Cardiac Surgery

Question 1

What calculator is used to risk stratify for cardiac surgery patients in the US?

Answer 1

Society of Thoracic Surgeons Risk Calculator

Question 2

What does a P2Y12 assay measure?

Answer 2

Responsiveness to Plavix

Question 3

What is the gold standard for diagnosing CAD?

Answer 3

Left heart cath

Question 4

How is valvular function evaluated?

Answer 4

TTE

Question 5

What kind of study tells you if the heart can be re-perfused post MI?

Answer 5

A PET viability study

Question 6

What percent of carotid stenosis would necessitate a consult pre-op to determine if pt is a candidate for carotid endarterectomy?

Answer 6

80% or greater

Question 7

What is a sternotomy?

Answer 7

An incision in the midline of the chest

Question 8

Mini thoracotomy is done mostly for what type of surgeries?

Answer 8

Valve surgeries

Question 9

What is cardioplegia?

Answer 9

Temporary intentional arrest of the heart

Question 10

How is cardioplegia done?

Answer 10

With a high K+ solution

Question 11

Who manages the cardiopulmonary bypass machine?

Answer 11

The perfusionist

Question 12

What are the two main indications for a CABG?

Answer 12

Significant left main coronary artery stenosis or presence of 3 vessel disease

Question 13

What percent stenosis of the left main coronary artery is considered “significant”?

Answer 13

50% or greater

Question 14

What artery is most often used to bypass the left anterior descending coronary artery?

Answer 14

Internal mammary artery

Question 15

What is the advantage of doing a bypass with the internal mammary artery over the saphenous vein?

Answer 15

Internal mammary artery bypass lasts longer

Question 16

What is tricuspid valve disease usually a result of?

Answer 16

Rheumatic heart disease or lung disease

Question 17

Which valve is rarely operated on?

Answer 17

The tricuspid valve

Question 18

When is surgery indicated for mitral valve stenosis?

Answer 18

For severely symptomatic pts - NYHA Class III or IV

Question 19

Acute mitral regurgitation is usually caused by what?

Answer 19

An MI causing papillary muscle rupture, endocarditis

Question 20

Aortic stenosis is usually a result of what?

Answer 20

Degenerative related issues

Question 21

When should pts with aortic stenosis undergo surgery?

Answer 21

When they are symptomatic

Question 22

When would you perform an aortic valve replacement in an asymptomatic pt?

Answer 22

If they have LV dysfunction with EF<50%

Question 23

Should all symptomatic aortic regurgitation pts be operated on?

Answer 23

Yes

Question 24

Severe aortic stenosis is when the valve opening is smaller than what?

Answer 24

0.8cm2

Question 25

What does an annuloplasty ring help with?

Answer 25

Valvular regurgitation

Question 26

What is a commissurotomy done for?

Answer 26

Stenotic valves

Question 27

What is a commissurotomy?

Answer 27

Surgeon opens up the valve to decrease stenosis

Question 28

Which lasts longer, mechanical or bioprosthetic valves?

Answer 28

Mechanical

Question 29

Which type of valve requires lifelong anticoagulation with warfarin?

Answer 29

Mechanical

Question 30

How long do bioprosthetic valves need antiplatelet therapy after placement?

Answer 30

Three months

Question 31

What must be done if a prosthetic valve becomes infected?

Answer 31

Surgical replacement

Question 32

When is a transcatheter aortic valve implantation done?

Answer 32

When pt is too sick for open heart surgery

Question 33

What is the goal time to extubate after cardiac surgery?

Answer 33

Within 4-6 hours after leaving the OR

Question 34

What type of ventilation should cardiac pts be on before extubation?

Answer 34

Pressure support

Question 35

PEEP should be what before extubation?

Answer 35

5-8

Question 36

FiO2 should be what before extubation?

Answer 36

Less than or equal to 0.4

Question 37

How is glycemic control managed in diabetic cardiac surgery pts?

Answer 37

They will all be placed on an insulin drip after surgery

Question 38

What is the goal blood sugar for cardiac surgery pts?

Answer 38

140-180

Question 39

What happens to volume status after cardiac surgery?

Answer 39

Most pts end surgery about 5-10% above their pre-op weight (volume overloaded)

Question 40

Why do cardiac surgery pts need a lot of volume after surgery?

Answer 40

Kidneys excrete a large amount of urine, so volume is needed to maintain hemodynamics

Question 41

Hematocrit should be what in the immediate post-op period?

Answer 41

27-30

Question 42

What should platelets be for surgical pts?

Answer 42

Above 50k

Question 43

How many units of plasma should you give if pt has high INR and is actively bleeding?

Answer 43

2-4 units

Question 44

What is protamine used to reverse?

Answer 44

Heparin

Question 45

Heparin elevates what lab value?

Answer 45

PPT

Question 46

What is fibrinogen given for?

Answer 46

Low cryoprecipitate

Question 47

How much cryo do you give?

Answer 47

1 unit per 10kg of body weight

Question 48

In what order do you address hemodynamics?

Answer 48

Preload, afterload, contractility

Question 49

What is vasoplegia?

Answer 49

Very low SVR

Question 50

What medication use increases risk of vasoplegia after surgery?

Answer 50

Ace inhibitors

Question 51

When should ACEI be stopped prior to cardiac surgery?

Answer 51

One week prior

Question 52

What is methylene blue used to treat?

Answer 52

Vasoplegia

Question 53

What is the most common complication after cardiac surgery?

Answer 53

A fib

Question 54

How do we treat unstable afib?

Answer 54

Cardiovert

Question 55

Can you give cardiac surgery pts calcium channel blockers for afib rate control?

Answer 55

No

Question 56

How should cardiac surgery pts be treated for afib after surgery?

Answer 56

Beta blockers

Question 57

Is rate control or rhythm control more important for cardiac surgery pts with afib?

Answer 57

Rhythm control

Question 58

When should anticoagulation be started on a cardiac surgery pt in afib?

Answer 58

After 36-48 hours without conversion to NSR

Question 59

What is an MI defined as?

Answer 59

A new Q wave on an EKG

Question 60

Is there any benefit to starting CCRT after cardiac surgery for kidney failure?

Answer 60

No

Question 61

What are the three most common causes of cardiac arrest after surgery?

Answer 61

Vfib, vtach, cardiac tamponade

Question 62

Why should epi not be used in cardiac arrest after surgery?

Answer 62

May damage graft

Question 63

What do you do if pt is in VT/VF?

Answer 63

Defib up to 3x, do not start chest compressions for one minute

Question 64

What do you do if pt is in asystole or bradycardic?

Answer 64

Pace

Question 65

What do you do is pt is in PEA?

Answer 65

ACLS

Question 66

What do you do if you've been attempting to resuscitate a post surgery arrest pt for 5+ minutes without success?

Answer 66

Re-sternotomy (usually at bedside) with cardiac massage