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ENTREGA > Cardiovascular Surgery > Flashcards

Cardiovascular Surgery Flashcards

1
Q

What is AI?

A

Aortic Insufficiency

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2
Q

What is AS?

A

Aortic Stenosis

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3
Q

What is ASD?

A

Atrial Septal Defect

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4
Q

What is CABG?

A

Coronary Artery Bypass Grafting

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5
Q

What is CAD?

A

Coronary Artery Disease

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6
Q

What is CPB?

A

CardioPulmonary Bypass

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7
Q

What is IABP?

A

IntraAortic Balloon Pump

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8
Q

What is LAD?

A

Left Anterior Descending coronary artery

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9
Q

What is IMA?

A

Internal Mammary Artery

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10
Q

What is MR?

A

Mitral Regurgitation

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11
Q

What is PTCA?

A

Percutaneous Transluminal Coronary Angioplasty (balloon angioplasty)

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12
Q

What is VAD?

A

Ventricular Assist Device

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13
Q

What is VSD?

A

Ventricular Septal Defect

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14
Q

What is stroke volume?

A

mL of blood pumped per heartbeat

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15
Q

What is cardiac output?

A

Amount of blood pumped by the heart each minute

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16
Q

What is cardiac index?

A

CO/BSA, BSA = body surface area

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17
Q

What is ejection fraction?

A

Percentage of blood pumped out of the left ventricle (SV/EDV)
Normal: 55-70%

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18
Q

What is compliance?

A

(Change in volume)/(Change in pressure)

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19
Q

What is SVR?

A

Systemic Vascular Resistance

MAP - CVP)/(CO X 80

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20
Q

What is preload?

A

Left ventricular end diastolic pressure or volume

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21
Q

What is afterload?

A

Arterial resistance the heart pumps against

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22
Q

What is PVR?

A

Pulmonary Vascular Resistance:

PAmean - PCWP)/(CO X 80

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23
Q

What is MAP?

A

Mean Arterial Pressure:

Diastolic BP + 1/3 X (Systolic BP - Diastolic BP)

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24
Q

What is a normal CO?

A

4-8 L/min

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25
Q

What is a normal CI?

A

2.5-4 L/(min*m2)

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26
Q

What are the ways to increase CO?

A 
MR. PAIR:
Mechanical assistance (IABP, VAD)
Rate: increase
Preload: increase
Afterload: decrease
Inotropes: increase contractility
Rhythm: normal sinus
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27
Q

When does most of the coronary blood flow take place?

A

During diastole

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28
Q

What are the 3 major coronary arteries?

A
  1. LAD
  2. Circumflex
  3. Right coronary
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29
Q

What are the 3 main cardiac electrolytes?

A

Ca, K, Mg

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30
Q

What is coronary artery disease?

A

Atherosclerotic occlusive lesions of the coronary arteries.

Segmented nature make CABG possible.

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31
Q

What is the incidence of CAD?

A

1 killer in western world

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32
Q

What are the symptoms of CAD?

A

If ischemia (due to low flow, vasospasm, thrombus formation, plaque rupture): chest pain, crushing, substernal SOB, nausea, upper abdominal pain, sudden death, fatigue

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33
Q

Who classically gets silent MIs?

A

Patients with diabetes (autonomic dysfunction)

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34
Q

What are the risk factors for CAD?

A

HTN, smoking, high cholesterol/lipids, obesity, diabetes, family history

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35
Q

Which diagnostic tests should be performed in CAD?

A

Exercise stress testing (+/- thallium); echocardiography; localize dyskinetic wall segments; valvular dysfunction; estimate EF; cardiac catheterization with coronary angiography and left ventriculography

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36
Q

What is the treatment for CAD?

A

Medical therapy (beta-blockers, aspirin, nitrates, HTN medication); PTCA +/- stents; CABG

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37
Q

What are the indications for CABG?

A
  1. Left main disease
  2. 2+ vessel disease
  3. Unstable or disabling angina unresponsive to medical therapy or PTCA
  4. Post-infarct angina
  5. Coronary artery rupture, dissection, thrombosis after PTCA
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38
Q

What are the pros and cons of CABG vs. PTCA +/- stents?

A

CABG: survival improvement for diabetics and 2+ vessel disease, increased short-term morbidity
PTCA: decreased short-term morbidity, decreased cost, decreased hospital stay, increased reintervention, increased post-procedure angina

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39
Q

What procedures are most often used in CABG?

A

Coronary arteries grafted (usually 3-6); internal mammary pedicle graft and saphenous vein free graft are most often used

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40
Q

Other than IMA and saphenous vein, what vessels are occasionally used for CABG?

A

Radial artery, inferior epigastric vein

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41
Q

What are the possible complications of CABG?

A

Hemorrhage, tamponade, MI, dysrhythmias, infection, graft thrombosis, sternal dehiscence, post-pericardiotomy syndrome, stroke

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42
Q

What is the operative mortality from CABG?

A

1-3% for elective CABG

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43
Q

What medications should almost every patient be given after CABG?

A

Aspirin, beta-blocker

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44
Q

Can a CABG be performed off cardiopulmonary bypass?

A

Yes, today they are performed with or without bypass

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45
Q

What is post-pericardiotomy syndrome?

A

Pericarditis after pericardiotomy.

Occurs weeks to 3 months postoperatively.

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46
Q

What are the signs and symptoms of post-pericardiotomy syndrome?

A

Fever, chest pain, atrial fibrillation, malaise, pericardial friction rub, pericardial effusion, pleural effusion

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47
Q

What is the treatment for post-pericardiotomy syndrome?

A

NSAIDs +/- steroids

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48
Q

What is pericarditis after an MI called?

A

Dressler’s syndrome

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49
Q

What is cardiopulmonary bypass?

A

Pump and oxygenation apparatus to remove blood from SVC and IVC and return it to the aorta, bypassing the heart and lungs and allowing cardiac arrest for open-heart procedures, heart transplant, lung transplant, or heart-lung transplant, as well as procedures on the proximal great vessels

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50
Q

Is anticoagulation necessary for CPB?

A

Yes, just before and during the procedure, with heparin

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51
Q

How is anticoagulation reversed?

A

Protamine

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52
Q

What are the ways to manipulate cardiac output after CPB?

A

Rate, rhythm, afterload, preload, inotropes, mechanical (e.g. IABP, VAD)

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53
Q

What mechanical problems can decrease CO after CPB?

A

Cardiac tamponade, pneumothorax

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54
Q

What is tamponade physiology?

A

Decreased CO, increased HR, hypotension, increased CVP

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55
Q

What are possible complications of CPB?

A

Trauma to formed blood elements (esp. thrombocytopenia, platelet dysfunction); pancreatitis (low flow); heparin rebound; CVA; failure to wean from bypass; technical complications (operative technique); MI

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56
Q

What are the options for treating post-op CABG mediastinal bleeding?

A

Protamine, increased PEEP, FFP, platelets, aminocaproic acid

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57
Q

What is heparin rebound?

A

Increased anticoagulation after CPB from increased heparin levels, as increase in peripheral blood flow after CPB returns heparin residual that was in the peripheral tissues

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58
Q

What is the method of lowering SVR after CPB?

A

Warm the patient; administer sodium nitroprusside and dobutamine

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59
Q

What are the options if a patient cannot be weaned from CPB?

A

Inotropes, VAD, IABP

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60
Q

What percentage of patients goes into AFib after CPB?

A

Up to 33%

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61
Q

What is the workup of a postoperative patient with AFib?

A

Rule out PTX (ABG, CT scan), acidosis (ABG), electrolyte abnormality (labs), and ischemia (EKG), CXR

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62
Q

What is a MIDCAB?

A

Minimally Invasive Direct Coronary Artery Bypass:

LIMA to LAD bypass without CPB and through a small thoracotomy

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63
Q

What is TMR?

A

TransMyocardial laser Revascularization:
Laser through groin catheter makes small holes (intramyocardial sinusoids) in cardiac muscle to allow blood to nourish the muscle

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64
Q

What is OPCAB?

A

Off Pump Coronary Artery Bypass:

Median sternotomy but no bypass pump

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65
Q

What is aortic stenosis?

A

Destruction and calcification of valve leaflets, resulting in obstruction of left ventricular outflow

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66
Q

What are the causes of aortic stenosis?

A

Calcification of bicuspid aortic valve; rheumatic fever; acquired calcific AS

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67
Q

What are the symptoms of aortic stenosis?

A

Angina, syncope, CHF, often asymptomatic until late

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68
Q

What is the memory aid for the aortic stenosis complications?

A

Aortic Stenosis Complications =

Angina Syncope CHF

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69
Q

What are the signs of aortic stenosis?

A

Murmur (crescendo-decrescendo systolic second right intercostal space with radiation to the carotids); left ventricular heave or lift from left ventricular hypertrophy

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70
Q

What tests should be performed for aortic stenosis?

A

CXR, ECG, echocardiography, cardiac catheterization (needed to plan operation)

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71
Q

What is the surgical treatment for aortic stenosis?

A

Valve replacement with tissue or mechanical prosthesis

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72
Q

What are the indications for surgical repair of aortic stenosis?

A

If patient is symptomatic, valve cross-sectional area is < 0.75 cm^2 (normal 2.5-3.5), or gradient > 50 mmHg

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73
Q

What are the pros and cons of mechanical valve replacement for aortic stenosis?

A

Mechanical valve is more durable, but requires lifetime anticoagulation

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74
Q

What is the treatment option for aortic stenosis in poor surgical candidates?

A

Balloon aortic valvuloplasty (percutaneous)

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75
Q

Why is a loud murmur often a good sign?

A

Implies a high gradient, which indicates preserved LV function

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76
Q

Why might an aortic stenosis murmur diminish over time?

A

It may imply a decreasing gradient from a decline in LV function

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77
Q

What is aortic insufficiency?

A

Incompetency of the aortic valve (regurgitant flow)

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78
Q

What are the causes of aortic insufficiency?

A

Bacterial endocarditis (S. aureus, S. viridans); rheumatic fever; annular ectasia from collagen vascular disease (Marfan’s syndrome)

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79
Q

What are the predisposing conditions for aortic insufficiency?

A

Bicuspid aortic valve, connective tissue disease

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80
Q

What are the symptoms of aortic insufficiency?

A

Palpitations from dysrhythmias and dilated LV; dyspnea/orthopnea from LV failure; excess fatigue; angina from decreased diastolic BP and coronary flow; Musset sign

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81
Q

What are the signs of aortic insufficiency?

A

Decreased diastolic BP; murmur (blowing, decrescendo diastolic at left sternal border); Austin-Flint murmur (reverberation of regurgitant flow); increased pulse pressure (“pistol shots”, “water-hammer” pulse palpated over peripheral arteries); Quincke sign (capillary pulsations of uvula)

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82
Q

Which diagnostic tests should be performed for aortic insufficiency?

A
  1. CXR (increasing heart size can be used to follow progression)
  2. Echocardiogram
  3. Catheterization (definitive)
  4. TEE
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83
Q

What is the treatment for aortic insufficiency?

A

Aortic valve replacement

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84
Q

What are the indications for surgical treatment of aortic insufficiency?

A

Symptomatic patients (CHF, PND); LV dilatation; decreasing LV function; decreasing EF; acute AI onset

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85
Q

What is the prognosis for aortic insufficiency?

A

Surgery gives symptomatic improvement and may improve longevity

86
Q

What is mitral stenosis?

A

Calcific degeneration and narrowing of the mitral valve resulting from rheumatic fever in most cases

87
Q

What are the symptoms of mitral stenosis?

A
  1. Dyspnea from increased LA pressure, causing pulmonary edema
  2. Hemoptysis
  3. Hoarseness from dilated left atrium impinging on the recurrent laryngeal nerve
  4. Palpitations (AFib)
88
Q

What are the signs of mitral stenosis?

A

Murmur (crescendo diastolic rumble at apex); irregular pulse from AFib caused by dilated LA; stroke caused by systemic emboli from LA

89
Q

Which diagnostic tests should be performed for mitral stenosis?

A

Echocardiogram, catheterization

90
Q

What are the indications for intervention for mitral stenosis?

A
  1. Symptoms (severe)
  2. Pulmonary HTN and mitral valve area < 1 cm^2
  3. Recurrent thromboembolism
91
Q

What are the treatment options for mitral stenosis?

A
  1. Open commissurotomy (open heart operation)
  2. Balloon valvuloplasty (percutaneous)
  3. Valve replacement
92
Q

What is the medical treatment for mild symptomatic patients with mitral stenosis?

A

Diuretics

93
Q

What is the prognosis for mitral stenosis?

A

> 80% of patients are well at 10 years with successful operation

94
Q

What is mitral regurgitation?

A

Incompetence of the mitral valve

95
Q

What are the causes of mitral regurgitation?

A

Severe mitral valve prolapse; rheumatic fever; post-MI from papillary muscle dysfunction or rupture; ruptured chordae

96
Q

What are the most common causes of mitral regurgitation?

A

Rheumatic fever; ruptured chordae; papillary muscle dysfunction

97
Q

What are the symptoms of mitral regurgitation?

A

Often insidious and late:

Dyspnea, palpitations, fatigue

98
Q

What are the signs of mitral regurgitation?

A

Murmur (holosystolic, apical radiating to the axilla)

99
Q

What are the indications for treatment of mitral regurgitation?

A
  1. Symptoms

2. LV > 45 mm end-systolic dimension

100
Q

What is the treatment for mitral regurgitation?

A
  1. Valve replacement

2. Annuloplasty (suture a prosthetic ring to the dilated valve annulus)

101
Q

What is artificial valve placement?

A

Replacement of damaged valves with tissue or mechanical prosthesis

102
Q

What are the types of artificial valves?

A

Tissue and mechanical

103
Q

What are pros and cons of tissue valve replacements?

A

No anticoagulation but shorter duration (30-40% need replacement in 10 years); good for elderly

104
Q

What are pros and cons of mechanical valve replacements?

A

Last longer (> 15 years) but require anticoagulation

105
Q

What are the contraindications to tissue valve replacement?

A

Dialysis (calcify), youth

106
Q

What are the contraindications to mechanical valve replacement?

A

Pregnancy (or going to be pregnant due to anticoagulation); bleeding risk (alcoholic, PUD)

107
Q

What is the operative mortality of artificial valve placement?

A

1-2%

108
Q

What must patients with an artificial valve receive before dental procedures?

A

Antibiotics

109
Q

What is the Ross procedure?

A

Aortic valve replacement with a pulmonary autograft

110
Q

What is infectious endocarditis?

A

Microbial infection of heart valves

111
Q

What are the predisposing conditions for infectious endocarditis?

A

Preexisting valvular lesion, procedures that lead to bacteremia, IV drug use

112
Q

What are the common causative agents of infectious endocarditis?

A

S. viridans (abnormal valves); S. aureus (IV drug use); S. epidermidis (prosthetic valves)

113
Q

What are the signs and symptoms of infectious endocarditis?

A

Murmur (new or changing); petechiae; splinter hemorrhage (fingernails); Roth spots (on retina); Osler nodes (raised, painful on soles and palms); Janeway lesions (similar to Osler nodes but flat and painless)

114
Q

Which diagnostic tests should be performed for infectious endocarditis?

A

Echocardiogram, TEE, serial blood cultures

115
Q

What is the treatment for infectious endocarditis?

A

Prolonged IV therapy with bactericidal antibiotics

116
Q

What is the prognosis for infectious endocarditis?

A

Infection can progress, requiring valve replacement

117
Q

What is the most common congenital heart defect?

A

VSD

118
Q

What is a ventricular septal defect?

A

Failure of ventricular septum to completely close (80% involve membranous portion of the septum), resulting in left-to-right shunt, increased pulmonary blood flow, and CHF if pulmonary to systemic flow is > 2:1.

119
Q

What is pulmonary vascular obstructive disease?

A

Pulmonary artery hyperplasia from increased pulmonary pressure caused by a left-to-right shunt (e.g. VSD)

120
Q

What is Eisenmenger’s syndrome?

A

Irreversible pulmonary HTN from chronic changes in pulmonary arterioles and increased right heart pressures.
Cyanosis develops when the shunt reverses (becomes right-to-left across the VSD)

121
Q

What is the treatment of Eisenmenger’s syndrome?

A

Only option is heart-lung transplant; otherwise, the disease is untreatable

122
Q

What is the incidence of VSD?

A

30% of heart defects (most common defect)

123
Q

What is patent ductus arteriosus?

A

Physiologic right-to-left shunt in fetal circulation connecting the pulmonary artery to the aorta bypassing fetal lungs.
Often this shunt persists in the neonate.

124
Q

What are the factors preventing closure of PDA?

A

Hypoxia, increased prostaglandins, prematurity

125
Q

What are the symptoms of PDA?

A

Often asymptomatic.

Poor feeding, respiratory distress, CHF with respiratory infections

126
Q

What are the signs of PDA?

A

Acyanotic, unless other cardiac lesions are present; continuous “machinery” murmur

127
Q

Which diagnostic tests should be performed?

A

PE; echocardiogram (rule out associated defects); catheter (seldom required)

128
Q

What is the medical treatment for PDA?

A

Indomethicin (prostaglandin inhibitor)

129
Q

What is the surgical treatment for PDA?

A

Surgical ligation or cardiac catheterization closure at 6-24 months

130
Q

What is tetralogy of Fallot?

A

Misalignment of the infundibular septum in early development, leading to the characteristic tetrad:

  1. Pulmonary stenosis/obstruction of RV outflow
  2. Overriding aorta
  3. RV hypertrophy
  4. VSD
131
Q

What are the symptoms of tetralogy of Fallot?

A

Hypoxic spells (squatting behavior increases SVR and increases pulmonary blood flow)

132
Q

What are the signs of tetralogy of Fallot?

A

Cyanosis, clubbing, murmur (SEM at left third intercostal space)

133
Q

Which diagnostic tests should be performed for tetralogy of Fallot?

A

CXR (small, “boot-shaped” heart and decreased pulmonary blood flow); echocardiography

134
Q

What is the prognosis for tetralogy of Fallot?

A

95% survival at specialized centers

135
Q

What is IHSS?

A

Idiopathic Hypertrophic Subaortic Stenosis:

Aortic outflow obstruction from septal tissue

136
Q

What is the usual presentation of IHSS?

A

Similar to aortic stenosis

137
Q

What is coarctation of the aorta?

A

Narrowing of the thoracic aorta, with or without intraluminal shelf (infolding of the media).
Usually found near ductus/ligamentum arteriosum.

138
Q

What are the 3 types of coarctation?

A
  1. Preductal (fatal in infancy if untreated)
  2. Juxtaductal
  3. Postductal
139
Q

What percentage of coarctations are associated with other cardiac defects?

A

60% (bicuspid aortic valve is most common)

140
Q

What is the major route of collateral circulation with coarctation?

A

Subclavian artery to the IMA to the intercostals to the descending aorta

141
Q

What are the risk factors for coarctation?

A

Turner’s syndrome, M > F

142
Q

What are the symptoms of coarctation?

A

HA, epistaxis, lower extremity fatigue (claudication)

143
Q

What are the signs of coarctation?

A

Decreased lower extremity pulses; systolic murmur (from turbulence across coarctation, often radiating to infrascapular region); continuous murmur (from dilated collaterals)

144
Q

Which diagnostic tests should be performed for coarctation?

A

CXR (aortic knob, coarctation, dilated post-stenotic aorta, rib notching is bony erosion from dilated intercostal collaterals); echocardiogram; cardiac catheterization if cardiac defects

145
Q

What is the treatment for coarctation?

A

Resection with end-to-end anastomosis; subclavian artery flap; patch graft (rare); interposition graft; endovascular repair (adults)

146
Q

What are the indications for surgery for coarctation?

A

Symptomatic patient or > 3-4 years

147
Q

What are the possible postoperative complications for coarctation?

A

Paraplegia; paradoxic HTN; mesenteric necrotizing panarteritis (GI bleeding); Horner’s syndrome; injury to recurrent laryngeal nerve

148
Q

What are the long-term concerns with surgery for coarctation?

A

Aortic dissection, HTN

149
Q

What is transposition of the great vessels?

A

Aorta originates from the RV and the pulmonary artery from the LV.
Fatal without PDA, ASD or VSD.

150
Q

What is the incidence of transposition of the great vessels?

A

5-8% of defects

151
Q

What are the signs and symptoms of transposition of the great vessels?

A

Cyanosis and CHF in neonatal period

152
Q

Which diagnostic tests should be performed for transposition of the great vessels?

A

CXR (“egg-shaped” heart contour), catheterization

153
Q

What is the treatment for transposition of the great vessels?

A

Arterial switch operation (aorta and pulmonary artery are moved to the correct ventricle and the coronaries are reimplanted)

154
Q

What is Ebstein’s anomaly?

A

Tricuspid valve is placed abnormally low in the RV, forming a large RA and a small RV, leading to tricuspid regurgitation and decreased RV output

155
Q

What are the signs and symptoms of Ebstein’s anomaly?

A

Cyanosis

156
Q

What are the risk factors of Ebstein’s anomaly?

A

400 X risk if mother has taken lithium

157
Q

What are vascular rings?

A

Many types.
Represent an anomalous development of the aorta/pulmonary artery from the embryonic aortic arch that surrounds and obstructs the trachea/esophagus.

158
Q

How are vascular rings diagnosed?

A

Barium swallow, MRI

159
Q

What are the signs and symptoms of vascular rings?

A

Most prominent is stridor from tracheal compression

160
Q

What are the causes of cyanosis?

A 
5 "Ts":
Tetralogy of Fallot
Truncus arteriosus
Totally anomalous pulmonary venous return
Tricuspid atresia
Transposition of the great vessels
161
Q

What is the most common benign cardiac tumor?

A

Myxoma in adults

162
Q

What is the most common location for cardiac tumor?

A

LA with pedunculated morphology

163
Q

What are the signs and symptoms of a cardia tumor?

A

Dyspnea, emboli

164
Q

What is the most common malignant cardiac tumor in children?

A

Rhabdomyosarcoma

165
Q

What is the cause of a thoracic aortic aneurysm?

A

Vast majority result from atherosclerosis, connective tissue disease

166
Q

What is the major differential diagnosis of a thoracic aortic aneurysm?

A

Aortic dissection

167
Q

What percentage of patients with a thoracic aortic aneurysm have aneurysms of the aorta at a different site?

A

33%

168
Q

What are the signs and symptoms of a thoracic aortic aneurysm?

A

Most are asymptomatic.

Chest pain, stridor, hemoptysis (rare), recurrent laryngeal nerve compression

169
Q

How is a thoracic aortic aneurysm most commonly discovered?

A

Routine CXR

170
Q

Which diagnostic tests should be performed for a thoracic aortic aneurysm?

A

CXR, CT, MRI, aortography

171
Q

What are the indications for treatment of a thoracic aortic aneurysm?

A

> 6 cm diameter; symptoms; rapid increase in diameter; rupture

172
Q

What is the treatment for a thoracic aortic aneurysm?

A

Replace with graft; open or endovascular stent

173
Q

What are the dreaded complications after treatment of a thoracic aortic aneurysm?

A

Paraplegia; anterior spinal syndrome

174
Q

What is aortic dissection?

A

Separation of the walls of the aorta from an intimal tear and disease of the tunica media.
A false lumen is formed and a “reentry” tear may occur, resulting in “double-barrel” aorta.

175
Q

What are the aortic dissection classifications?

A

DeBakey classification; Stanford classification

176
Q

What is a DeBakey type I?

A

Aortic dissection that involves the ascending and descending aorta

177
Q

What is a DeBakey type II?

A

Aortic dissection that involves the ascending aorta only

178
Q

What is a DeBakey type III?

A

Aortic dissection that involves the descending aorta only

179
Q

What is a Stanford type A?

A

A DeBakey type I or II aortic dissection

180
Q

What is a Stanford type B?

A

A DeBakey type III aortic dissection

181
Q

What is the etiology of an aortic dissection?

A

HTN; Marfan’s syndrome; bicuspid aortic valve; coarctation of the aorta; cystic medial necrosis; proximal aortic aneurysm

182
Q

What are the signs and symptoms of an aortic dissection?

A

Abrupt onset of severe chest pain, most often radiating/tearing to the back.
Onset is typically more abrupt than that of MI.
The pain can migrate as the dissection progresses.

183
Q

What are 3 sequelae of aortic dissection?

A
  1. Cardiac tamponade (Beck’s triad)
  2. Aortic insufficiency
  3. Aortic arterial branch occlusion/shearing, leading to ischemia in the involved circulation (i.e. unequal pulses, CVA, paraplegia, renal insufficiency, bowel ischemia, claudication)
184
Q

Which diagnostic tests are indicated for aortic dissection?

A

CXR (widened mediastinum, pleural effusion); TEE; CTA; aortography

185
Q

What is the treatment for a DeBakey type I or II aortic dissection?

A

Surgical because of risk of aortic insufficiency, compromise of cerebral and coronary circulation, tamponade, rupture

186
Q

What is the treatment for a DeBakey type III aortic dissection?

A

Medical (control BP), unless complicated by rupture or significant occlusions

187
Q

What is the surgery for an aortic dissection?

A

Open the aorta at the proximal extent of dissection, and then sew (graft to) intimal flap and adventitia circumferentially (endovascular an option)

188
Q

What is the preoperative treatment of aortic dissection?

A

Control BP with sodium nitroprusside and beta-blockers (e.g. esmolol)

189
Q

what is the postoperative treatment of aortic dissection?

A

Lifetime control of BP and monitoring of aortic size

190
Q

What is the possible cause of MI in a patient with aortic dissection?

A

Dissection involves the coronary arteries or underlying LAD

191
Q

What is a dissecting aortic aneurysm?

A

Misnomer (not aneurysm)

192
Q

What are the EKG signs of atrial fibrillation?

A

Irregularly irregular

193
Q

What are the EKG signs of premature ventricular complex?

A

Wide QRS

194
Q

What are the EKG signs of ventricular aneurysm?

A

ST elevation

195
Q

What are the EKG signs of ischemia?

A

ST elevation; ST depression; flipped T waves

196
Q

What are the EKG signs of infarction?

A

Q waves

197
Q

What are the EKG signs of pericarditis?

A

ST elevation throughout leads

198
Q

What are the EKG signs of RBBB?

A

Wide QRS and “rabbit ears” or R-R in V1 or V2

199
Q

What are the EKG signs of LBBB?

A

Wide QRS and “rabbit ears” or R-R in V5 or V6

200
Q

What are the EKG signs of Wolff-Parkinson-White?

A

Delta wave = slurred upswing on QRS

201
Q

What are the EKG signs of 1st degree A-V block?

A

Prolonged PR interval (0.2 seconds)

202
Q

What are the EKG signs of 2nd degree A-V block?

A

Dropped QRS.

Not all P waves transmit to produce ventricular contraction.

203
Q

What are the EKG signs of the Wenckebach phenomenon?

A

2nd degree block with progressive delay in PR interval prior to dropped beat

204
Q

What are the EKG signs of 3rd degree A-V block?

A

Complete A-V dissociation.

Random P wave and QRS.

205
Q

What is Mondor’s disease?

A

Thrombophlebitis of the thoracoepigastric veins

206
Q

How does an IABP work?

A

Has a balloon tip resting in the aorta.
Balloon inflates in diastole, increasing diastolic BP and coronary blood flow.
In systole, the balloon deflates, creating a negative pressure, lowering afterload, and increasing systolic BP.

207
Q

What electrolyte must be monitored during diuresis after CPB?

A

K

208
Q

How is extent/progress of post-bypass diuresis followed?

A

IO, CXR, JVD, edema, daily weight

209
Q

What is an Austin-Flint murmur?

A

Diastolic murmur of AI secondary to regurgitant turbulent flow

210
Q

Where is the least oxygenated blood in the body?

A

Coronary sinus

211
Q

What is the most common cause of a cardiac tumor?

A

Metastasis

ENTREGA (40 decks)

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