Vulvular Heart Disease Surgery Flashcards

1
Q

name some causes of cardiac ischemia

A
> atherosclerosis
> embolism
> coronary thrombosis
> aortic dissection
> arteritides: inflammation of the arteries
> congenital problems
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2
Q

how does ischemic heart disease manifest?

A
> angina
> myocardial infarction
> arrhythmias
> chronic heart failure
> sudden death
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3
Q

what should you look for when selecting patients for coronary artery bypass?

A
> adequate lung function
> adequate mental health
> adequate hepatic function
> ascending aorta is okay
> distal coronary targets are okay
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4
Q

what are the conduits for coronary artery bypass graft?

A

> reversed saphenous vein
internal mammary arteries
radial arteries

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5
Q

what problems can arise due to sternotomy?

A

> wire infection
painful wires
sternal dehiscence
sternal malunion

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6
Q

what is sternal dehiscence?

A

when the wires from a sternotomy cuts through the sternum bone, due to osteoporosis

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7
Q

what can infection under the heart lead to?

A

sudden cardiac death

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8
Q

what cardiac problems can arise post op?

A

> cardiac tamponade ( abnormal pressure in the heart)
death
stroke

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9
Q

what are the primary features of cardiac tamponade?

A

> raised cardiac venous pressure?
raised heart rate
low blood pressure

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10
Q

what are the secondary feature of cardiac tamponade?

A

> oliguria
increased oxygen requirements
metabolic acidosis

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11
Q

how would you treat cardiac tamponade?

A

re-open the chest and wash out the pericardium, stopping the bleeding

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12
Q

what are the long term outcomes of post coronary artery bypass?

A

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.

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13
Q

what is the function of the cordiea tendinea?

A

they stop the leaflets from blowing back into the atrium

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14
Q

name some causes of valvular heart disease?

A
> degenerative
> congenital
> infective (endocarditis)
> inflammatory
> lv/rv dilatation
> trauma
> neoplastic
> paraneoplastic
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15
Q

what is rheumatic fever?

A

this is a relapsing illness related to a streptococcal infection and it’s a hallmark pathology is pancarditis.

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16
Q

how is rheumatic fever treated?

A

with aspirin and bed rest

17
Q

what is the main reason cardiac surgery is undertaken in pregnancy?

A

chronic rheumatic heart disease

18
Q

what organism gives rise to sub-acute endocarditis?

A

strep viridens

19
Q

what organism gives rise to acute endocarditis?

A

staph aureus

20
Q

what is the chance that native heart valve endocarditis can be treated by antibiotics alone?

21
Q

why is it less likely that prosthetic endocarditis less likely to be cured by antibiotics alone?

A

the prosthetic valve gives a sanctuary site for the bacteria where the antibiotics cannot diffuse through

22
Q

what indicates surgery is needed for endocarditis?

A

> severe valvular regurgitation
large vegetations
persistent pyrexia
progressive renal failure

23
Q

what is the post operative treatment for endocarditis?

A

antibiotics given intravenously for 6 weeks

24
Q

what would an aortic stenosis be replaced with in older patient?

A

an animal valve, these can wear out but the patient does not need to be on warfirin

25
what would an audible mitral stenosis indicate about the condition?
that it is severe, the patient may need to be exercised to make it loud enough
26
what is severe mitral regurgitation usually associated with?
left ventricular and atrial dilatation. onset of atrial fibrillation pulmonary hypertension
27
on an ECHO what is severe mitral regurgitation associated with?
systolic blood flow reversal in the pulmonary veins
28
describe a cardiopulmonary bypass?
blood is drained from the right atrium and returned to the ascending aorta, it is passed through a CPB machine that takes over the heart and lung function. there is no pulsatile flow.
29
what is the max limit of a CPB?
12 hours
30
what problems are associated with CABG?
> coagulopathy
31
what are the cons of a biological heart valve?
they wear out in 15 years
32
what are the pros of a mechanical valve?
it lasts for over 40 years
33
what are the cons of a mechanical valve?
warfarin is required for life
34
in what cases can the mitral valve be repaired instead of replaced?
degenerative mitral regurgitation