Cardiac Diseases and

Cardiac Surgery
By Dr. Tehreem Nasir
MBBS, RMP
Acquired Heart Diseases
 Disease affecting cardiac tissue and function
which does not have its inception at birth
and usually is secondary to an external
agent.
 Types of acquired cardiac disorders:
◦ Ischemic / hypoxic
◦ Hypertensive
◦ infectious
◦ Inflammatory
◦ Metabolic
◦ Nutritional
◦ Traumatic
Types of acquired cardiac disorders:
 Ischemic / hypoxic  Inflammatory
◦ Coronary ◦ Rheumatic fever
Atherosclerosis
 Metabolic
 Hypertensive ◦ Endocrine disorders
◦ Pulmonary affecting heart
Hypertension  Thyroid
◦ Systemic  Parathyroid
Hypertension
 Nutritional
 Infectious ◦ Nutritional deficiencies
◦ Pericarditis  Starvation
◦ Myocarditis  Vitamin
◦ Endocarditis  Traumatic
◦ Penetrating
◦ Blunt
Pericardial Diseases:
 Pericarditis:
◦ Inflammation (Infection) of pericardial space
◦ Causes:
 Infective (viral, bacterial, fungal)
 Autoimmune (SLE)
 Traumatic injury
 Idiopathic
 Pericardial Effusion:
◦ Accumulation of excessive fluid in pericardial space
◦ Normal amount of fluid in pericardial space = 15-50ml
◦ Causes:
 Neoplasm of pericardial lining (mesothelioma)
 Trauma
 Systemic conditions like Congestive heart failure, Hypothyroidism,
Cirrhosis.
 Congenital Heart Diseases
 Atrial Septal defect:
◦ A defect in inter-atrial septum that separates left atrium
and right atrium causing blood to flow from LA to RA
 Ventricular Septal Defect (VSD)
◦ Blood flows from Left Ventricle to Right Ventricle
through a hole, resulting in increased pulmonary blood
flow
 Coarctation of Aorta:
◦ Narrowing/ constriction of aorta, usually at origin of left
subclavian artery near ligamentum arteriosum, which
leads to obstruction between the proximal and distal
aorta.
◦ HTN in upper extremities with hypotension in lower
extremities
 Patent Ductus Arteriosus:
◦ Communication between aorta and
pulmonary artery that persists after
birth.
 Teratology of Fallot:
◦ Tetrad of cardiac abnormalities
 Ventricular septal defect
 Right ventricular hypertrophy
 Pulmonary artery stenosis
 Overriding aorta
◦ Cause:
 Defects in the development of infundibular
septum
Cardiac Surgery
Cardiac surgery is the surgical management of
cardiac abnormalities and of the great vessels
of the thorax.
 In general terms, surgical intervention of the
heart is performed to directly restore
adequate pump function, correct inherent
structural issues, and reestablish proper
blood supply via the coronary circulation.
 Common interventions treat ischemic and
valvular heart disease as well as disorders of
the great vessels.
Investigations prior to cardiac
surgery
Following are the tests that are
performed prior to a cardiac surgery:
 Baseline Blood Tests (CBC, Clotting profile,
RFTs, LFTs, HBsAg, Anti-HCV, Anti-HIV)
 Chest X-ray
 ECG
 Echocardiography
 Ankle-Brachial Index ”ABIs”( to check
peripheral artery diseases)
Pericardiocentesis
 Definition:
◦ Pericardiocentesis is an
invasive procedure that
consists of inserting a needle
into the pericardial space to
extract, for diagnostic or
therapeutic reasons, fluid from
the pericardial space.
 Indications:
◦ Diagnostic pericardiocentesis (obtaining pericardial
fluid for diagnosis):
 Suspicion of bacterial, mycobacterial, or fungal effusion
 Suspicion of malignant effusion
◦ Therapeutic pericardiocentesis:
 Cardiac tamponade: restriction in cardiac filling due
to excessive accumulation of fluid within pericardial
cavity; leads to decreased cardiac output and
potentially hemodynamic instability
(hypotension and shock)
 Large pericardial effusions with no known etiology
 Contraindications
◦ Coagulopathy (PTT > 2x normal) or
thrombopenia (platelet count < 50,000)
◦ Small or loculated pericardial effusion
◦ Traumatic hemopericardium
◦ Non-viral infectious pericarditis
 Complications:
◦ Lack of clinical resolution
◦ Penetration of the myocardial wall
◦ Coronary artery puncture
◦ Hemothorax: accumulation of blood within the pleural
space
◦ Pneumothorax: accumulation of air within the pleural
space (between the parietal and visceral pleura)
◦ MI
◦ Pneumopericardium
◦ Hepatic injury
◦ Bowel perforation
◦ Pleuropericardial fistula
 Pericardial Window
 Definition
◦ A pericardial window
is a surgical procedure
done on
the parietal pericardiu
m to provide access
to the pericardial
space and to evacuate
occupying fluid and
break loculations.
◦ The main goal of this
procedure is to
restore
effective ventricular
filling and cardiac
output.
 Indications
◦ Cardiac tamponade
 Symptomatic pericardial effusion that persists despite 7–10
days of intensive medical treatment
 Contraindications
◦ There are no absolute contraindications.
◦ Relative contraindications include
coagulopathy, thrombocytopenia, and lack of operator
experience.
 Complications
◦ Bleeding
◦ Surgical site infection(SSI)
◦ Arrhythmia
◦ MI
◦ Hemodynamic collapse
 Coronary Artery Bypass Graft
(CABG)
 Definition:
◦ Coronary artery bypass graft (CABG) surgery is an
invasive revascularization procedure that consists of placing grafts
between the arterial and coronary circulations in order to bypass
obstructed segments of the coronary arteries and supply
the myocardium with oxygenated blood.
 Indications
◦ Individuals with anginal pain on exertion despite maximum medical
therapy
◦ Significant narrowing (> 70%) of coronary artery
◦ Coronary artery disease (CAD) affecting multiple vessels
 Contraindications
◦ Coronary arteries incompatible with grafting
 Complications
◦ Graft failure
◦ Stroke
◦ SSI (Surgical site infection)
◦ Atrial fibrillation (rapid, uncontrolled atrial contractions)
 Cardiac Catheterization(angiography):
 Definition
◦ Cardiac catheterization is an invasive procedure that consists of inserting a
catheter into the systemic arterial circulation and advancing it toward the heart to
inject contrast dye. This procedure allows for diagnostic vascular imaging and
potential therapeutic intervention.
 Indications:
◦ This procedure may be interventional (angioplasty or stent placement)
or diagnostic (visualizing).
◦ Coronary artery disease  stenosis of the coronary arteries, typically
from atherosclerosis.
◦ Heart failure  decreased contractility of heart
◦ Measuring the blood pressures in the right and left sides of the heart
◦ Arrhythmias
◦ Valvular heart disease
◦ Assessment of pericardial and myocardial diseases
◦ Assessment of the congenital cardiopathies
 Contraindications:
◦ There are no absolute contraindications for cardiac catheterization.
However, if the likelihood of complications is reasonably high, the
surgeon may consider other methods. Individuals with renal
impairment should be treated cautiously, as contrast media may be
nephrotoxic.
 Complications:
◦ Hematoma
◦ Retroperitoneal bleeding
◦ Pseudoaneurysm
◦ AV fistula
◦ Embolism (e.g., thrombus, atherosclerotic plaque, air)
◦ Ventricular fibrillation: uncoordinated ventricular contraction,
which leads to a decrease in cardiac output and immediate
hemodynamic collapse
◦ MI
◦ Stroke
◦ Aortic dissection
◦ Hypersensitivity reaction
◦ AKI (acute kidney injury): due to contrast required for the
procedure
Percutaneous Coronary
Intervention (PCI) (angioplasty)
 Definition
◦ Formerly known as coronary angioplasty and
stenting, PCI is an invasive, nonsurgical procedure
that consists of introducing a catheter into the
coronary arteries and using a balloon and stent
to relieve an occlusion within the vessel.
 Indications:
◦ Critical coronary heart disease(CHD):
 Persistent stenosis of coronary arteries, typically from
atherosclerosis. PCI is indicated in individuals who do
not qualify for CABG
◦ Myocardial Infarction
 Contraindications
◦ Absolute:
 Increased bleeding risk (i.e., thrombocytopenia)
 Restenosis due to multiple previous PCIs
◦ Relative:
 Hypercoagulable state
 Severe CKD
 Complications
◦ Rupture or dissection of the coronary artery or aorta
◦ Bleeding from the puncture site
◦ SSI
◦ Sepsis
◦ AKI: due to contrast from procedure
◦ Stroke: due to thrombi generated during the procedure
◦ MI: due to dissection or thrombus within the stent
Thanks!