Surgical Treatment for IHD and Valve Replacement

Question 1

What causes ischaemic heart disease?

Answer 1

Atherosclerosis
Thrombosis
Embolism
Aortic dissection
Congenital

Question 2

How does IHD manifest?

Answer 2

Stable/unstable angina
MI -NSTEMI/STEMI
Sudden cardiac ceath
Chronic heart failure
Arrhythmias

Question 3

What are the most dangerous types/patterns of IHD?

Answer 3

Left main stem stenosis

3 vessel CAD - narrowing near the origin of the coronary artery cuts off supply to all branches

Question 4

When would a CABG be considered?

Answer 4

If symptomatic and the IHD symptoms get worse

If they have the dangerous patterns

Question 5

What patients are suitable for a CABG?

Answer 5

Must have adequate lung, mental and hepatic function

Health ascending aorta and distal coronary arteries

LV ejection fraction must be >20%

Question 6

What vessels are used in a CABG? How are they used?

Answer 6

Long saphenous vein taken from leg and reversed - attached to aorta and coronary artery distal to occlusion

Internal mammary arteries - left one redirected to heart away from breasts/chest wall

Radial artery - easier to remove than ulnar

Question 7

What is a sternotomy?

Answer 7

Opening of chest and sternum to get into the thoracic cavity

Question 8

Problems of a sternotomy

Answer 8

Wire infections
Painful wires

Sternal malunion - a healed fracture in a bad position

Sternal dehisence - wound rupture

Question 9

Other post op CABG issues?

Answer 9

Cardiac tamponade
Stroke
Death

Question 10

What is a cardiac tamponade?

Answer 10

Compression of the heart by an accumulation of fluid (blood) in the pericardial sac

This prevents atria filling properly

Question 11

Signs of a cardiac tamponade?

Answer 11

Raised central venous pressure, HR

Low BP

Question 12

Treatment for a cardiac tamponade?

Answer 12

Need to reopen chest

Question 13

What are the common adult valve surgeries?

Answer 13

Aortic and mitral?

Question 14

Common paeds valve surgeries?

Answer 14

All 4 valves roughly equal

Question 15

Causes of valve disease?

Answer 15

Degenerative
Congenital
Infective
Inflammatory 
LV/RV dilatation
Trauma
Neoplastic
Para-neoplastic

Question 16

What is a neoplasm?

Answer 16

New and abnormal growth of tissue

Question 17

How does AS present?

Answer 17

Heart failure
Angina
Syncopal episodes

Asymptomatic and found incidentally sometimes

Question 18

Murmur of AS?

Answer 18

Ejection systolic murmur
Easily heard
Loss of S2 differentiates it from aortic sclerosis

Question 19

What will an echo see in AS?

Answer 19

LVH

AV-pressure gradient above 50mmHg

Question 20

How does AR present?

Answer 20

Heart failure
Angina

Incidental finding

Question 21

Describe the murmur for AR

Answer 21

High pitched early diastolic murmur
Soft - difficult to hear

Louder it is more severe it is

Question 22

When is surgery recommended for MS?

Answer 22

If the MV area is less than 1.5cm^2 on an echo

Question 23

Describe the murmur of MS

Answer 23

Low rumbling diastolic murmur

Best heard on expiration

Question 24

How is severe MR seen?

Answer 24

LV and RV dilatation

Onset of A-fib and pulmonary hypertension

Question 25

What will a severe MR look like on a echo?

Answer 25

Systolic blood will be seen flowing backwards into pulmonary vein

Question 26

How does the murmur of MR sound?

Answer 26

Pan-systolic Easy to hear Louder - more severe

Question 27

How does a cardiopulmonary bypass machine work, what does it do and what's its major problem?

Answer 27

Directs blood from RA to aorta bypassing pulmonary circulation This takes over the heart and lung function Main problem is systemic anticoagulation is needed as it can cause coagulopathy

Question 28

What is the pos and neg of a bio valve?

Answer 28

No warfarin is needed Valve wears out after 15 years

Question 29

What are the pos and neg of a mechanical valve?

Answer 29

Valve lasts a good 40 years Warfarin needed for life

Question 30

Mitral Valve - is replacement or repair better?

Answer 30

Repair is better than replacement