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Flashcards in Valvular Heart Disease Therapy Deck (29)
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1

What are the main causes of cardiac ischaemia?

Atherosclerosis
Embolism
Coronary thrombosis
Aortic dissection
Arteritides
Congenital

2

What are the commonest manifestations of ischaemic heart disease?

Angina
MI
Arrhythmia
Chronic heart failure
Sudden death

3

What are the most dangerous patterns of coronary artery disease?

Left main stem stenosis
3 vessel coronary artery disease

4

What are the indications for coronary artery bypass grafting?

Symptomatic - any CAD pattern
Prognostic - LMSS, 3VDx

5

What is necessary in patients when selecting them for CABG?

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

6

What are the potential sternotomy-related problems?

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion

7

What are the major post-operative problems in cardiac surgery?

Cardiac tamponade
Stroke
Death

8

What are the features of cardiac tamponade following cardiac surgery?

Primary
- Raised CVP
- Raised HR
- Low BP

Secondary
- Oliguria
- Increased oxygen requirement
- Metabolic acidosis

9

What is the treatment of cardiac tamponade following cardiac surgery?

Chest re-opening

10

What are the long term outcomes post-CABG?

50% have no further cardiac problems in 10 years
Of the 50% who do have a problem, most are minor and easily controlled with medication
5% of patients may require a repeat CABG

11

What are the possible conduits used in CABG?

Reversed saphenous vein
Internal mammary arteries
Radial arteries

12

How does cardiopulmonary bypass work?

Blood drained from right atrium and returned to the ascending aorta
Heart and lung function taken over by CPB machine
Systemic anticoagulation necessary
Induced hypothermia

13

What is the maximum time limit of CPB?

12 hours

14

What is the maximum cardiac ischaemia time in CPB?

6 hours

15

What are the potential causes of valvular heart disease in adults?

Degenerative
Congenital
Infective
Inflammatory
LV or RV dilatation
Trauma
Neoplastic
Paraneoplastic

16

What is the typical presentation of aortic stenosis?

Heart failure
Angina
Syncopal episodes
Or as an asymptomatic finding
Murmur usually easily heart

17

When is aortic valve replacement recommended in aortic stenosis?

In severe AS

18

What differentiates aortic stenosis from aortic sclerosis?

Loss of aortic S2

19

What is the typical presentation of aortic regurgitation?

Heart failure
Angina
Or as an asymptomatic incidental finding
Louder the murmur, the more severe the regurgitation

20

When is aortic valve replacement recommended in aortic regurgitation?

In severe AR, especially with left ventricular dilatation

21

What does an easily heard murmur suggest in mitral stenosis?

That stenosis is severe

22

When is surgery recommended in mitral stenosis?

If MVA on echo is < 1.52cm

23

What does a loud murmur suggest in mitral regurgitation?

Severe MR

24

What is severe mitral regurgitation associated with?

LV and LA dilatation
Onset of atrial fibrillation
Pulmonary hypertension

25

When is surgery recommended in mitral regurgitation?

On basis of severe mitral regurgitation being present

26

What are the valve types in common use in replacement?

Biological
Mechanical

27

What are the advantages and disadvantages of biological valves?

No warfarin required but valve wears out after 15 years

28

What are the advantages and disadvantages of mechanical valves?

Warfarin required for life but valves last > 40 years

29

What are the indications for surgery in infective endocarditis?

Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure