MEDI7302 Study Guide - Final Guide: Mediastinitis, Ergotamine, Stenosis
Cardiac surgery
Learning objectives Outline the workup and intervention options for coronary artery disease
Contrast aortic and mitral valvular heart disease including risk factors and clinical
presentation
Outline the options for heart valve replacement
Understand the fundamental indications for and types of cardiac pacemakers
Discuss the principles of access to the chest eg. median sternotomy and
thoracotomy
Understand the principles of cardiopulmonary bypass
Coronary artery
disease
Anatomy
L coronary artery -> LAD (with diagonal artery branches) and circumflex
artery
R coronary artery -> right marginal and posterior descending artery
Classification of disease distribution is single, double or triple vessel
disease relating to # of epicardial large arteries involved that can be bypassed or
stented (eg LAD< RCA), not the number of territories involved
oExample - triple bypass may only involve one territory, but 3
large arteries involved (LAD + its branches)
Clinical features
Angina (stable or unstable), myocardial infarction, heart failure, cardiac
arrhythmia, resuscitated sudden death
Investigations
CT angiogram
Coronary angiogram - gold standard
Management
Indications Failed medical control of sx
High likelihood of catastrophic event (eg infarction)
Documented reversible ischaemia or high level
coronary obstruction
Mechanical complications of infarction (eg
ventricular rupture, mitral regurgitation, ventricular septal defect)
Lytic therapy Mainstay (acute clot on established plaque)
Intervention Intra-coronary stenting and endo-vascular
procedures
oAtherectomy (remove atheroma)
oBalloon dilatation +/- stent
oDrug eluting stent (anti-metabolite on
surface of stent to prevent growth of intima into narrow segment)
Coronary bypass procedures
oTake conduit vein and attach to aorta
(proximally) and recipient artery (distally); conduit vein attached to
site distal to blockage (bypass blockage and allow continued flow
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Document Summary
Outline the workup and intervention options for coronary artery disease. Contrast aortic and mitral valvular heart disease including risk factors and clinical presentation thoracotomy. Understand the fundamental indications for and types of cardiac pacemakers. Discuss the principles of access to the chest eg. median sternotomy and. L coronary artery -> lad (with diagonal artery branches) and circumflex. R coronary artery -> right marginal and posterior descending artery. Classification of disease distribution is single, double or triple vessel disease relating to # of epicardial large arteries involved that can be bypassed or stented (eg lad< rca), not the number of territories involved o. Example - triple bypass may only involve one territory, but 3 large arteries involved (lad + its branches) Angina (stable or unstable), myocardial infarction, heart failure, cardiac arrhythmia, resuscitated sudden death. Documented reversible ischaemia or high level coronary obstruction. Mechanical complications of infarction (eg ventricular rupture, mitral regurgitation, ventricular septal defect)
