Cardiac Surgery Flashcards

1
Q

Indications for aortic valve stenosis intervention?

A
Severe stenosis evidence (area of valve <1cm)
\+ 1 if the following:
- symptomatic 
- EJECTION FRACTION <50%
- already was gonna do another surgery
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2
Q

Afib for 6 hours post CABG- what to do?

A

Afib after cabg should resolve within 24 hours, benign afib
<24 hours long Afib means just rhythm control (Amiodarone) and rate control (b blockers)

Otherwise cardioversion

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3
Q

3 complications (mistakes) that can occur following femoral artery access establishment?

A
  • hematoma (just a mass in groin)
  • pseudoaneurysm (systolic bruit, PULSATILE mass - cuz artery anurysm) - due to inadequate closure of the puncture site during surgery
  • AV fistula (both vein and artery punctured (accidental) can cause blood flow between them )
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4
Q

AV Fistula complication? Explain 3:

  • edema
  • high output cardiac failure
  • leg ischemia
A
  • edema- hypertension of vein
  • high output cardiac failure - high venous return= decr afterload cuz decr Svr, incr CO to keep up MAP
  • leg ischemia (if femoral artery access tried to be gained and it avf made- cuz artery blood shunted into vein so less o2 to feed leg
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5
Q

Dx and tx of arteriovenous fistula

A

Dx- doppler ultrasound
Tx- small avfs close spontaneously, so just observation -or compression can be used
Large avfs- surgery

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6
Q

Dx and Tx of patient with: pain, pallor, paresthesia, poikilothermia, pulselessness, paralysis?

A

Dx Acute limb ischemia
Tx: immediate heparin infusion (to prevent further arterial thrombus propagation and stasis of blood distal to the block)
This then buys time for imaging (CT angiography to guide thrombolysis (surgical/ medicinal)

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7
Q

Patient has a fall- sternal and back pain now, BP of upper arms= 120 mmHg, lower legs are cold with diminished pulses. Hoarse voice. Dx?

A

Blunt thoracic aortic injury.
AORTIC ISTHMUS mc site- because its the transition between anterior and posterior area of chest
pt could have had an incomplete rupture of ascending aorta- which explains diff between upper and lower extremity BP
Hoarse voice could be because recurrent laryngeal nerve compression due to expanded adventitia (due to xtra high flow)

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8
Q

Blunt aortic trauma- Dx?

A

CT angiography best (pass pt under small CT machine, and draw up 3D image of his chest vessels)

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9
Q

Acute cardiac tamponade vs subacute

A

acute- small heart size and small effusion (pleural effusion seen on CXR
subacute- large heart with large effusion

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10
Q

MC causes of subacute c. tamponade

A
Malignancy
Renal failure (uremia toxins)
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