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Cardiology > 02.18a Surgical Management of CAD > Flashcards

02.18a Surgical Management of CAD Flashcards

1
Q

Etiology of CAD

A

Atherosclerosis

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2
Q

Risk factors of CAD

A 
Age
Cigarette smoking
HPN
Dyslipidemia
Sedentary lifestyle
Obesity
DM
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3
Q

How to prevent CAD according to Class 1 recommendations by the ACC and AHA

A 
Smoking cessation
BP < 140/90 (130/80 for DM or CKD)
LDL < 100
ASA therapy
BMI < 25
DM management HbA1c < 7%
Daily exercises
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4
Q

Clinical manifestations of CAD

A 
Angina pectoris
MI
Ischemic heart failure
Arrhythmia
Sudden death
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5
Q

Clinical evaluation of CAD

A 
Lab work-up
Chext x-ray
12-lead ECG
Stress test (Stress Echocardiography)
2D echocardiography
Coronary angiography
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6
Q

Have the ability to assess global ventricular function in terms of LV ejection fraction which can be used to determine operative risk

A

Stress echocardiography

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7
Q

Primary diagnostic tool for CAD

A

Coronary angiography

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8
Q

Normal LV ejection fraction

A

0.55-0.70

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9
Q

Mild depression level of LV ejection fraction

A

9

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10
Q

Moderate level of LV ejection fraction

A

< 0.4

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11
Q

Severe level of LV ejection fraction

A

< 0.25

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12
Q

Evidence and or general agreement that procedure is beneficial, useful and effective

A

Class I

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13
Q

Conflicting evidence

A

Class II

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14
Q

Conflicting evidence in favor of usefulness or efficacy

A

Class IIA

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15
Q

Conflicting evidence in favor of not being useful

A

Class IIB

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16
Q

Evidence and or general agreement that procedure is not useful or effective and may be harmful

A

Class III

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17
Q

Significantly higher rates of repeat revascularization in _____

A

PCI than CABG

18
Q

Most important criterion in conduit selection

A

Graft patency

19
Q

Conduit with highest patency rate

A

Internal thoracic artery

20
Q

Vessels used for conduit

A

Internal mammary artery
Saphenous vein graft
Radial artery
Gastroepiploic artery

21
Q

How to harvest saphenous vein

A

Conventional vein harvesting

Endoscpic vein harvesting

22
Q

Open technique, incision is made along the course of the vein on the medial aspect of the lower extremity

A

Conventional vein harvesting

23
Q

Starts with a small incision just above and medial to the knee where the endoscope is inserted

A

Endoscopic vein harvesting

24
Q

In using radial artery, confirm ulnar collateral flow to the hand by

A

Allen’s test

Duplex ultrasound study

25
Q

In harvesting radial artery, incision is made point near the _____

A

radial styloid process ending just medial and distal to the biceps tendon on the non-dominant hand

26
Q

To preserve myocardium, a temperature of ____ is needed

A

28 - 33 dec C

27
Q

Types of cardioplegic solution

A

Crystalloid

Blood

28
Q

Recommended to revascularize the area with the most concern for ischemia then give cardioplegia down the completed graft

A

Retrograde cardioplegia

29
Q

In LAD graft, this is performed last to avoid kinking or disruption of bypass

A

Left internal thoracic artery

30
Q

Does not make use of the heart-lung machine
Done to avoid the adverse consequences of cardiopulmonary bypass
Heart is left beating through myocadial stabilization devices for immobility while anastomoses are being done

A

Off-pump coronary artery bypass (OBCAP)

31
Q

One internal mammary and the rest are veins

A

Single IMA CABG

32
Q

Arteries still come from internal mammary artery

Higher success rates

A

Bilateral IMA CBG

33
Q

Fats in the vein are left behind and grafted

A

No touch saphenous vein technique

34
Q

Saphenous vein solution

A

Nitric oxide synthase

35
Q

Minimal incision, but maximum difficulty
Done through a left anterior mini-thoracotomy through which mobilization of the left internal thoracic and direct anastomosis to LAD is performed
Done to single-vessel disease

A

Minimally invasive direct coronary artery bypass (MIDCAB)

36
Q

Surgery may perform the procedure from another place, through the use of consoles
Expensive

A

Total endoscopic coronary artery bypass (TECAB)

37
Q

Similar to catheterization lab but it also serves as an operating room
Provides catheterization, agiography, CABG

A

Hybrid coronary revascularization

38
Q

Puncture the myocardium and expose to laser

Candidates are those not allowed for stenting, angioplasty or bypass

A

Transmyocardial laser revascularization

39
Q

Used for patients with end stage coronary artery disease

No longer recommended

A

Transmyocardial laser revascularization

40
Q

Regenerative medicine and tissue engineering

A

Cardiac stem cell theray

41
Q

Alternatives to CABG

A

Off-pump coronary artery bypass
Multiple arterial coronary revascularization
Minimally invasive direct coronary artery bypass
Total endoscopic coronary artery bypass
Hybrid coronary revascularization
Transmyocardial laser revascularization
Cardiac stemm cell therapy

Cardiology (13 decks)

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