VHD Therapy Flashcards
What are the causes of cardiac ischaemia?
Atherosclerosis.
Embolism.
Coronary thrombosis.
Aortic dissection.
Congenital.
What are the manifestations of IHD?
Angina, MI, chronic HF, arrhythmias.
Sudden death.
What are the indications for CABG?
Symptomatic - CAD.
Prognostic - left main stem stenosis, or involves three vessels.
Adequate lung/mental/hepatic function.
Ascending aorta and distal coronary targets.
LVEF > 20%.
What are the problems with sternotomy?
Wire infection and pain.
Sternal dehiscence and malunion.
What are post-operation problems?
Cardiac tamponade.
Primary - raised CVP and HR, low BP.
Secondary - increased O2 requirements, metabolic acidosis.
Treatment - chest re-opening.
Stroke and death.
What are the causes of VHD surgery?
Adult cardiac surgery - mainly aortic/mitral valve.
Paediatric cardiac surgery - all four valves operated with equal frequency.
Causes - degenerative, congenital, infective, LV or RV dilatation, trauma, (para)neoplastic.
What are the most common valve problems requiring surgery?
Senile tricuspid AS.
Bicuspid AS.
Degenerative MR.
What is rheumatic fever?
A relapsing illness, related to strep infections.
Investigations - antistreptolysin O (ASO) titre.
Hallmark pathology - pancarditis.
Signs - skin and joint manifestations, Sydenham Chorea (jerky, uncontrollable movements).
Treatment - aspirin and bed rest.
What is chronic rheumatic heart disease?
Gradually progressive MVDx +/- AVDx.
The most common heart problem, a major cause of death in pregnancy.
Can be a reason for cardiac surgery during pregnancy.
What is endocarditis?
Strep viridans - subacute (higher chance of cure).
Staph aureus - acute.
Infected heart valves may have been diseased beforehand or not.
Native valve endocarditis - 90% chance of cure with antibiotics alone.
Prosthetic valve endocarditis - 50% chance of cure with antibiotics alone.
What are the indications for surgery in endocarditis?
Severe valvular regurgitation.
Large vegetations.
Persistent pyrexia.
Progressive renal failure.
Post-op - IV abx for 6wks.
What are the treatment options for VHD?
AS - AVR (if severe).
AR - AVR (if severe, especially with LV dilatation).
MS - surgery (if MVA on ECHO is <1.5cm2)
MR - MVR (if severe).
What is a cardiopulmonary bypass?
Blood drains from the RA and returned to the ascending aorta. A CPB machine takes over heart and lung function; non-pulsatile flow.
Induced hypothermia.
What are the problems of CPB?
Coagulopathy.
Air embolism (more common in open cardiac surgical procedures, such as valve replacement, compared to closed cardiac operations).
How are prosthetic heart valves chosen?
Biological - no warfarin, ~15yr lifespan.
Mechanical - warfarin, >40yr lifespan.
MV repair - possible in many cases of degenerative MR.
