Ischaemic HD - Surgery

Question 1

What are the major dangerous patterns of coronary artery disease?

Answer 1

IF the Left Coronary Artery is stenosed

Or if all 3 vessels have coronary artery disease.

Question 2

What 2 reasons are there for choosing surgery over ACS medical therapy?

Answer 2

Symptomatic reasoning, if the patient is very unwell and needs rapid intervention.
Prognostic intervention, if the patient has Left main stem stenosis or 3 vessel disease.

Question 3

What are the 2 types of surgical intervention?

Answer 3

Angioplasty + Stenting

or CABG

Question 4

What criteria are there for a CABG patient?

Answer 4

• Adequate Lung Function
• Adequate Mental Function
• Adequate Hepatic Function
• Ok ascending Aorta
• Ok distal coroanry targets
• LV Ejection Fraction > 20%

Question 5

What conduits can we use for CABG?

Answer 5

Reversed Saphenous Vein, Internal mamary arteries, radial arteries or synthetic

Question 6

What procedure gives access to the heart for CABG?

Answer 6

A sternotomy. Cutting through the centre of the sternum down the torso and then putting it back together with wires in the sternum.

Question 7

What problems can occur due to the sternotomy?

Answer 7

The wires can be painful or infected.
Sternal Dehiscence - The sternal wound ruptures and comes apart
Stenal malunion - The sternum heals in an awkward position, possibly with wires stickin out

Question 8

What problems can arise post-op in cardiac surgery?

Answer 8

Death
Stroke
Cardiac Tamponade (fluid accumulates in pericardial sac crushing the heart)

Question 9

What are the symptoms of cardiac tamponade?

Answer 9

Raised HR & low BP
Dyspnoea
dizziness/syncope
Weakness

Question 10

How do we treat cardiac tamponade?

Answer 10

Re-opening the chest and draining the fluid