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Cardiovascular system SA > Ischaemic Heart Disease and Valvular Heart Disease – The Cardiac Surgeon’s approach > Flashcards

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

1
Q

What is the causes of ischaemic heart disease

A 
Atherosclerosis
Embolism
Coronary thrombosis
Aortic dissection (tear allows blood to leak in)
Arteritis
Congenital
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2
Q

What is the possible manifestations of ischaemic heart disease

A 
Angina
MI
Arrythmias
Chronic heart failure
Sudden death
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3
Q

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

A

Left main stem stenosis

3 vessel coronary artery disease

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4
Q

What is the selection critique for coronary by pass grafting

A 
Adequate lung function
Adequate mental function
Adequate hepatic function
Ascending aorta OK
Distal coronary targets OK
LV EF > 20%
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5
Q

What is the three different conduits used for CABG

A

Reversed saphenous vein
Internal mammary arteries
Radial arteries

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6
Q

Why is the saphenous vein reversed

A

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

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7
Q

What is the possible post operative problems in cardiac surgery

A

Cardiac Tamponade
Death
Stroke

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8
Q

What is cardiac tamponade

A

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

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9
Q

What is the primary features of cardiac tamponade

A

Raised Central venous pressure,
raised heart rate,
low BP

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10
Q

What is the secondary features of cardiac tamponade

A

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

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11
Q

What is the treatment of cardiac tamponade

A

chest re-opening and drain

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12
Q

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

A

Adult is mainly aortic and mitral valve surgery where

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

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13
Q

What is the causes of valvular heart disease

A 
Degenerative
Congenital
Infective
Inflammatory 
LV or RV dilatation
Trauma
Neoplastic 
Paraneoplastic
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14
Q

What is the main cause of valvular heart disease

A

Degenerative

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15
Q

What affect does degenerative have on the aortic valves

A

Causes aortic valve stenosis due to calcification

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16
Q

What affect does degenerative have on mitral valves

A

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

17
Q

What is an example of a congenital heart valve problem

A

Bicuspid valve of the aortic

18
Q

What is examples of three common valve problems requiring cardiac surgery

A

Senile Tricuspid Aortic Stenosis
Bicuspid Aortic Stenosis

Degenerative Mitral Regurgitation

19
Q

What is examples of infections resulting in heart valve problems

A

Rheumatic heart disease

Endocarditis

20
Q

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

A

streptococcal infections

21
Q

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

A

ASO titre

22
Q

What is rheumatic heart disease treated with

A

Aspirin and bed rest

23
Q

What bacterial infection results in acute endocarditis

A

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

24
Q

What bacterial infection results in subacute endocarditis

A

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

25
Q

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

A

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

26
Q

What endocarditis infection needs immediate treatment

A

acute endocarditis

27
Q

What is the indications for surgery in endocarditis

A

Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure

28
Q

What is the treatment plan post operative endocarditis

A

Antibiotics are given IV for 6 weeks

29
Q

What is the recommended for severe aortic stenosis/regurgitation

A

aortic valve replacement

30
Q

What is the process Cardiopulmonary Bypass and what does this allow

A

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

31
Q

What medical intervention is needed during Cardiopulmonary Bypass

A

Systemic anticoagulation

32
Q

What can Cardiopulmonary Bypass induce

A

Hypothermia

33
Q

What is the flow like in Cardiopulmonary Bypass

A

Non-pulsatile

34
Q

What is a common problem in cardiopulmonary bypass

A

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

35
Q

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

A

valve replacement than in closed cardiac operations such as CABG

36
Q

What is two types of valves used in valvular replacement

A

Biological

Mechanical

37
Q

What is the advantage and disadvantage to biological valve replacement

A

Adv- Don’t have to take warfarin

Dis - Wears out after 15 years

38
Q

What is the advantage and disadvantage to mechanical valve replacement

A

Adv- Last for over 40 years

Dis - have to take warfarin

39
Q

What is the best treatment for mitral valve

A

repair is better than replacement

Cardiovascular system SA (43 decks)

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