function
  • Adequate mental function
  • Adequate hepatic function
  • Ascending aorta OK
  • Distal coronary targets OK
  • LV EF>20%
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7
Q

What are the conduits for CABG?

A
  • Reversed saphenous vein
  • Internal mammary arteries
  • Radial arteries
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8
Q

What problems may arise related to sternotomy?

A
  • Wire infection
  • Painful wires
  • Sternal dehiscence
  • Sternal malunion
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9
Q

What post-op problems are there in cardiac surgery?

A
  • Cardiac tamponade
  • Stroke
  • Death
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10
Q

What are the primary features of cardiac tamponade following cardiac surgery?

A
  • Raised CVP
  • Raised HR
  • Low BP
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11
Q

What are the secondary features of cardiac tamponade following cardiac surgery?

A
  • Oliguria
  • Increased oxygen requirements
  • Metabolic acidosis
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12
Q

What is the treatment for cardiac tamponade after cardiac surgery?

A

Chest re-opening

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13
Q

What are the long term outcomes post CABG?

A
  • 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
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14
Q

What are the main surgeries carried out on adults fro valvular heart disease?

A

Aortic and mitral valve surgery

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15
Q

What are the main paediatric surgeries carried out for valvular heart disease?

A

All 4 heart valves operated with roughly equal frequency

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16
Q

What causes of valvular heart disease in adults are there?

A
  • Degenerative
  • Congenital
  • Infective
  • Inflammatory
  • LV or RV dilatation
  • Trauma
  • Neoplastic
  • Paraneoplastic
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17
Q

What are the 3 most common valve problems requiring cardiac surgery in Aberdeen?

A
  • Senile tricuspid AS
  • Bicuspid AS
  • Degenerative MR
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18
Q

What is rheumatic fever?

A

A relapsing illness related to streptococcal infections

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19
Q

What is the hallmark pathology of rheumatic fever?

A

Pancarditis

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20
Q

What other manifestations are usual with rheumatic fever?

A
  • Skin
  • Joint
  • Sydenham’s chorea/ St Vitus’ Dance
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21
Q

How is rheumatic fever treated?

A

Aspirin and bed rest

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22
Q

What investigation is used in the diagnosis of rheumatic fever?

A

ASO titre

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23
Q

What odes chronic rheumatic heart disease lead to?

A

Gradually progressive mitral valve disease with/without aortic valve disease

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24
Q

What is the most common organism responsible for endocarditis?

A

Strep viridans

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25
Q

What is the second most common organism responsible for endocarditis?

A

Staph aureus

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26
Q

What type of endocarditis does strep viridans give rise to?

A

Sub-acute bacterial endocarditis

27
Q

What type of endocarditis does staph aureus give rise to?

A

Acute bacterial endocarditis

28
Q

What is the prognosis for natural valve endocarditis?

A

90% chance of cure with antibiotics alone

29
Q

What is the prognosis for prosthetic valve endocarditis?

A

50% chance of cure with antibiotics alone

30
Q

How does the chances of cure for endocarditis vary dependent on the organism it is caused by?

A

Chances of cure are much higher with strep viridans than with staph aureus

31
Q

What are the indication for surgery for endocarditis?

A
  • Severe valvular regurgitation
  • Large vegetations
  • Persistent pyrexia
  • Progressive renal failure
32
Q

How long are antibiotic given for endocarditis post-operatively?

A

IV for 6 weeks

33
Q

How does aortic stenosis typically present?

A

Typically presents as:

  • Heart failure
  • Syncopal episodes
  • Angina
  • Asymptomatic incidental finding
34
Q

What is usually easily heard with aortic stenosis?

A

Murmur

35
Q

How is aortic stenosis differentiated from aortic sclerosis?

A

Loss of aortic S2

36
Q

How is LVH indicated on an ECG/ECHO?

A

AV gradient > 50mmHg

37
Q

What is recommended for severe AS?

A

AVR

38
Q

How does aortic regurgitation typically present?

A
  • Heart failure
  • Angina
  • Asymptomatic incidental finding
39
Q

What does the murmur tell us about AR?

A
  • Usually difficult to hear

- The louder the murmur the more severe the AR

40
Q

What is recommended for severe AR?

A

AVR especially when there is LV dilatation

41
Q

What happens in severe AR during aortography?

A

The entire LV is filled with contrast after one diastolic interval

42
Q

What does the murmur tell us about mitral stenosis?

A
  • Murmur is usually difficult to hear
  • If easily heard then the stenosis is severe
  • May have toe exercise the patient to hear the murmur
43
Q

Other than murmur, what may be present on auscultation of mitral stenosis?

A

Presystolic accentuation

44
Q

When is surgery recommended for mitral stenosis?

A

If MVA on ECHO is <1.5cm2

45
Q

What does the murmur tell us about mitral regurgitation?

A
  • Murmur is usually easy to hear

- If murmur is loud, MR is usually severe

46
Q

What is severe MR associated with?

A

LV and LA dilatation, onset of AF and pulmonary hypertension

47
Q

What is recommended on the basis of severe MR being present?

A

MVR

48
Q

What is severe MR on ECHO characterised by?

A

Systolic blood flow reversal in the pulmonary veins

49
Q

How is cardiopulmonary bypass performed?

A

Blood drained from the RA and returned to the ascending aorta

50
Q

What is necessary with cardiopulmonary bypass?

A

Systemic anticoagulation

51
Q

What is induced during cardiopulmonary bypass?

A

Hypothermia

52
Q

What kind of flow is there during CPB?

A

Non-pulsatile flow

53
Q

What is the maximum time limit for CPB?

A

12 hours

54
Q

What is the maximum cardiac ischaemic time?

A

6 hours

55
Q

Who operates the CPB machine?

A

Perfusionists

56
Q

What is a common problem in CPB?

A

Coagulopathy

57
Q

What is more common in open cardiac procedures than in closed cardiac surgeries?

A

Air embolism

58
Q

What are the 2 kinds of heart valve?

A
  • Biological

- Mechanical

59
Q

What is the advantage of the biological valve?

A

No warfarin required

60
Q

What is the disadvantage of the biological valve?

A

It wears out after 15 years

61
Q

What is the advantage of the mechanical valve?

A

Valve last >40 years

62
Q

What is the disadvantage of the mechanical valve?

A

Warfarin required for life

63
Q

When is mitral valve repair possible?

A

In many cases of degenerative MR

Systems: Cardiovascualar AB (42 decks)

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