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Assessment & Diagnosis > Cardiac Surgery > Flashcards

Cardiac Surgery Flashcards

1
Q

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

A

Society of Thoracic Surgeons Risk Calculator

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2
Q

What does a P2Y12 assay measure?

A

Responsiveness to Plavix

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3
Q

What is the gold standard for diagnosing CAD?

A

Left heart cath

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4
Q

How is valvular function evaluated?

A

TTE

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5
Q

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

A

A PET viability study

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6
Q

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

A

80% or greater

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7
Q

What is a sternotomy?

A

An incision in the midline of the chest

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8
Q

Mini thoracotomy is done mostly for what type of surgeries?

A

Valve surgeries

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9
Q

What is cardioplegia?

A

Temporary intentional arrest of the heart

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10
Q

How is cardioplegia done?

A

With a high K+ solution

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11
Q

Who manages the cardiopulmonary bypass machine?

A

The perfusionist

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12
Q

What are the two main indications for a CABG?

A

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

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13
Q

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

A

50% or greater

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14
Q

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

A

Internal mammary artery

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15
Q

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

A

Internal mammary artery bypass lasts longer

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16
Q

What is tricuspid valve disease usually a result of?

A

Rheumatic heart disease or lung disease

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17
Q

Which valve is rarely operated on?

A

The tricuspid valve

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18
Q

When is surgery indicated for mitral valve stenosis?

A

For severely symptomatic pts - NYHA Class III or IV

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19
Q

Acute mitral regurgitation is usually caused by what?

A

An MI causing papillary muscle rupture, endocarditis

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20
Q

Aortic stenosis is usually a result of what?

A

Degenerative related issues

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21
Q

When should pts with aortic stenosis undergo surgery?

A

When they are symptomatic

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22
Q

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

A

If they have LV dysfunction with EF<50%

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23
Q

Should all symptomatic aortic regurgitation pts be operated on?

A

Yes

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24
Q

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

A

0.8cm2

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25
Q

What does an annuloplasty ring help with?

A

Valvular regurgitation

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26
Q

What is a commissurotomy done for?

A

Stenotic valves

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27
Q

What is a commissurotomy?

A

Surgeon opens up the valve to decrease stenosis

28
Q

Which lasts longer, mechanical or bioprosthetic valves?

A

Mechanical

29
Q

Which type of valve requires lifelong anticoagulation with warfarin?

A

Mechanical

30
Q

How long do bioprosthetic valves need antiplatelet therapy after placement?

A

Three months

31
Q

What must be done if a prosthetic valve becomes infected?

A

Surgical replacement

32
Q

When is a transcatheter aortic valve implantation done?

A

When pt is too sick for open heart surgery

33
Q

What is the goal time to extubate after cardiac surgery?

A

Within 4-6 hours after leaving the OR

34
Q

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

A

Pressure support

35
Q

PEEP should be what before extubation?

A

5-8

36
Q

FiO2 should be what before extubation?

A

Less than or equal to 0.4

37
Q

How is glycemic control managed in diabetic cardiac surgery pts?

A

They will all be placed on an insulin drip after surgery

38
Q

What is the goal blood sugar for cardiac surgery pts?

A

140-180

39
Q

What happens to volume status after cardiac surgery?

A

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

40
Q

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

A

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

41
Q

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

A

27-30

42
Q

What should platelets be for surgical pts?

A

Above 50k

43
Q

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

A

2-4 units

44
Q

What is protamine used to reverse?

A

Heparin

45
Q

Heparin elevates what lab value?

A

PPT

46
Q

What is fibrinogen given for?

A

Low cryoprecipitate

47
Q

How much cryo do you give?

A

1 unit per 10kg of body weight

48
Q

In what order do you address hemodynamics?

A

Preload, afterload, contractility

49
Q

What is vasoplegia?

A

Very low SVR

50
Q

What medication use increases risk of vasoplegia after surgery?

A

Ace inhibitors

51
Q

When should ACEI be stopped prior to cardiac surgery?

A

One week prior

52
Q

What is methylene blue used to treat?

A

Vasoplegia

53
Q

What is the most common complication after cardiac surgery?

A

A fib

54
Q

How do we treat unstable afib?

A

Cardiovert

55
Q

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

A

No

56
Q

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

A

Beta blockers

57
Q

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

A

Rhythm control

58
Q

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

A

After 36-48 hours without conversion to NSR

59
Q

What is an MI defined as?

A

A new Q wave on an EKG

60
Q

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

A

No

61
Q

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

A

Vfib, vtach, cardiac tamponade

62
Q

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

A

May damage graft

63
Q

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

A

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

64
Q

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

A

Pace

65
Q

What do you do is pt is in PEA?

A

ACLS

66
Q

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

A

Re-sternotomy (usually at bedside) with cardiac massage

Assessment & Diagnosis (5 decks)

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