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LS CV Oral Review > 201-300 > Flashcards

201-300 Flashcards

1
Q

Surgical treatment of aneurysm of the ascending aorta with aortic insufficiency and marked displacement of the coronary ostia with a saphenous vein graft.

A

Zubiate- Kay procedure

JTCVS 1976

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2
Q

Tachy-brady syndrome

A

PAT/flutter/ fibrillation followed by symptomatic pauses

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3
Q

Carotid sinus syndrome

A

Hyperactive carotid sinus reflex

a. carotid sinus stimulation - cardiac asystole > 3 seconds
b. carotid sinus syndrome - hyperactive reflex _ production of symptoms with carotid sinus stimulation

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4
Q

Treatment of Carotid sinus syndrome

A

Pacemaker therapy - for patients with a cardioinhibitory response (syncope)

PPM may not resolve the vasodepressor response

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5
Q

Electrode testing

Pacing threshold (atrial / ventricle)

Sensing threshold (atria / ventricle)

A

pacing threshold = lowest voltage to produced depolarization

  • Atrial - 1.0V or less
  • Ventricular - 0.3V or less

Sensing threshold - Ability to identify depolarization

  • Atrial p wave - 2mv or more
  • Ventricular QRS: 5 mv or more
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6
Q

CHADS2 score

A

C - Congestive heart failure (1)

H - Hypertension (1)

A - Age 65-74 (1), >75 (2)

D - Diabetes - 1

S - Prior Stroke or TIA (2)

V - Vascular (1)

S - sex (female -1)

Max sore 9

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7
Q

Atrial fibrillation - criteria for:

Isolated vs recurrent vs paroxysmal vs persistent vs permanent

A
  1. Isolated - a single episode
  2. recurrent > 2 episodes
    • Paroxysmal - lasts < 7 days and reverts spontaneously
    • persistent - does not terminate spontenously - requires Rx or DC cardioversion
    • Permanent - does not revert
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8
Q

Common causes of atrial fibrillation

A
  1. idiopathic
  2. Mitral valve and subsequent LA dilation
  3. Ischemic heart disease
  4. HTN
  5. Post-cardiac surgery
  6. Alcohol
  7. Thyrotoxicosis
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9
Q

what are the AHA guidelines for afib and anticoagulation

A

All patients with recurrent afib

Paroxysmal

Persistent

Permanent

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10
Q

INR Goal for afib with a mechanical valve

A

2.5-3.5

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11
Q

In considering INR, what are high risk factors for thromboembolism

A
  1. Stroke
  2. TIA
  3. Systemic embolism
  4. Rheumatic heart disease
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12
Q

For what a fib patients should the INR goal be between 2.0 and 3.0

A

Afib + either

1 high-risk factor

> 1 Moderate risk factor

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13
Q

What are the risk factors for atrial fibrillation following cardiac surgery

A
  1. Age
  2. beta-blocker withdraw
  3. Electrolyte imbalance
  4. Hypoxia
  5. Ischemia
  6. Pericardial effusion
  7. infection
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14
Q

In general, in what patients is a Maze procedure less successful

A

Atria > 5 cm

Afib > 5 years

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15
Q

Ligament of Marshall

A

The ligament of Marshall (LOM)

located on the epicardium between the left atrial appendage and the left pulmonary veins.

The corresponding endocardial structure is the left lateral ridge.

LOM is a source of paroxysmal AF, and may activate at fast rates during persistent AF.

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16
Q

Heart Rate identification of atrial fibrillation

A

Typically a variable block

2:1, 3:1, 4:1

Atrial rate of 300 bpm, with a V response of 150, 100, 75

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17
Q

Class I Antiarrhythmic

A

Class I:

1a: Quinidine, procainamide disopyramide
1b: Lidocaine, phenytoin
1c: Flecainide, propafenone

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18
Q

Class IV Antiarrhythmic

A

Slow calcium channel

Verapamil, diltiasem, adenosine

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19
Q

Coronary artery concerns with surgical ablation

A

Left dominant patients are at increased risk of injury when ablating close to the coronary sinus

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20
Q

Tetralogy of Fallot

key elements to ask about the ECHO

A
  1. what is the status of the RVOT + Pulmonary valve
  2. Pulm atresia/stenosis
  3. are the PA’s confluent or MAPCA
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21
Q

causes of shock in a patient s/p bullectomy

and how to work up

A

Tension ptx

  • check ct not clamped
  • intubate
  • large bore IV

MI

PE

septic shock

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22
Q

Initial treatment of massive PE

A

70 u/kg bolus

heparin infusion 20u/kg/hr

Goal PTT 50-70

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23
Q

Options if a patient with massive PE if they do not stabilize after starting anticoagulation

A
  1. Thrombolytics
  2. Percutaneous mechanical removal
  3. Pulmonary thrombectomy
  4. VA ECMO
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24
Q

Survival of PE patients in shock vs not shock

A

Mortality

Shock: 52%

Not schock: 15%

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25
Q

Indications for surgical embolectomy

A
  1. Hemodynamic collapse with unlikely patient survival
  2. unequivocal PE in the main or lobar PA resulting in significant impairment of gas exchange
  3. unstable patient with absolute contraindication for thrombolytic or anticoagulation
  4. risk of potential pulmonary embolism by large RA or RV clot
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26
Q

Prognosis of post MI VSD

A

Poor

  • 25% in 24 hours
  • 50% in one week
  • 80% in one month
  • 97% in one year
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27
Q

preoperative management of post MI VSD

A

Reduce afterload to reduce left to right shunt

Maintain adequate output with inotropes and or IABP

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28
Q

Most common levels of the Artery of Adamkiewicz

A

T8-T12

29
Q

Major complications associated with aortic aneurysm disease

A

Stroke: 2-11%

paraplegia 2-20%

Renal failure: 3-15%

Pulmonary failure: 20-30%

30
Q

2010 AHA/STS Guidelines for stenting of the thoacic aorta

A

Class 1: acute, traumatic, ischemic type B

Class IIa; symptomatic PAU/IMH chronic traumatic dege

31
Q

Aorta

Endovascular zone

A

0 - ascending to innominate

1 - inominate to the the subclavin

2 - left cartoid to the left subclavian

3- Left sc to proimal descending

4 - descending

32
Q

Types of endograft leak

A

5 types

Type 1 - leak at the ends of the graft

Type 2: sac filling via branch vessel

Type 3: defect in the graft fabric

Type IV: porous graft (intentional leak)

Type V - endotension

33
Q

Type 1 Endovascular leak

A

Type 1: leak at the graft ends

1a proximal

1b distal

1c iliac occluder

34
Q

Type II endovascular leak

A

Type II: sac filling via vascular branch

IIa: single vessel

IIb: two vessels

35
Q

Type III Endovascular leak

A

leak through a defect in the graft fabric

IIIa - junctional separation of the modular components

IIIb fracture or hole involving the endograft

36
Q

Type Iv endovascular leak

A

generally due to a porous graft (design of the graft)

37
Q

Type V endoleak

A

due to endotension

38
Q

Endovascular zone?

Ascending to innominate

A

Zone 0

Ascending to innominae

39
Q

Endovascular zone

Innominate to left carotid

A

zone 1

40
Q

Endovascular zone

Left carotid to left subclavian

A

zone 2

41
Q

Endovascular zone

left subclavian to descending aorta

A

zone 3

42
Q

Endovascular zone

Descending aorta

A

zone 4

43
Q

what type of endoleak requires intervention

A

Type I and III

will need intervention

44
Q

what type of endovascular leas is the most common

A

type II back bleeding from branch vessels

45
Q

how to decompress the heart during descending left heart bypass

A

Left superior pulmonary vein

or

LV Apex

46
Q

Post descending repair

ICP /MAP goals

A

Keep the ICP < 10

Do not drain more CSF than 20ml/hr

MAP > 80-90

47
Q

Components of Del Nido Cardioplegia

A

Components of the crystalloid solution include:

  1. Plasmalyte A
  2. sodium bicarbonate
  3. mannitol (decreases myocardial edema and acts as a free radical scavenger),
  4. potassium (depolarization),
  5. lidocaine (maintains arrest in a hyperpolarized state)
  6. magnesium
48
Q

MUF

A

modified ultrafiltration

Used to minimize total body oedema

49
Q

Root cardioplegia needle size

kids / adults

A

Kids > 5kg- 18g angiocath

Bigger: 12-16g

50
Q

Retograde cardioplegia catheter size

Adult

Pediatric

neonate

A

Adult : 15

Kid : 9 - 13

Neonate: 6

51
Q

Fench to mm conversion

A

1F = 0.33 mm

8F - 2.64 mm

52
Q

Correlation between Edwards

24-, 22-, 19-, and 18-F sheaths and mm size

A

24-, 22-, 19-, and 18-F sheaths

9.2, 8.4, 7.5, and 7.2 mm, respectively.

notice 19–> 18 is 0.3

53
Q

Incidence of HIT in patients who undergocardiac surgery

A

1The overall incidence of HIT in patients who undergo cardiac surgery ranges from 0.1% to 3% .

54
Q

Factors Strongly associaed with HIT

A
  • Female sex
  • atrial fibrillation
  • congestive heart failure
  • chronic kidney disease
  • chronic liver disease
55
Q

Effect of HIT on mortality after Cardiac surgery

A

No HIT: 4.5%

+ HIT: 11%

Any thrombocytopenia: 4%

HIT in post cardiac patients can thus result in more than 50% increase in mortality

56
Q

What type of thrombosis is most common in patients with HIT?

A

Arterial thrombosis is more common than venous thrombosis in cardiac patients with HIT

57
Q

Timing of CABG Post MI

A

EF > 30% - proceed any point after MI completed

EF < 30% stabalize recover for 7 days after MI

58
Q

How to differentiatte the cause of TR based on RV pressures

A

If RVs is > 60 mmHg then tricuspid regurigation in functional and due to left sided heart pressure

if the RVs > 40 then there is a substantial organic component

59
Q

If there is no gradient between the RA to PA diastolic …

A

the the RV likely has severe dysfunction

tricuspid valve replacement will likely not help

60
Q

RVESA and tricuspid regurgitation

A

if RVESA is < 20 cm2 then RV function is preserved

or if change in area < 35% then reduced function

61
Q

criteria for prompting imaging of the chest in trauma

A

Nexus Criteria (similar to spine)

>= 1 should have imaging

  1. Age > 60
  2. Rapid decelleration
    1. fall > 20 feet
    2. MVC > 40 mph
  3. Chest pain
  4. Intoxication
  5. Altered Mendtal Status
  6. Distracting Injury
  7. TTP
62
Q

Clamp and sew surgical repair of traumatic aortic injury

  • time limit for clamp and sew
A

Cross clamp time >30 minutes is associated with a paraplegia rate of 15-30%

63
Q

Significant mediastinal injury - what should you not forget to do?

A

EGD.

particularly gun shot wounds, may be associated with multiple other injuries.

need to be suspicious for an esophageal injury. EGD should be done prior to closing the chest.

64
Q

Definition of FFR

A

pressure in the post stenotic area of a coronary artery to

pressure in the ascending aorta

-at Maximal coronary vascular pharmacologic dilation

65
Q

What FFR indiciates significat coronary artery stenosis

A

An FFR less than 0.8 is significant for coronary artery stenosis

66
Q

What was the FAME study?

What did it show ?

A

Functional Flow Reserve vs Angiography for Multivessel Evaluation

(FAME)

FFR was negative :

  • in 90% stenosis - in 4% of cases
  • in 71-90% stenosis - 20% of cases
  • in 51 - 70% stenosis - 65% of cases
67
Q

David-Feindel formula

A

To determine the size of a graft for a David procedure

diameter = [2x (Hcusp x 2/3)] + 6-8mm

68
Q

nodule of Arantius.

A

Nodule at the free edge of the aortic leaflet.

LS CV Oral Review (6 decks)

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