Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery Clerkship > Cardiothoracic > Flashcards

Cardiothoracic Flashcards

1
Q

When might CKMB and troponin have increased half lives, thinking the patient is having another MI when they are not?

A

Kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is most common coronary artery in which to have MI?

A

LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the optimal timing of revascularization of the heart after MI?

A

W/in 90 minutes, but some benefit up to 6 hours after onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the workup for suspected MI?

A
  1. ECG
  2. Cardiac enzymes Q8 hours x 24 hours (troponin-I, CKMB)
  3. CXR to rule out aortic dissection
  4. Echo to rule out wall motion abnormalities and decreased EF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the initial treatment/management for MI?

A

Meds: aspirin, clopidogrel, platelet glycoprotein IIb/IIIa antagonist, heparin, beta blocker, nitro, statin and morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the definitive treatment for STEMI?

A

PCI w/in 90 minutes or systemic thrombosis if PCI not available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the definitive treatment for NSTEMI?

A

usually do not require PCI, elective cardiac catheterization on a selective basis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is an emergent CABG indicated for MI? (3)

A
  1. cardiogenic shock
  2. failed PCI
  3. presenting >12 hours after initial insult
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is elective CABG indicated?

A
  1. Left main coronary artery disease (>50%)
  2. Multivessel disease of other coronaries (LAD + 1 more, or 3 others)
  3. Failed PCI or not amenable to PCI (e.g. at bifurcations)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the preferred graft for CABG?

A

Internal mammary artery from L subclavian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What meds do we discontinue before CABG?

A

Clopidogrel or other similar category drugs should be discontinued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Should more than one coronary artery be bypassed during CABG?

A

Yes: long term survival is superior in patients receiving 2 or more coronary bypass grafts vs. one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most concerning symptom in patients with aortic stenosis?

A

Dyspnea, because those patients with evidence of CHF will succumb to the disease w/in 2 years w/o valve replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What imaging is recommended for acute chest pain?

A
  1. CXR: look for CHF, aortic dissection
  2. Echo: look for ventricular dysfunction
  3. CT angiography if PE/aortic dissection suspected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the treatment for aortic stenosis with heart failure?

A

Aortic valve replacement: reduces afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the indications for surgery for aortic stenosis?

A

Symptomatic aortic stenosis

17
Q

What drugs do we avoid in aortic stenosis, and why?

A

Diuretics, beta blockers and vasodilators due to risk of hypotension

18
Q

What are risks/benefits of bioprosthetic valve vs. mechanical valve? Which is preferred?

A

Bioprosthetic: Degraded by dystrophic calcification and possible chronic antigenicity and don’t last as long
Mechanical valves: require lifetime anticoagulation

Use mechanical as long as patient doesn’t have contraindication to anticoagulation

19
Q

When is percutaneous balloon valvuloplasty appropriate in aortic stenosis?

A

Bridge to surgery in hemodynamically stable patient. Transient benefit + smaller hemodynamic benefit vs. surgical valve replacement

20
Q

When is percutaneous aortic valve replacement indicated?

A

Only for aortic stenosis patients who are too high risk for conventional surgical valve replacement. May not be durable and has increased risk of stroke perioperatively

21
Q

What are the risk factors for aortic dissection?

A 
Hypertension
CT disease
Advanced age
atherosclerosis
Pregnancy
cocaine use
bicuspid aortic valve
aortic coarctation
22
Q

What is significance of uneven pulses in patients with aortic dissection?

A

Blood supply to one of extremities is affected - suggests location of dissection!

23
Q

Why are Marfan’s patients at increased risk of aortic dissection?

A

Misfolded fibrillin proteins can result in cystic medial necrosis of large vessels

24
Q

How we we classify aortic dissection?

A

Stanford A: involving ascending aorta (can involve descending, too)
Stanford B: involves descending distal to subclavian artery only

25
Q

How do aortic dissections cause complications?

A

False lumen can interfere with blood flow and compromise perfusion to branching vessels = malperfusion syndrome

26
Q

What are the life threatening complications of Stanford A aortic dissection?

A

Dissect into and obstruct coronary arteries –> MI
Disrupt blood flow in carotid arteries –> ischemic stroke
Dissect into pericardial sac –> acute tamponade
Dissect aortic valve –> acute aortic insufficiency

27
Q

What is first imaging modality recommended for a patient who presents with acute chest pain?

A

CXR

28
Q

What is the next step for a patient who is hemodynamically unstable and aortic dissection is highly suspected?

A

Go to OR immediately. Perform TEE into OR and if confirmatory, proceed with surgery.

29
Q

What is first step in management of aortic dissection?

A

Maintain low blood pressure: 100-110 systolic to decrease shear forces on the aorta. Usually with IV beta blocker.

30
Q

What do we do after reducing blood pressure in Stanford A vs. B aortic dissection?

A

A: go to OR for repair via median sternotomy
B: admitted to ICU and BP closely monitored

31
Q

When do Type B dissections undergo surgical repair?

A

Develop complications (e.g. malperfusion syndrome) secondary to compromised perfusion to branches of descending thoracic or abdominal aorta (limb or visceral ischemia)

32
Q

If type B dissection needs surgical intervention, what are options?

A

1 Open repair via thoracotomy

2 Endovascular repair via a stent graft

33
Q

Why are beta blockers contraindicated in patients with aortic dissection complicated by cardiac tamponade or severe AR?

A

Worsen hypotension and may precipitate cardiac arrest.

34
Q

What are diagnostic steps for aortic dissection?

A

1 CXR: widened mediastinum, but 15-20% won’t show that
2 CT chest with IV contrast if mediastinum wide or suspicion is high
3 unstable patient: directly to OR with transesophageal echo

Surgery Clerkship (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions