Vulvular Heart Disease Surgery Flashcards
name some causes of cardiac ischemia
> atherosclerosis > embolism > coronary thrombosis > aortic dissection > arteritides: inflammation of the arteries > congenital problems
how does ischemic heart disease manifest?
> angina > myocardial infarction > arrhythmias > chronic heart failure > sudden death
what should you look for when selecting patients for coronary artery bypass?
> adequate lung function > adequate mental health > adequate hepatic function > ascending aorta is okay > distal coronary targets are okay
what are the conduits for coronary artery bypass graft?
> reversed saphenous vein
internal mammary arteries
radial arteries
what problems can arise due to sternotomy?
> wire infection
painful wires
sternal dehiscence
sternal malunion
what is sternal dehiscence?
when the wires from a sternotomy cuts through the sternum bone, due to osteoporosis
what can infection under the heart lead to?
sudden cardiac death
what cardiac problems can arise post op?
> cardiac tamponade ( abnormal pressure in the heart)
death
stroke
what are the primary features of cardiac tamponade?
> raised cardiac venous pressure?
raised heart rate
low blood pressure
what are the secondary feature of cardiac tamponade?
> oliguria
increased oxygen requirements
metabolic acidosis
how would you treat cardiac tamponade?
re-open the chest and wash out the pericardium, stopping the bleeding
what are the long term outcomes of post coronary artery bypass?
50% have no further cardiac outcomes 10 years later, those that do are minor and medically controlled.
5% of patients may require repeat coronary artery bypass surgery.
what is the function of the cordiea tendinea?
they stop the leaflets from blowing back into the atrium
name some causes of valvular heart disease?
> degenerative > congenital > infective (endocarditis) > inflammatory > lv/rv dilatation > trauma > neoplastic > paraneoplastic
what is rheumatic fever?
this is a relapsing illness related to a streptococcal infection and it’s a hallmark pathology is pancarditis.
how is rheumatic fever treated?
with aspirin and bed rest
what is the main reason cardiac surgery is undertaken in pregnancy?
chronic rheumatic heart disease
what organism gives rise to sub-acute endocarditis?
strep viridens
what organism gives rise to acute endocarditis?
staph aureus
what is the chance that native heart valve endocarditis can be treated by antibiotics alone?
90%
why is it less likely that prosthetic endocarditis less likely to be cured by antibiotics alone?
the prosthetic valve gives a sanctuary site for the bacteria where the antibiotics cannot diffuse through
what indicates surgery is needed for endocarditis?
> severe valvular regurgitation
large vegetations
persistent pyrexia
progressive renal failure
what is the post operative treatment for endocarditis?
antibiotics given intravenously for 6 weeks
what would an aortic stenosis be replaced with in older patient?
an animal valve, these can wear out but the patient does not need to be on warfirin
