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R-Cradio-illness > Valvular Heart Disease Therapy > Flashcards

Valvular Heart Disease Therapy Flashcards

1
Q

What are the main causes of cardiac ischaemia?

A 
Atherosclerosis
Embolism
Coronary thrombosis
Aortic dissection
Arteritides
Congenital
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2
Q

What are the commonest manifestations of ischaemic heart disease?

A 
Angina
MI 
Arrhythmia
Chronic heart failure 
Sudden death
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3
Q

What are the most dangerous patterns of coronary artery disease?

A

Left main stem stenosis

3 vessel coronary artery disease

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4
Q

What are the indications for coronary artery bypass grafting?

A

Symptomatic - any CAD pattern

Prognostic - LMSS, 3VDx

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5
Q

What is necessary in patients when selecting them for CABG?

A 
Adequate lung function
Adequate mental function
Adequate hepatic function 
Ascending aorta OK
Distal coronary targets OK
LV ejection fraction > 20%
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6
Q

What are the potential sternotomy-related problems?

A

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion

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7
Q

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

A

Cardiac tamponade
Stroke
Death

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8
Q

What are the features of cardiac tamponade following cardiac surgery?

A

Primary

  • Raised CVP
  • Raised HR
  • Low BP

Secondary

  • Oliguria
  • Increased oxygen requirement
  • Metabolic acidosis
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9
Q

What is the treatment of cardiac tamponade following cardiac surgery?

A

Chest re-opening

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10
Q

What are the long term outcomes post-CABG?

A

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

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11
Q

What are the possible conduits used in CABG?

A

Reversed saphenous vein
Internal mammary arteries
Radial arteries

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12
Q

How does cardiopulmonary bypass work?

A

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

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13
Q

What is the maximum time limit of CPB?

A

12 hours

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14
Q

What is the maximum cardiac ischaemia time in CPB?

A

6 hours

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15
Q

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

A 
Degenerative
Congenital
Infective
Inflammatory 
LV or RV dilatation
Trauma
Neoplastic
Paraneoplastic
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16
Q

What is the typical presentation of aortic stenosis?

A 
Heart failure
Angina
Syncopal episodes
Or as an asymptomatic finding 
Murmur usually easily heart
17
Q

When is aortic valve replacement recommended in aortic stenosis?

A

In severe AS

18
Q

What differentiates aortic stenosis from aortic sclerosis?

A

Loss of aortic S2

19
Q

What is the typical presentation of aortic regurgitation?

A

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

20
Q

When is aortic valve replacement recommended in aortic regurgitation?

A

In severe AR, especially with left ventricular dilatation

21
Q

What does an easily heard murmur suggest in mitral stenosis?

A

That stenosis is severe

22
Q

When is surgery recommended in mitral stenosis?

A

If MVA on echo is < 1.52cm

23
Q

What does a loud murmur suggest in mitral regurgitation?

A

Severe MR

24
Q

What is severe mitral regurgitation associated with?

A

LV and LA dilatation
Onset of atrial fibrillation
Pulmonary hypertension

25
Q

When is surgery recommended in mitral regurgitation?

A

On basis of severe mitral regurgitation being present

26
Q

What are the valve types in common use in replacement?

A

Biological

Mechanical

27
Q

What are the advantages and disadvantages of biological valves?

A

No warfarin required but valve wears out after 15 years

28
Q

What are the advantages and disadvantages of mechanical valves?

A

Warfarin required for life but valves last > 40 years

29
Q

What are the indications for surgery in infective endocarditis?

A

Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure

R-Cradio-illness (27 decks)

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