Cardiac Surgery - Josh Corwin



Cardiac Surgery

I. Ischemic Heart Disease- perfusion demand deficit or mismatch. The heart is an end organ that perfuses the entire body with blood as well as itself. 80% of blood flow to the heart itself occurs during diastole.

a. Causes of ischemic heart disease

i. Atherosclerotic cardiovascular disease

ii. Valvular heart disease

iii. Vasculitis

iv. Congenital coronary anomalies

v. Dissection of the Thoracic aorta

vi. Myocardial ischemia- very important to give aspirin for this reason

II. Common Symptoms and Signs of Ischemic Heart Disease

a. Respiratory changes

i. Dyspnea

ii. Orthopnea

iii. Paroxysmal nocturnal dyspnea

iv. SOB

b. Chest pain or discomfort

c. Palpitations

d. Fatigue

e. Presyncope

f. Syncope

g. Changes in heart rate or blood pressure

Anxiety, diaphoresis. Cyanosis or pallor may accompany any of the symptoms. Any combination is possible.

III. Diagnostic Evaluation of Ischemic Heart Disease- If the index of clinical suspicion is high. Further diagnostic studies are necessary.

a. ECG- look for changes acute and chronic

i. Acute ECG changes may include, Q waves, ST segment elevations, T wave inversions, and QT prolongation

ii. Chronic forms of ischemia may produce similar ECG findings often coexisting with persistent chest pain

b. Exercise stress testing

c. Echocardiogram- can show wall hypertrophy and chamber size

d. Left heart catheterization- dye contrast study remains the gold standard in the diagnosis of ischemic heart disease. Can help to determine if coronary artery or valvular heart disease is present.

i. Ejection fraction- dye is injected into the left ventricular cavity to evaluate left ventricular function

IV. Treatment of Ischemic Heart Disease

a. Medical management- CCB, BB, vasodilators

b. Percutaneous transluminal coronary angioplasty (PTCA)- AKA- balloon angioplasty; with or without stent placement

i. Typically performed in catheterization lab and is used more often than CABG

ii. 20-30% chance of recurrence; 1/3 reanastamosis

c. Surgical treatment- coronary artery bypass grafting (CABG)

i. Indications: include failure with medical management techniques, lab evidence of continued ischemia (ex. liver enzymes, ABG), ejection fraction ................
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