What is cardiac tamponade? 2

- clinical syndrome caused by the accumulation of fluid in the pericardial space. - resulting in reduced ventricular filling and subsequent hemodynamic compromise.

What does the aortic root consist of? 3

- sinuses of valsalva (aortic sinuses) - aortic valve - annulus of aorta

Valvular (& Ischaemic) Heart Disease - Treatment Flashcards by Liam McCreadie

What is a commissure of a heart valve?

the places where the cusps of the valves meet

How well did you know this?

Not at all

Perfectly

Name some conditions that cause cardiac ischaemia.

atherosclerosis
embolism
coronary thrombosis
aortic dissection
arteritides
congenital defects

How well did you know this?

Not at all

Perfectly

What is aortic dissection?

The t. intima and t. media of the aorta are ripped apart and blood enters the space.

How well did you know this?

Not at all

Perfectly

What are the manifestations of ischaemic heart diseases?

angina
MI
arrythmias
chronic heart failure (inability to pump enough blood)
sudden death

How well did you know this?

Not at all

Perfectly

What are the two dangerous patterns of coronary artery disease (CAD) i.e. which arteries are blocked?

left main stem stenosis

3-vessel CAD

How well did you know this?

Not at all

Perfectly

What are the indications for Coronary Artery Bypass Grafting (CABG)?

(2)

symptomatic (any CAD pattern)

- prognostic (left main stem stenosis, 3-vessel CAD)

How well did you know this?

Not at all

Perfectly

what are requirements for patients to be able to undergo CABG?

(6)

adequate lung function
adequate mental function
adequate hepatic function
ascending aorta OK
distal coronary targets OK
LV ejection fraction > 20 %

How well did you know this?

Not at all

Perfectly

What are the potential conduits used for CABG?

i.e. which vessels are grafted for the by-pass

(3)

reversed saphenous vein
internal mammary arteries
radial arteries

How well did you know this?

Not at all

Perfectly

What is a sternotomy?

the “cracking” of the chest

- dividing the sternum in order to access the internal organs during surgery e.g. open heart surgery

How well did you know this?

Not at all

Perfectly

What are the sternotomy related problems?

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion

How well did you know this?

Not at all

Perfectly

What are the post-op complications associated with cardiac surgery?

(3)

Cardiac Tamponade
Death
Stroke

How well did you know this?

Not at all

Perfectly

What is cardiac tamponade?

clinical syndrome caused by the accumulation of fluid in the pericardial space.
resulting in reduced ventricular filling and subsequent hemodynamic compromise.

How well did you know this?

Not at all

Perfectly

What are the complications of cardiac tamponade?

pulmonary oedema
shock/cardiac arrest
death

How well did you know this?

Not at all

Perfectly

What are the primary features of cardiac tamponade?

Raised CVP
Tachycardia
Hypotension

How well did you know this?

Not at all

Perfectly

What are the secondary features of cardiac tamponade?

Oliguria (low urine output)
Increased O2 requirements
Metabolic acidosis

How well did you know this?

Not at all

Perfectly

What is the required intervention for cardiac tamponade?

chest re-opening

How well did you know this?

Not at all

Perfectly

What are the valves most commonly operated on in adults?

aortic and mitral valves

How well did you know this?

Not at all

Perfectly

Which valves of the heart are operated on in children?

all four, equal frequency

How well did you know this?

Not at all

Perfectly

What does the aortic root consist of?

sinuses of valsalva (aortic sinuses)
aortic valve
annulus of aorta

How well did you know this?

Not at all

Perfectly

What can cause severe mitral regurgitation, where one of the cusps of the valve is inverted?

(2)

papillary muscle infarction

- snapping of chordae tendinae

How well did you know this?

Not at all

Perfectly

What are the general causes of valvular heart disease in adults?

(8)

degenerative
congenital
infective
inflammatory
LV or RV dilatation
trauma
neoplastic
paraneoplastic

How well did you know this?

Not at all

Perfectly

What are the three most common valve problems in Aberdeen?

senile tricuspid aortic stenosis
bicuspid aortic stenosis
degenerative mitral regurgitation

What is the name of the test used when indicating recent rheumatic fever?

ASO titre

Anti-streptolysin O titre

What does the ASO titre test measure?

Levels of ASO in the blood (an antibody produced against streptococcus bacteria)

What is the treatment for rheumatic fever? | 2

aspirin | bed rest

What are the symptoms of rheumatic fever? | 3

- arthritis - erythema marginatum - sydenham's chorea

What is pancarditis?

inflammation of the entire heart.

Which organism gives rise to subacute bacterial endocarditis?

strep. viridans

Which organism gives rise to acute bacterial endocarditis?

staph. aureus

Is endocarditis causes staph. aureas or strep. viridans more likely to be cured?

strep. viridans

Is there a greater chance of curing native valve endocarditis or prosthetic valve endocarditis?

NVE (90% chance compared to 50%)

What are the indications for surgery in endocarditis? | 4

- severe valvular regurgitation - large vegetations - persistent pyrexia - progressive renal failure

What is given after surgery to treat infective endocarditis?

antibiotics IV for 6 weeks

What is the typical presentation for aortic stenosis? | 4

- heart failure - angina - syncopal episodes - or asymptomatic incidental finding

How are the heart sounds interpreted in aortic stenosis?

- easily identifiable | - systolic crescendo-decrescendo murmur

What is the difference between aortic sclerosis and aortic stenosis? (2)

- aortic sclerosis is a less severe form of aortic stenosis. | - in aortic stenosis there is loss of S2 but not in sclerosis.

What does an ECG/Echo show up as with aortic stenosis? | 2

- LVH | - AV gradient > 55mmHg

What is the recommended treatment for severe aortic stenosis?

aortic valve replacement

What is the typical presentation of aortic regurgitation? | 3

- heart failure - angina - or asymptomatic incidental finding

How are the heart sounds interpreted in aortic regurgitation? (2)

- murmur is usually difficult to hear | - the louder the murmur the more severe the AR

What is the recommended treatment for aortic regurgitation? Especially in what situation?

aortic valve replacement, especially with LV dilatation.

How are the heart sounds interpreted in mitral stenosis (MS)? (2)

- Murmur is usually difficult to hear | - If easily heard then the stenosis is severe

When is surgery recommended in mitral stenosis?

if mitral valve area (MVA) on ECHO is < 1.5cm2

How are the heart sounds interpreted in mitral regurgitation (MR)? (2)

- Murmur is usually easy to hear | - If murmur is loud, MR is usually severe

What is the severe mitral regurgitation associated with? | 3

- LV and LA dilatation - onset of atrial fibrillation - pulmonary hypertension

What is the treatment for severe mitral regurgitation?

mitral valve regurgitation

How does severe mitral regurgitation appear on an ECHO?

systolic blood flow reversal in the pulmonary veins

What is the function of a cardiopulmonary bypass machine?

takes over the function of the heart and lung during heart surgery.

What must be induced in the patient during bypass surgery? | 2

- hypothermia | - anticoagulation

What is a complication of open heart surgery?

air embolism

What is another complication to bypass surgery?

coagulopathy (bleeding disorder, blood doesn't clot effectively)

What are the pros and cons of a biological valve?

+ no warfarin required - only lasts 15 years

What are the pros and cons of a mechanical valve?

+ lasts >40 years - warfarin required for life

What other surgical procedure apart from mitral valve replacement is available to perform on the mitral valve?

mitral valve repair