Ischaemic Heart Disease and Valvular Heart Disease – The Cardiac Surgeon’s approach

Question 1

What is the causes of ischaemic heart disease

Answer 1

Atherosclerosis
Embolism
Coronary thrombosis
Aortic dissection (tear allows blood to leak in)
Arteritis
Congenital

Question 2

What is the possible manifestations of ischaemic heart disease

Answer 2

Angina
MI
Arrythmias
Chronic heart failure
Sudden death

Question 3

What are two examples of dangerous pattens to CAD that require surgery intervention

Answer 3

Left main stem stenosis

3 vessel coronary artery disease

Question 4

What is the selection critique for coronary by pass grafting

Answer 4

Adequate lung function
Adequate mental function
Adequate hepatic function
Ascending aorta OK
Distal coronary targets OK
LV EF > 20%

Question 5

What is the three different conduits used for CABG

Answer 5

Reversed saphenous vein
Internal mammary arteries
Radial arteries

Question 6

Why is the saphenous vein reversed

Answer 6

so the valves are facing the right ways to allow blood flow to not flow back from the heart

Question 7

What is the possible post operative problems in cardiac surgery

Answer 7

Cardiac Tamponade
Death
Stroke

Question 8

What is cardiac tamponade

Answer 8

Excessive collection of blood in the pericardial sac that is under pressure and prevent the filling stages of the heart

Question 9

What is the primary features of cardiac tamponade

Answer 9

Raised Central venous pressure,
raised heart rate,
low BP

Question 10

What is the secondary features of cardiac tamponade

Answer 10

Oliguria - abnormally small amounts of urine
increased oxygen requirements,
metabolic acidosis

Question 11

What is the treatment of cardiac tamponade

Answer 11

chest re-opening and drain

Question 12

What is the difference between adult and paediatric cardiac surgery on heart valves

Answer 12

Adult is mainly aortic and mitral valve surgery where

Paediatric Cardiac Surgery is all four heart valves operated with roughly equal frequency

Question 13

What is the causes of valvular heart disease

Answer 13

Degenerative
Congenital
Infective
Inflammatory 
LV or RV dilatation
Trauma
Neoplastic 
Paraneoplastic

Question 14

What is the main cause of valvular heart disease

Answer 14

Degenerative

Question 15

What affect does degenerative have on the aortic valves

Answer 15

Causes aortic valve stenosis due to calcification

Question 16

What affect does degenerative have on mitral valves

Answer 16

Causes mitral regurgitation possible due to a force on the chordae tendae resulting in them snapping

Question 17

What is an example of a congenital heart valve problem

Answer 17

Bicuspid valve of the aortic

Question 18

What is examples of three common valve problems requiring cardiac surgery

Answer 18

Senile Tricuspid Aortic Stenosis
Bicuspid Aortic Stenosis

Degenerative Mitral Regurgitation

Question 19

What is examples of infections resulting in heart valve problems

Answer 19

Rheumatic heart disease

Endocarditis

Question 20

Rheumatic heart disease is a relapsing illness causes by what type of infection

Answer 20

streptococcal infections

Question 21

What is the blood test to measure rheumatic heart disease antibodys against strep

Answer 21

ASO titre

Question 22

What is rheumatic heart disease treated with

Answer 22

Aspirin and bed rest

Question 23

What bacterial infection results in acute endocarditis

Answer 23

Staph aureus the second commonest organism – gives rise to acute bacterial endocarditis

Question 24

What bacterial infection results in subacute endocarditis

Answer 24

Strep viridans the commonest organism – gives rise to subacute bacterial endocarditis

Question 25

What infection in endocarditis has a much higher cure rate with anitibiotics treatment alone

Answer 25

Native vascular endocarditis - strep. viridans in subacute endocarditis (90%)

Question 26

What endocarditis infection needs immediate treatment

Answer 26

acute endocarditis

Question 27

What is the indications for surgery in endocarditis

Answer 27

Severe valvular regurgitation Large vegetations Persistent pyrexia Progressive renal failure

Question 28

What is the treatment plan post operative endocarditis

Answer 28

Antibiotics are given IV for 6 weeks

Question 29

What is the recommended for severe aortic stenosis/regurgitation

Answer 29

aortic valve replacement

Question 30

What is the process Cardiopulmonary Bypass and what does this allow

Answer 30

Blood drained from the RA and returned to the ascending aorta allowing Heart and lung function taken over by CPB machine

Question 31

What medical intervention is needed during Cardiopulmonary Bypass

Answer 31

Systemic anticoagulation

Question 32

What can Cardiopulmonary Bypass induce

Answer 32

Hypothermia

Question 33

What is the flow like in Cardiopulmonary Bypass

Answer 33

Non-pulsatile

Question 34

What is a common problem in cardiopulmonary bypass

Answer 34

Coagulopathy - a condition in which the blood's ability to clot is impaired. This condition can cause prolonged or excessive bleeding

Question 35

In what kind of cardiac surgery procedures is air embolism more likely to occur

Answer 35

valve replacement than in closed cardiac operations such as CABG

Question 36

What is two types of valves used in valvular replacement

Answer 36

Biological | Mechanical

Question 37

What is the advantage and disadvantage to biological valve replacement

Answer 37

Adv- Don't have to take warfarin | Dis - Wears out after 15 years

Question 38

What is the advantage and disadvantage to mechanical valve replacement

Answer 38

Adv- Last for over 40 years | Dis - have to take warfarin

Question 39

What is the best treatment for mitral valve

Answer 39

repair is better than replacement