Surgical intervention of Ischaemic and Valvular Heart Disease

Question 1

Ischaemia

Answer 1

Inadequate blood supply to organ or part of the body

Question 2

Ischaemic heart disease

Answer 2

Heart problems caused by narrowed coronary arteries that supply blood to heart muscle

Question 3

Aetiology of ischaemic heart disease

Answer 3

Atherosclerosis 
Embolism
Coronary thrombus
Congenital
Arteritides
Aortic dissection

Question 4

Manifestations of ischaemic heart disease

Answer 4

Angina
MI
Arrhythmia
Chronic heart failure
Sudden death

Question 5

Dangerous patterns of coronary heart disease

Answer 5

Left main stem stenosis

3 vessel coronary artery disease - proximal

Question 6

Symptomatic coronary artery bypass grafting

Answer 6

Stops symptoms but doesn’t increase life expectancy

Question 7

Prognostic coronary artery bypass grafting

Answer 7

Gets rid of angina and increase life expectancy

Question 8

Symptomatic bypass grafting is performed for which coronary artery disease patterns

Answer 8

All

Question 9

Prognostic bypass grafting is performed for which coronary artery disease patterns

Answer 9

Left main stem stenosis

3 vessel coronary artery disease

Question 10

Selection of patients for coronary artery bypass grafting depends on

Answer 10

Adequate lung, mental and hepatic function
Ascending aorta and distal coronary targets are okay
Left ventricular ejection fraction > 20%

Question 11

Conduits for coronary artery bypass grafting

Answer 11

Reversed saphenous vein
Left internal mammary arteries
Radial arteries

Question 12

Sternotomy related problems

Answer 12

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion

Question 13

Post-operation problems in cardiac surgery

Answer 13

Cardiac tamponade
Death
Stroke

Question 14

Cardiac tamponade

Answer 14

Accumulation of fluid in the pericardial space resulting in reduced filling of heart

Question 15

Primary features of cardiac tamponade

Answer 15

Raised central venous pressure
Raised heart rate
Low blood pressure

Question 16

Secondary features of cardiac tamponade

Answer 16

Oliguria (low urine)
Increased oxygen requirements
Metabolic acidosis

Question 17

Treatment of cardiac tamponade

Answer 17

Chest re-opening

Question 18

Percentage of coronary artery bypass grafting patients that have no further cardiac problems 10 years later

Answer 18

50%

Question 19

Percentage of coronary artery bypass grafting patients who may require repeat or stent

Answer 19

5-10%

Question 20

What valves are operated on in adult cardiac surgery

Answer 20

Mainly aortic and mitral

Question 21

What valves are operated on in paediatric cardiac surgery

Answer 21

All 4

Question 22

Causes of valvular heart disease in the adult

Answer 22

Degenerative
Congenital
Infective 
Inflammatory
Ventricular dilation
Trauma 
Neoplastic 
Paraneoplastic

Question 23

3 commonest valve problems requiring surgery in Aberdeen

Answer 23

Senile tricuspid aortic stenosis
Bicuspid aortic stenosis
Degenerative mitral regurgitation

Question 24

Rheumatic fever

Answer 24

Inflammatory disease that develops after a streptococcal throat infection

Question 25

Symptoms of rheumatic fever

Answer 25

Skin rashes Joint pain St Vitus' Dance

Question 26

Treatment for rheumatic fever

Answer 26

Aspirin and bed rest

Question 27

ASO titre

Answer 27

Blood test to measure antibodies against streptolysin produced by streptococcus

Question 28

Chronic rheumatic heart disease

Answer 28

Gradually progressive mitral valve disease and/or aortic valve disease

Question 29

What is the commonest heart problem worldwide

Answer 29

Chronic rheumatic heart disease

Question 30

Endocarditis

Answer 30

Infection of endocardium of heart

Question 31

Organism that gives rise to subacute bacterial endocarditis

Answer 31

Strep viridans

Question 32

Organism that gives rise to acute bacterial endocarditis

Answer 32

Staph aureus

Question 33

Indications for surgery in endocarditis

Answer 33

Severe valvular regurgitation Large vegetations Persistent pyrexia (raised body temp) Progressive renal failure

Question 34

Endocarditis post-op management

Answer 34

IV antibiotics for 6 weeks

Question 35

Surgical management for severe aortic stenosis

Answer 35

Aortic valve replacement

Question 36

Surgical management for severe aortic regurgitation

Answer 36

Aortic valve replacement

Question 37

Mitral stenosis surgery is only carried out if the size of the mitral valve annulus on ECHO is less than

Answer 37

1.5cm2

Question 38

Surgical management for mitral regurgitation

Answer 38

Mitral valve replacement for severe or repair for degenerative

Question 39

Cardiopulmonary bypass

Answer 39

Machine that takes over heart and lung function during surgery

Question 40

How does cardiopulmonary bypass work

Answer 40

Blood is drained from the right atrium and returned to the ascending aorta Also induced hypothermia

Question 41

Cardiopulmonary bypass requires

Answer 41

Systemic anticoagulation

Question 42

During cardiopulmonary bypass flow is

Answer 42

Non-pulstatile

Question 43

Max time limit for cardiopulmonary bypass

Answer 43

12 hours

Question 44

Max cardiac ischaemic time

Answer 44

6 hours

Question 45

Common problem of cardiopulmonary bypass

Answer 45

Coagulopathy

Question 46

Advantage of closed cardiac operation like coronary artery bypass grafting over open cardiac surgical procedures like valve replacement

Answer 46

Air embolisms are less common

Question 47

Biological valve

Answer 47

Lasts only 15 years but no warfarin required

Question 48

Mechanical valve

Answer 48

Lasts for over 40 years but warfarin required for life

Question 49

Warfarin

Answer 49

Anticoagulant