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Cardiovascular System > Valvular (& Ischaemic) Heart Disease - Treatment > Flashcards

Valvular (& Ischaemic) Heart Disease - Treatment Flashcards

1
Q

What is a commissure of a heart valve?

A

the places where the cusps of the valves meet

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2
Q

Name some conditions that cause cardiac ischaemia.

6

A 
atherosclerosis
embolism
coronary thrombosis
aortic dissection
arteritides
congenital defects
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3
Q

What is aortic dissection?

A

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

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4
Q

What are the manifestations of ischaemic heart diseases?

5

A 
angina
MI
arrythmias
chronic heart failure (inability to pump enough blood)
sudden death
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5
Q

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

A

left main stem stenosis

3-vessel CAD

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6
Q

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

(2)

A
  • symptomatic (any CAD pattern)

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

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7
Q

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

(6)

A
  • adequate lung function
  • adequate mental function
  • adequate hepatic function
  • ascending aorta OK
  • distal coronary targets OK
  • LV ejection fraction > 20 %
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8
Q

What are the potential conduits used for CABG?

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

(3)

A
  • reversed saphenous vein
  • internal mammary arteries
  • radial arteries
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9
Q

What is a sternotomy?

A
  • the “cracking” of the chest

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

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10
Q

What are the sternotomy related problems?

4

A

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion

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11
Q

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

(3)

A

Cardiac Tamponade
Death
Stroke

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12
Q

What is cardiac tamponade?

2

A
  • clinical syndrome caused by the accumulation of fluid in the pericardial space.
  • resulting in reduced ventricular filling and subsequent hemodynamic compromise.
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13
Q

What are the complications of cardiac tamponade?

3

A
  • pulmonary oedema
  • shock/cardiac arrest
  • death
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14
Q

What are the primary features of cardiac tamponade?

3

A

Raised CVP
Tachycardia
Hypotension

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15
Q

What are the secondary features of cardiac tamponade?

3

A

Oliguria (low urine output)
Increased O2 requirements
Metabolic acidosis

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16
Q

What is the required intervention for cardiac tamponade?

A

chest re-opening

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17
Q

What are the valves most commonly operated on in adults?

A

aortic and mitral valves

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18
Q

Which valves of the heart are operated on in children?

A

all four, equal frequency

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19
Q

What does the aortic root consist of?

3

A
  • sinuses of valsalva (aortic sinuses)
  • aortic valve
  • annulus of aorta
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20
Q

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

(2)

A
  • papillary muscle infarction

- snapping of chordae tendinae

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21
Q

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

(8)

A
  • degenerative
  • congenital
  • infective
  • inflammatory
  • LV or RV dilatation
  • trauma
  • neoplastic
  • paraneoplastic
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22
Q

What are the three most common valve problems in Aberdeen?

A
  • senile tricuspid aortic stenosis
  • bicuspid aortic stenosis
  • degenerative mitral regurgitation
23
Q

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

A

ASO titre

Anti-streptolysin O titre

24
Q

What does the ASO titre test measure?

A

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

25
Q

What is the treatment for rheumatic fever?

2

A

aspirin

bed rest

26
Q

What are the symptoms of rheumatic fever?

3

A
  • arthritis
  • erythema marginatum
  • sydenham’s chorea
27
Q

What is pancarditis?

A

inflammation of the entire heart.

28
Q

Which organism gives rise to subacute bacterial endocarditis?

A

strep. viridans

29
Q

Which organism gives rise to acute bacterial endocarditis?

A

staph. aureus

30
Q

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

A

strep. viridans

31
Q

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

A

NVE (90% chance compared to 50%)

32
Q

What are the indications for surgery in endocarditis?

4

A
  • severe valvular regurgitation
  • large vegetations
  • persistent pyrexia
  • progressive renal failure
33
Q

What is given after surgery to treat infective endocarditis?

A

antibiotics IV for 6 weeks

34
Q

What is the typical presentation for aortic stenosis?

4

A
  • heart failure
  • angina
  • syncopal episodes
  • or asymptomatic incidental finding
35
Q

How are the heart sounds interpreted in aortic stenosis?

A
  • easily identifiable

- systolic crescendo-decrescendo murmur

36
Q

What is the difference between aortic sclerosis and aortic stenosis?

(2)

A
  • aortic sclerosis is a less severe form of aortic stenosis.

- in aortic stenosis there is loss of S2 but not in sclerosis.

37
Q

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

2

A
  • LVH

- AV gradient > 55mmHg

38
Q

What is the recommended treatment for severe aortic stenosis?

A

aortic valve replacement

39
Q

What is the typical presentation of aortic regurgitation?

3

A
  • heart failure
  • angina
  • or asymptomatic incidental finding
40
Q

How are the heart sounds interpreted in aortic regurgitation?

(2)

A
  • murmur is usually difficult to hear

- the louder the murmur the more severe the AR

41
Q

What is the recommended treatment for aortic regurgitation?

Especially in what situation?

A

aortic valve replacement, especially with LV dilatation.

42
Q

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

(2)

A
  • Murmur is usually difficult to hear

- If easily heard then the stenosis is severe

43
Q

When is surgery recommended in mitral stenosis?

A

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

44
Q

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

(2)

A
  • Murmur is usually easy to hear

- If murmur is loud, MR is usually severe

45
Q

What is the severe mitral regurgitation associated with?

3

A
  • LV and LA dilatation
  • onset of atrial fibrillation
  • pulmonary hypertension
46
Q

What is the treatment for severe mitral regurgitation?

A

mitral valve regurgitation

47
Q

How does severe mitral regurgitation appear on an ECHO?

A

systolic blood flow reversal in the pulmonary veins

48
Q

What is the function of a cardiopulmonary bypass machine?

A

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

49
Q

What must be induced in the patient during bypass surgery?

2

A
  • hypothermia

- anticoagulation

50
Q

What is a complication of open heart surgery?

A

air embolism

51
Q

What is another complication to bypass surgery?

A

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

52
Q

What are the pros and cons of a biological valve?

A

+ no warfarin required

  • only lasts 15 years
53
Q

What are the pros and cons of a mechanical valve?

A

+ lasts >40 years

  • warfarin required for life
54
Q

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

A

mitral valve repair

Cardiovascular System (37 decks)

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