Valvular and Ischaemic Heart Disease

Question 1

Causes of cardiac ischaemia

Answer 1

Atherosclerosis 
Embolism
Coronary thrombosis
Aortic dissection
Arteritides
Congenital

Question 2

Presentation of IHD

Answer 2

Angina
MI 
Arrythmias
Chronic Heart failure
Sudden death

Question 3

Dangerous patterns of coronary artery disease

Answer 3

Left main stem stenosis

3 vessel coronary artery disease

Question 4

Causes of valvular heart disease in adults

Answer 4

Degenerative
Congenital
Infective (subacute/acute endocarditis)
Inflammatory
LV or RV dilation 
Neoplastic (abnormal growth)
Trauma
Paraneoplastic (neurological syndromes due to cancer)

Question 5

Symptoms/signs of Rheumatic fever

Answer 5

ASO titre
Pancarditis (affects all 3 layers of the heart)
Skin and joint manifestations
Syndenhams chorea/St vitus’ dance (jerky dance - very rare)
Cellulite on legs

Question 6

Surgical technique available for ischaemic heart disease

Answer 6

CABG (sternotomy)

Question 7

Indications for CABG

Answer 7

Symptomatic (any CAD pattern)

Prognostic (LMSS, 3VDx)

Question 8

Selection of patients for CABG

Answer 8

Adequate lung function
Adequate mental function
Adequate hepatic function
Ascending aorta OK
Distal coronary artery targets OK
LVEF >20%

Question 9

Conduits for CABG

Answer 9

Reversed saphenous vein
Internal mammary arteries
Radial arteries

Question 10

Sternotomy related problems

Answer 10

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion
Infection most serious as if it gets below the sternum then the heart is there

Question 11

Post-op problems in cardiac surgery

Answer 11

Cardiac tamponade
Death
Stroke

Question 12

Features of cardiac tamponade

Answer 12

Primary features: raised CVP, raised HR, low BP

Secondary features: oliguria (small amounts of urine), increased 02 requirements, metabolic acidosis

Question 13

Treatment for cardiac tamponade following cardiac surgery

Answer 13

Chest re-opening

Question 14

Indications for valve replacement

Answer 14

Severe aortic stenosis
Severe aortic regurgitation especially with LV dilatation
Mitral stenosis surgery if valve on ECHO <1.5cm3
Severe mitral regurgitation on ECHO characterised by systolic blood flow reversal in the pulmonary veins

Question 15

Types of prosthetic heart valves

Answer 15

Biological valve: No warfarin required but valve wears out after approx. 15 years
Mechanical valve: warfarin required for life but the valve will last for >40 years

Question 16

Indications for surgery in endocarditis

Answer 16

Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure
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