Valvular (& Ischaemic) Heart Disease - Treatment Flashcards
What is a commissure of a heart valve?
the places where the cusps of the valves meet
Name some conditions that cause cardiac ischaemia.
6
atherosclerosis embolism coronary thrombosis aortic dissection arteritides congenital defects
What is aortic dissection?
The t. intima and t. media of the aorta are ripped apart and blood enters the space.
What are the manifestations of ischaemic heart diseases?
5
angina MI arrythmias chronic heart failure (inability to pump enough blood) sudden death
What are the two dangerous patterns of coronary artery disease (CAD) i.e. which arteries are blocked?
left main stem stenosis
3-vessel CAD
What are the indications for Coronary Artery Bypass Grafting (CABG)?
(2)
- symptomatic (any CAD pattern)
- prognostic (left main stem stenosis, 3-vessel CAD)
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 %
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
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
What are the sternotomy related problems?
4
Wire infection
Painful wires
Sternal dehiscence
Sternal malunion
What are the post-op complications associated with cardiac surgery?
(3)
Cardiac Tamponade
Death
Stroke
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 are the complications of cardiac tamponade?
3
- pulmonary oedema
- shock/cardiac arrest
- death
What are the primary features of cardiac tamponade?
3
Raised CVP
Tachycardia
Hypotension
What are the secondary features of cardiac tamponade?
3
Oliguria (low urine output)
Increased O2 requirements
Metabolic acidosis
What is the required intervention for cardiac tamponade?
chest re-opening
What are the valves most commonly operated on in adults?
aortic and mitral valves
Which valves of the heart are operated on in children?
all four, equal frequency
What does the aortic root consist of?
3
- sinuses of valsalva (aortic sinuses)
- aortic valve
- annulus of aorta
What can cause severe mitral regurgitation, where one of the cusps of the valve is inverted?
(2)
- papillary muscle infarction
- snapping of chordae tendinae
What are the general causes of valvular heart disease in adults?
(8)
- degenerative
- congenital
- infective
- inflammatory
- LV or RV dilatation
- trauma
- neoplastic
- paraneoplastic
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
