Brainscape's Knowledge GenomeTM

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


See full index

Section III Subspecialty Surgery P517 > Cardiovascular Surgery, C72 P648-671 > Flashcards

Cardiovascular Surgery, C72 P648-671 Flashcards

1
Q

What do the following
abbreviations stand for:
AI?
P648

A

Aortic Insufficiency/regurgitation

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

What do the following
abbreviations stand for:
AS?
P648

A

Aortic Stenosis

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

What do the following
abbreviations stand for:
ASD?
P648

A

Atrial Septal Defect

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

What do the following
abbreviations stand for:
CABG?
P648

A

Coronary Artery Bypass Grafting

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

What do the following
abbreviations stand for:
CAD?
P648

A

Coronary Artery Disease

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

What do the following
abbreviations stand for:
CPB?
P648

A

CardioPulmonary Bypass

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

What do the following
abbreviations stand for:
IABP?
P648

A

IntraAortic Balloon Pump

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

What do the following
abbreviations stand for:
LAD?
P648

A

Left Anterior Descending coronary

artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do the following
abbreviations stand for:
IMA?
P649

A

Internal Mammary Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do the following
abbreviations stand for:
MR?
P649

A

Mitral Regurgitation

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

What do the following
abbreviations stand for:
PTCA?
P649

A

Percutaneous Transluminal Coronary

Angioplasty (balloon angioplasty)

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

What do the following
abbreviations stand for:
VAD?
P649

A

Ventricular Assist Device

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

What do the following
abbreviations stand for:
VSD?
P649

A

Ventricular Septal Defect

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

Define the following terms:
Stroke volume (SV)
P649

A

mL of blood pumped per heartbeat

SV = CO/HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define the following terms:
Cardiac output (CO)
P649

A

Amount of blood pumped by the heart

each minute: heart rate x SV

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

Define the following terms:
Cardiac Index (CI)
P649

A

CO/BSA (body surface area)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define the following terms:
Ejection fraction
P649

A

Percentage of blood pumped out of the
left ventricle: SV = end diastolic volume
(nl 55%–70%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define the following terms:
Compliance
P649

A

Change in volume/change in pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define the following terms:
SVR
P649

A

Systemic Vascular Resistance

= (MAP – CVP) / (CO x 80)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define the following terms:
Preload
P649

A

Left ventricular end diastolic pressure or

volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define the following terms:
Afterload
P649

A

Arterial resistance the heart pumps

against

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Define the following terms:
PVR
P649

A

Pulmonary Vascular Resistance =

PA(mean) – PCWP/CO x 80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Define the following terms:
MAP
P649

A

Mean Arterial Pressure = diastolic BP +

1/3 (systolic BP – diastolic BP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a normal CO?

P649

A

4 to 8 L/minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a normal CI?

P649

A

2.5 to 4 L/minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the ways to
increase CO?
P650

A

Remember “MR. PAIR”:

1. Mechanical assistance (IABP, VAD)
2. Rate—Increase heart rate

3. Preload—Increase preload
4. Afterload—Decrease afterload
5. Inotropes—Increase contractility
6. Rhythm—Normal sinus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When does most of the
coronary blood flow take
place?
P650

A

During diastole (66%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Name the three major
coronary arteries.
P650

A
  1. Left Anterior Descending (LAD)
  2. Circumflex
  3. Right coronary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the three main
“cardiac electrolytes”?
P650

A
  1. Calcium (inotropic)
  2. Potassium (dysrhythmias)
  3. Magnesium (dysrhythmias)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

ACQUIRED HEART DISEASE
CORONARY ARTERY DISEASE (CAD)
What is it?
P650

A

Atherosclerotic occlusive lesions of the
coronary arteries; segmental nature
makes CABG possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

ACQUIRED HEART DISEASE
CORONARY ARTERY DISEASE (CAD)
What is the incidence?
P650

A

CAD is the #1 killer in the Western
world; >50% of cases are triple vessel
diseases involving the LAD, circumflex,
and right coronary arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

ACQUIRED HEART DISEASE
CORONARY ARTERY DISEASE (CAD)
What are the symptoms?
P650

A 
If ischemia occurs (low flow, vasospasm,
thrombus formation, plaque rupture, or a
combination), patient may experience
chest pain, crushing, substernal shortness
of breath, nausea/upper abdominal pain,
sudden death, or may be asymptomatic
with fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q 
ACQUIRED HEART DISEASE
CORONARY ARTERY DISEASE (CAD)
Who classically gets “silent”
MIs?
P650
A

Patients with diabetes (autonomic

dysfunction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

ACQUIRED HEART DISEASE
CORONARY ARTERY DISEASE (CAD)
What are the risk factors?
P651

A 
HTN
Smoking
High cholesterol/lipids (240)
Obesity
Diabetes mellitus
Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q 
ACQUIRED HEART DISEASE
CORONARY ARTERY DISEASE (CAD)
Which diagnostic tests
should be performed?
P651
A 
Exercise stress testing ( ± thallium)
Echocardiography
Localize dyskinetic wall segments
Valvular dysfunction
Estimate ejection fraction
Cardiac catheterization with coronary
    angiography and left ventriculography
    (the definitive test)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

ACQUIRED HEART DISEASE
CORONARY ARTERY DISEASE (CAD)
What is the treatment?
P651

A

Medical therapy (-blockers, aspirin,
nitrates, HTN medications), angioplasty
(PTCA), +/- stents, surgical therapy: CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

CABG
What is it?
P651 (picture)

A

Coronary Artery Bypass Grafting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

CABG
What are the indications?
P651

A 
Left main disease
≥2-vessel disease (especially diabetics)
Unstable or disabling angina unresponsive
    to medical therapy/PTCA
Postinfarct angina
Coronary artery rupture, dissection,
    thrombosis after PTCA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

CABG
CABG vs. PTCA +/- stents?
P652

A 
CABG = Survival improvement for
    diabetics and ≥2-vessel disease,
    ↑ short-term morbidity
PTCA = ↓ short-term morbidity, ↓ cost,
    ↓ hospital stay, ↑ reintervention,
    ↑ postprocedure angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

CABG
What procedures are most
often used in the treatment?
P652

A 
Coronary arteries grafted (usually 3–6):
internal mammary pedicle graft and
saphenous vein free graft are most often
used (IMA 95% 10-year patency vs. 50%
with saphenous)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q 
CABG
What other vessels are
occasionally used for
grafting?
P652
A

Radial artery, inferior epigastric vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

CABG
What are the possible
complications?
P652

A 
Hemorrhage
Tamponade
MI, dysrhythmias
Infection
Graft thrombosis
Sternal dehiscence
Postpericardiotomy syndrome, stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

CABG
What is the operative
mortality?
P652

A

1% to 3% for elective CABG

vs. 5%–10% for acute MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q 
CABG
What medications should
almost every patient be
given after CABG?
P652
A

Aspirin, ℬ-blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

CABG
Can a CABG be performed
off cardiopulmonary bypass?
P652

A

Yes, today they are performed with or

without bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

POSTPERICARDIOTOMY SYNDROME
What is it?
P652

A

Pericarditis after pericardiotomy
(unknown etiology), occurs weeks to
3 months postoperatively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

POSTPERICARDIOTOMY SYNDROME
What are the signs/
symptoms?
P652

A 
Fever
Chest pain, atrial fibrillation
Malaise
Pericardial friction rub
Pericardial effusion/pleural effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

POSTPERICARDIOTOMY SYNDROME
What is the treatment?
P653

A

NSAIDs, +/- steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

POSTPERICARDIOTOMY SYNDROME
What is pericarditis after an
MI called?
P653

A

Dressler’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

CARDIOPULMONARY BYPASS (CPB)
What is it?
P653 (picture)

A 
Pump and oxygenation apparatus 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

CARDIOPULMONARY BYPASS (CPB)
Is anticoagulation necessary?
P653

A

Yes, just before and during the procedure,

with heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

CARDIOPULMONARY BYPASS (CPB)
How is anticoagulation
reversed?
P653

A

Protamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q 
CARDIOPULMONARY BYPASS (CPB)
What are the ways to
manipulate cardiac output
after CPB?
P653
A

Rate, rhythm, afterload, preload, inotropes,

mechanical (IABP and VAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

CARDIOPULMONARY BYPASS (CPB)
What mechanical problems
can decrease CO after CPB?
P653

A

Cardiac tamponade, pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

CARDIOPULMONARY BYPASS (CPB)
What is “tamponade
physiology”?
P653

A

↓ Cardiac output, ↑ heart rate, hypotension,

↑ CVP = ↑ wedge pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

CARDIOPULMONARY BYPASS (CPB)
What are the possible
complications?
P654

A 
Trauma to formed blood elements
    (especially thrombocytopenia and
    platelet dysfunction)
Pancreatitis (low flow)
Heparin rebound
CVA
Failure to wean from bypass
Technical complications (operative
    technique)
MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q 
CARDIOPULMONARY BYPASS (CPB)
What are the options for
treating postop CABG
mediastinal bleeding?
P654
A

Protamine, ↑ PEEP, FFP, platelets,

aminocaproic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

CARDIOPULMONARY BYPASS (CPB)
What is “heparin rebound”?
P654

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

CARDIOPULMONARY BYPASS (CPB)
What is the method of
lowering SVR after CPB?
P654

A

Warm the patient; administer sodium

nitroprusside (SNP) and dobutamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q 
CARDIOPULMONARY BYPASS (CPB)
What are the options if a
patient cannot be weaned
from CPB?
P654
A

Inotropes (e.g., epinephrine)

VAD, IABP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

CARDIOPULMONARY BYPASS (CPB)
What percentage of patients
goes into AFib after CPB?
P654

A

Up to 33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q 
CARDIOPULMONARY BYPASS (CPB)
What is the workup of a
postoperative patient with
AFib?
P654
A 
Rule out PTX (ABG, CT scan), acidosis
(ABG), electrolyte abnormality (LABS),
and ischemia (EKG), CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

CARDIOPULMONARY BYPASS (CPB)
What is a MIDCAB?
P654

A

Minimally Invasive Direct Coronary Artery
Bypass—LIMA to LAD bypass without
CPB and through a small thoracotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

CARDIOPULMONARY BYPASS (CPB)
What is TMR?
P654

A 
TransMyocardial laser Revascularization:
laser through groin catheter makes small
holes (intramyocardial sinusoids) in
cardiac muscle to allow blood to nourish
the muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

CARDIOPULMONARY BYPASS (CPB)
What is OPCAB?
P655

A

Off Pump Coronary Artery Bypass—

median sternotomy but no bypass pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

AORTIC STENOSIS (AS)
What is it?
P655

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

AORTIC STENOSIS (AS)
What are the causes?
P655

A

Calcification of bicuspid aortic valve
Rheumatic fever
Acquired calcific AS (7th to 8th decades)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

AORTIC STENOSIS (AS)
What are the symptoms?
P655

A 
Angina (5 years life expectancy if left
    untreated)
Syncope (3 years life expectancy if left
    untreated)
CHF (2 years life expectancy if left
    untreated)
Often asymptomatic until late
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q 
AORTIC STENOSIS (AS)
What is the memory aid
for the aortic stenosis
complications?
P655
A

Aortic Stenosis Complications = Angina

Syncope CHF—5,3,2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

AORTIC STENOSIS (AS)
What are the signs?
P655

A 
Murmur: crescendo-decrescendo systolic
    second right intercostal space with
    radiation to the carotids
Left ventricular heave or lift from left
    ventricular hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

AORTIC STENOSIS (AS)
What tests should be
performed?
P655

A

CXR, ECG, echocardiography
Cardiac catheterization—needed to plan
operation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

AORTIC STENOSIS (AS)
What is the surgical
treatment?
P655

A

Valve replacement with tissue or

mechanical prosthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

AORTIC STENOSIS (AS)
What are the indications for
surgical repair?
P655

A

If patient is symptomatic or valve crosssectional
area is (normal 2.5
to 3.5 cm) and/or gradient >50 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

AORTIC STENOSIS (AS)
What are the pros/cons of
mechanical valve?
P655

A

Mechanical valve is more durable, but

requires lifetime anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

AORTIC STENOSIS (AS)
What is the treatment option
in poor surgical candidates?
P656

A

Balloon aortic “valvuloplasty”

percutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

AORTIC STENOSIS (AS)
Why is a loud murmur often
a good sign?
P656

A

Implies a high gradient, which indicates

preserved LV function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

AORTIC STENOSIS (AS)
Why might an AS murmur
diminish over time?
P656

A

It may imply a decreasing gradient from

a decline in LV function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

AORTIC INSUFFICIENCY (AI)
What is it?
P656

A

Incompetency of the aortic valve

regurgitant flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

AORTIC INSUFFICIENCY (AI)
What are the causes?
P656

A 
Bacterial endocarditis (Staphylococcus
    aureus, Streptococcus viridans)
Rheumatic fever (rare)
Annular ectasia from collagen vascular
    disease (especially Marfan’s syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

AORTIC INSUFFICIENCY (AI)
What are the predisposing
conditions?
P656

A

Bicuspid aortic valve, connective tissue

disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

AORTIC INSUFFICIENCY (AI)
What are the symptoms?
P656

A 
Palpitations from dysrhythmias and
    dilated left ventricle
Dyspnea/orthopnea from left ventricular
    failure
Excess fatigue
Angina from ↓ diastolic BP and coronary
    flow (Note: Most coronary blood flow
    occurs during diastole and aorta
    rebound)
Musset sign (bobble-head)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

AORTIC INSUFFICIENCY (AI)
What are the signs?
P656

A 
↑ 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

AORTIC INSUFFICIENCY (AI)
Which diagnostic tests
should be performed?
P657

A 
1. CXR: increasing heart size can be
    used to follow progression
2. Echocardiogram
3. Catheterization (definitive)
4. TEE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

AORTIC INSUFFICIENCY (AI)
What is the treatment?
P657

A

Aortic valve replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

AORTIC INSUFFICIENCY (AI)
What are the indications for
surgical treatment?
P657

A 
Symptomatic patients (CHF, PND, etc.),
left ventricle dilatation, decreasing LV
function, decreasing EF, acute AI onset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

AORTIC INSUFFICIENCY (AI)
What is the prognosis?
P657

A

Surgery gives symptomatic improvement
and may improve longevity; low operative
risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

MITRAL STENOSIS (MS)
What is it?
P657

A

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

88
Q

MITRAL STENOSIS (MS)
What are the symptoms?
P657

A 
1. Dyspnea from increased left atrial
    pressure, causing pulmonary edema
    (i.e., CHF)
2. Hemoptysis (rarely life-threatening)
3. Hoarseness from dilated left atrium
    impinging on the recurrent laryngeal
    nerve
4. Palpations (AFib)
89
Q

MITRAL STENOSIS (MS)
What are the signs?
P657

A

Murmur: crescendo diastolic rumble at apex
Irregular pulse from AFib caused by
dilated left atrium
Stroke caused by systemic emboli from
left atrium (AFib and obstructed valve
allow blood to pool in the left atrium
and can lead to thrombus formation)

90
Q

MITRAL STENOSIS (MS)
Which diagnostic tests
should be performed?
P657

A

Echocardiogram

Catheterization

91
Q

MITRAL STENOSIS (MS)
What are the indications for
intervention?
P657

A
  1. Symptoms (severe)
  2. Pulmonary HTN and mitral valve area
    /m
  3. Recurrent thromboembolism
92
Q

MITRAL STENOSIS (MS)
What are the treatment
options?
P658

A
  1. Open commissurotomy (open heart
    operation)
  2. Balloon valvuloplasty: percutaneous
  3. Valve replacement
93
Q 
MITRAL STENOSIS (MS)
What is the medical
treatment for mild
symptomatic patients?
P658
A

Diuretics

94
Q

MITRAL STENOSIS (MS)
What is the prognosis?
P658

A

> 80% of patients are well at 10 years

with successful operation

95
Q

MITRAL REGURGITATION (MR)
What is it?
P658

A

Incompetence of the mitral valve

96
Q

MITRAL REGURGITATION (MR)
What are the causes?
P658

A 
Severe mitral valve prolapse (some
    prolapse is found in 5% of the
    population, with women ≥men)
Rheumatic fever
Post-MI from papillary muscle
    dysfunction/rupture
Ruptured chordae
97
Q

MITRAL REGURGITATION (MR)
What are the most common
causes?
P658

A 
Rheumatic fever (#1 worldwide), ruptured
chordae/papillary muscle dysfunction
98
Q

MITRAL REGURGITATION (MR)
What are the symptoms?
P658

A

Often insidious and late: dyspnea,

palpitations, fatigue

99
Q

MITRAL REGURGITATION (MR)
What are the signs?
P658

A

Murmur: holosystolic, apical radiating to

the axilla

100
Q

MITRAL REGURGITATION (MR)
What are the indications for
treatment?
P658

A
  1. Symptoms
  2. LV 45 mm end-systolic dimension
    (left ventricular dilation)
101
Q

MITRAL REGURGITATION (MR)
What is the treatment?
P658

A
  1. Valve replacement
  2. Annuloplasty: suture a prosthetic ring
    to the dilated valve annulus
102
Q

ARTIFICIAL VALVE PLACEMENT
What is it?
P659

A

Replacement of damaged valves with

tissue or mechanical prosthesis

103
Q

ARTIFICIAL VALVE PLACEMENT
What are the types of
artificial valves?
P659

A

Tissue and mechanical

104
Q

ARTIFICIAL VALVE PLACEMENT
What are the pros and cons:
Tissue?
P659

A

NO anticoagulation but shorter duration
(20%–40% need replacement in 10 years);
good for elderly

105
Q

ARTIFICIAL VALVE PLACEMENT
What are the pros and cons:
Mechanical?
P659

A 
Last longer ( > 15 years) but require
ANTICOAGULATION
106
Q 
ARTIFICIAL VALVE PLACEMENT
What are the pros and cons:
Contraindications for
tissue valve?
P659
A

Dialysis (calcify), youth

107
Q 
ARTIFICIAL VALVE PLACEMENT
What are the pros and cons:
Contraindications for
mechanical valve?
P659
A

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

108
Q

ARTIFICIAL VALVE PLACEMENT
What is the operative
mortality?
P659

A

From 1% to 5% in most series

109
Q 
ARTIFICIAL VALVE PLACEMENT
What must patients with an
artificial valve receive before
dental procedures?
P659
A

Antibiotics

110
Q

ARTIFICIAL VALVE PLACEMENT
Define the Ross procedure.
P659

A

Aortic valve replacement with a pulmonary

autograft (i.e., patient’s own valve!)

111
Q

INFECTIOUS ENDOCARDITIS
What is it?
P659

A

Microbial infection of heart valves

112
Q

INFECTIOUS ENDOCARDITIS
What are the predisposing
conditions?
P659

A

Preexisting valvular lesion, procedures

that lead to bacteremia, IV drug use

113
Q

INFECTIOUS ENDOCARDITIS
What are the common
causative agents?
P659

A 
S. viridans: associated with abnormal
    valves
S. aureus: associated with IV drug use
S. epidermidis: associated with prosthetic
    valves
114
Q

INFECTIOUS ENDOCARDITIS
What are the signs/
symptoms?
P660

A 
Murmur (new or changing)
Petechiae
Splinter hemorrhage (fingernails)
Roth spots (on retina)
Osler nodes (raised, painful on soles and
    palms; Osler = Ouch!)
Janeway lesions (similar to Osler nodes,
    but flat and painless) (JaneWAY =
    pain aWAY)
115
Q

INFECTIOUS ENDOCARDITIS
Which diagnostic tests
should be performed?
P660

A

Echocardiogram, TEE

Serial blood cultures (definitive)

116
Q

INFECTIOUS ENDOCARDITIS
What is the treatment?
P660

A

Prolonged IV therapy with bactericidal
antibiotics, to which infecting
organisms are sensitive

117
Q

INFECTIOUS ENDOCARDITIS
What is the prognosis?
P660

A

Infection can progress, requiring valve

replacement

118
Q

CONGENITAL HEART DISEASE
VENTRICULAR SEPTAL DEFECT (VSD)
What is its claim to fame?
P660

A

Most common congenital heart defect

119
Q

CONGENITAL HEART DISEASE
VENTRICULAR SEPTAL DEFECT (VSD)
What is it?
P660

A 
Failure of ventricular septum to
completely close; 80% of cases involve
the 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
120
Q 
CONGENITAL HEART DISEASE
VENTRICULAR SEPTAL DEFECT (VSD)
What is pulmonary vascular
obstructive disease?
P660
A

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

121
Q 
CONGENITAL HEART DISEASE
VENTRICULAR SEPTAL DEFECT (VSD)
What is Eisenmenger’s
syndrome?
P660
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)
122
Q 
CONGENITAL HEART DISEASE
VENTRICULAR SEPTAL DEFECT (VSD)
What is the treatment of
Eisenmenger’s syndrome?
P660
A

Only option is heart-lung transplant;

otherwise, the disease is untreatable

123
Q 
CONGENITAL HEART DISEASE
VENTRICULAR SEPTAL DEFECT (VSD)
What is the incidence of
VSD?
P661
A

30% of heart defects (most common

defect)

124
Q

CONGENITAL HEART DISEASE
PATENT DUCTUS ARTERIOSUS (PDA)
What is it?
P661

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

125
Q 
CONGENITAL HEART DISEASE
PATENT DUCTUS ARTERIOSUS (PDA)
What are the factors
preventing closure?
P661
A

Hypoxia, increased prostaglandins,

prematurity

126
Q

CONGENITAL HEART DISEASE
PATENT DUCTUS ARTERIOSUS (PDA)
What are the symptoms?
P661

A

Often asymptomatic
Poor feeding
Respiratory distress
CHF with respiratory infections

127
Q

CONGENITAL HEART DISEASE
PATENT DUCTUS ARTERIOSUS (PDA)
What are the signs?
P661

A

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

128
Q 
CONGENITAL HEART DISEASE
PATENT DUCTUS ARTERIOSUS (PDA)
Which diagnostic tests
should be performed?
P661
A

Physical examination
Echocardiogram (to rule out associated
defects)
Catheter (seldom required)

129
Q 
CONGENITAL HEART DISEASE
PATENT DUCTUS ARTERIOSUS (PDA)
What is the medical
treatment?
P661
A

Indomethacin is an NSAID:
prostaglandin (PG) inhibitor (PG keeps
PDA open)

130
Q 
CONGENITAL HEART DISEASE
PATENT DUCTUS ARTERIOSUS (PDA)
What is the surgical
treatment?
P661
A

Surgical ligation or cardiac
catheterization closure at 6 months to
2 years of age

131
Q

CONGENITAL HEART DISEASE
TETRALOGY OF FALLOT (TOF)
What is it?
P661

A 
Misalignment of the infundibular septum
in early development, leading to the
characteristic tetrad:
    1. Pulmonary stenosis/obstruction of
       right ventricular outflow
    2. Overriding aorta
    3. Right ventricular hypertrophy
    4. VSD
132
Q

CONGENITAL HEART DISEASE
TETRALOGY OF FALLOT (TOF)
What are the symptoms?
P662

A

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

133
Q

CONGENITAL HEART DISEASE
TETRALOGY OF FALLOT (TOF)
What are the signs?
P662

A

Cyanosis
Clubbing
Murmur: SEM at left third intercostal
space

134
Q 
CONGENITAL HEART DISEASE
TETRALOGY OF FALLOT (TOF)
Which diagnostic tests
should be performed?
P662
A

CXR: small, “boot-shaped” heart and
decreased pulmonary blood flow
Echocardiography

135
Q

CONGENITAL HEART DISEASE
TETRALOGY OF FALLOT (TOF)
What is the prognosis?
P662

A

95% survival at specialized centers

136
Q

CONGENITAL HEART DISEASE
IHSS
What is IHSS?
P662

A

Idiopathic Hypertrophic Subaortic

Stenosis

137
Q

CONGENITAL HEART DISEASE
IHSS
What is it?
P662

A

Aortic outflow obstruction from septal

tissue

138
Q 
CONGENITAL HEART DISEASE
IHSS
What is the usual
presentation?
P662
A

Similar to aortic stenosis

139
Q

CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What is it?
P662

A

Narrowing of the thoracic aorta, with or
without intraluminal “shelf” (infolding of
the media); usually found near ductus/
ligamentum arteriosum

140
Q

CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What are the three types?
P662

A
  1. Preductal (fatal in infancy if untreated)
  2. Juxtaductal
  3. Postductal
141
Q 
CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What percentage are
associated with other
cardiac defects?
P662
A

60% (bicuspid aortic valve is most

common)

142
Q 
CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What is the major route of
collateral circulation?
P662
A

Subclavian artery to the IMA to the

intercostals to the descending aorta

143
Q

CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What are the risk factors?
P662

A

Turner’s syndrome, male > female

144
Q

CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What are the symptoms?
P663

A

Headache
Epistaxis
Lower extremity fatigue → claudication

145
Q

CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What are the signs?
P663

A

Pulses: decreased lower extremity pulses
Murmurs:
1. Systolic—from turbulence across
coarctation, often radiating to infrascapular
region
2. Continuous—from dilated collaterals

146
Q 
CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
Which diagnostic tests
should be performed?
P663
A

CXR: “3” sign is aortic knob, coarctation,
and dilated poststenotic aorta; rib
notching is bony erosion from dilated
intercostal collaterals
Echocardiogram
Cardiac catheterization if cardiac defects

147
Q

CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What is the treatment?
P663

A

Surgery:
Resection with end-to-end anastomosis
Subclavian artery flap
Patch graft (rare)
Interposition graft
Endovascular repair an option in adults

148
Q 
CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What are the indications for
surgery?
P663
A

Symptomatic patient

Asymptomatic patient >3 to 4 years

149
Q 
CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What are the possible
postoperative complications?
P663
A 
Paraplegia
“Paradoxic” HTN
Mesenteric necrotizing panarteritis (GI
    bleeding), Horner’s syndrome, injury
    to recurrent laryngeal nerve
150
Q 
CONGENITAL HEART DISEASE
COARCTATION OF THE AORTA
What are the long-term
concerns?
P663
A

Aortic dissection, HTN

151
Q

CONGENITAL HEART DISEASE
TRANSPOSITION OF THE GREAT VESSELS
What is it?
P663

A 
Aorta originates from the right ventricle
and the pulmonary artery from the left
ventricle; fatal without PDA, ASD, or
VSD—to allow communication between
the left and right circulations
152
Q

CONGENITAL HEART DISEASE
TRANSPOSITION OF THE GREAT VESSELS
What is the incidence?
P664

A

From 5% to 8% of defects

153
Q 
CONGENITAL HEART DISEASE
TRANSPOSITION OF THE GREAT VESSELS
What are the signs/
symptoms?
P664
A

Most common lesion that presents with
cyanosis and CHF in neonatal period
( >90% by day 1)

154
Q 
CONGENITAL HEART DISEASE
TRANSPOSITION OF THE GREAT VESSELS
Which diagnostic tests
should be performed?
P664
A

CXR: “egg-shaped” heart contour

Catheterization (definitive)

155
Q

CONGENITAL HEART DISEASE
TRANSPOSITION OF THE GREAT VESSELS
What is the treatment?
P664

A

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

156
Q

CONGENITAL HEART DISEASE
EBSTEIN’S ANOMALY
What is it?
P664

A 
Tricuspid valve is placed abnormally low
in the right ventricle, forming a large
right atrium and a small right ventricle,
leading to tricuspid regurgitation and
decreased right ventricular output
157
Q

CONGENITAL HEART DISEASE
EBSTEIN’S ANOMALY
What are the signs/symptoms?
P664

A

Cyanosis

158
Q

CONGENITAL HEART DISEASE
EBSTEIN’S ANOMALY
What are the risk factors?
P664

A

400x the risk if the mother has taken

lithium

159
Q

CONGENITAL HEART DISEASE
VASCULAR RINGS
What are they?
P664

A

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

160
Q

CONGENITAL HEART DISEASE
VASCULAR RINGS
How are they diagnosed?
P664

A

Barium swallow, MRI

161
Q 
CONGENITAL HEART DISEASE
VASCULAR RINGS
What are the signs/
symptoms?
P664
A

Most prominent is stridor from tracheal

compression

162
Q

CONGENITAL HEART DISEASE
CYANOTIC HEART DISEASE
What are the causes?
P664

A 
Five “Ts” of cyanotic heart disease:
    Tetralogy of Fallot
    Truncus arteriosus
    Totally anomalous pulmonary venous
       return (TAPVR)
    Tricuspid atresia
    Transposition of the great vessels
163
Q

CARDIAC TUMORS
What is the most common
benign lesion?
P665

A

Myxoma in adults

164
Q

CARDIAC TUMORS
What is the most common
location?
P665

A

Left atrium with pedunculated morphology

165
Q

CARDIAC TUMORS
What are the signs/
symptoms?
P665

A

Dyspnea, emboli

166
Q

CARDIAC TUMORS
What is the most common
malignant tumor in children?
P665

A

Rhabdomyosarcoma

167
Q

DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
What is the cause?
P665

A

Vast majority result from atherosclerosis,

connective tissue disease

168
Q 
DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
What is the major
differential diagnosis?
P665
A

Aortic dissection

169
Q 
DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
What percentage of patients
have aneurysms of the aorta
at a different site?
P665
A

≈33%! (Rule out AAA)

170
Q 
DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
What are the signs/
symptoms?
P665
A

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

171
Q 
DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
How is it most commonly
discovered?
P665
A

Routine CXR

172
Q 
DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
Which diagnostic tests
should be performed?
P665
A

CXR, CT scan, MRI, aortography

173
Q 
DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
What are the indications for
treatment?
P665
A

>6 cm in diameter
Symptoms
Rapid increase in diameter
Rupture

174
Q

DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
What is the treatment?
P666

A

Replace with graft, open or endovascular

stent

175
Q 
DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
What are the dreaded
complications after
treatment of a thoracic
aortic aneurysm?
P666
A

Paraplegia (up to 20%)

Anterior spinal syndrome

176
Q 
DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
What is anterior spinal
syndrome?
P666
A

Syndrome characterized by:
Paraplegia
Incontinence (bowel/bladder)
Pain and temperature sensation loss

177
Q

DISEASES OF THE GREAT VESSELS
THORACIC AORTIC ANEURYSM
What is the cause?
P666

A

Occlusion of the great radicular artery
of Adamkiewicz, which is one of the
intercostal/lumbar arteries from T8 to L4

178
Q

DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What is it?
P666

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

179
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the aortic
dissection classifications?
P666
A

DeBakey classification

Stanford classification

180
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
Define the DeBakey
classifications:
DeBakey type I
P666 (picture)
A

Involves ascending and descending

aorta

181
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
Define the DeBakey
classifications:
DeBakey type II
P667 (picture)
A

Involves ascending aorta only

182
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
Define the DeBakey
classifications:
DeBakey type III
P667 (picture)
A

Involves descending aorta only

183
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
Define the Stanford
classifications:
Type A
P667 (picture)
A 
Ascending aorta (requires surgery)
± Descending aorta (includes DeBakey
types I and II)
184
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
Define the Stanford
classifications:
Type B
P668 (picture)
A

Descending aorta only (nonoperative,
except for complications) (same as
DeBakey type III)

185
Q

DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What is the etiology?
P668

A 
HTN (most common)
Marfan’s syndrome
Bicuspid aortic valve
Coarctation of the aorta
Cystic medial necrosis
Proximal aortic aneurysm
186
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the signs/
symptoms?
P668
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; patient describes a
“tearing pain”

187
Q

DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
Note three other sequelae.
P668

A
  1. Cardiac tamponade; Beck’s triad—
    distant heart sounds, ↑ CVP with JVD,
    ↓ BP
  2. Aortic insufficiency—diastolic murmur
  3. Aortic arterial branch occlusion/
    shearing, leading to ischemia in the
    involved circulation (i.e., unequal pulses,
    CVA, paraplegia, renal insufficiency,
    bowel ischemia, claudication)
188
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
Which diagnostic tests are
indicated?
P668
A 
CXR:
    1. Widened mediastinum
    2. Pleural effusion
TEE
CTA (CT angiography)
Aortography (definitive gold standard but
    time-consuming!)
189
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What is the treatment of the
various types:
Types I and II (Stanford
type A)?
P669
A 
Surgical because of risk of:
    1. Aortic insufficiency
    2. Compromise of cerebral and coronary
       circulation
    3. Tamponade
    4. Rupture
190
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What is the treatment of the
various types:
Type III (Stanford
type B)?
P669
A

Medical (control BP), unless complicated

by rupture or significant occlusions

191
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
Describe the surgery for an
aortic dissection (Type I, II,
Stanford A).
P669
A

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

192
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What is the preoperative
treatment?
P669
A

Control BP with sodium nitroprusside
and -blockers (e.g., esmolol); -blockers
decrease shear stress

193
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What is the postoperative
treatment?
P669
A

Lifetime control of BP and monitoring of

aortic size

194
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What is the possible cause of
MI in a patient with aortic
dissection?
P669
A

Dissection involves the coronary arteries

or underlying LAD

195
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What is a dissecting aortic
aneurysm?
P669
A

Misnomer! Not an aneurysm!

196
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
Atrial fibrillation?
P669 (picture)
A

Irregularly irregular

197
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
PVC?
P670 (picture)
A

Premature Ventricular Complex:

Wide QRS

198
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
Ventricular aneurysm?
P670
A

ST elevation

199
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
Ischemia?
P670
A

ST elevation/ST depression/flipped

T waves

200
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
Infarction?
P670 (picture)
A

Q waves

201
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
Pericarditis?
P670
A

ST elevation throughout leads

202
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
RBBB?
P670
A

Right Bundle Branch Block: wide QRS

and “rabbit ears” or R-R in V1 or V2

203
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
LBBB?
P670
A

Left Bundle Branch Block: wide QRS

and “rabbit ears” or R-R in V5 or V6

204
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
Wolff-Parkinson-White?
P670
A

Delta wave = slurred upswing on QRS

205
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of the following disorders:
First degree A-V block?
P670
A

Prolonged P-R interval (0.2 second)

206
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
Second degree A-V block?
P670
A

Dropped QRS; not all P waves transmit

to produce ventricular contraction

207
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
Wenckebach
phenomenon?
P670
A

Second-degree block with progressive

delay in P-R interval prior to dropped beat

208
Q 
DISEASES OF THE GREAT VESSELS
AORTIC DISSECTION
What are the EKG signs of
the following disorders:
Third-degree A-V block?
P671
A

Complete A-V dissociation; random

P wave and QRS

209
Q

MISCELLANEOUS
What is Mondor’s disease?
P671

A

Thrombophlebitis of the

thoracoepigastric veins

210
Q

MISCELLANEOUS
What is a VAD?
P671

A

Ventricular Assist Device

211
Q

MISCELLANEOUS
How does an IABP work?
P671

A

IntraAortic Balloon Pump 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

212
Q 
MISCELLANEOUS
What electrolyte must be
monitored during diuresis
after CPB?
P671
A

K⁺

213
Q

MISCELLANEOUS
How is extent/progress of
postbypass diuresis followed?
P671

A

I’s and O’s, CXR, JVD, edema, daily

weight

214
Q

MISCELLANEOUS
What is an Austin Flint
murmur?
P671

A

Diastolic murmur of AI secondary to

regurgitant turbulent flow

215
Q

MISCELLANEOUS
Where is the least oxygenated
blood in the body?
P671

A

Coronary sinus

216
Q

MISCELLANEOUS
What is the most common
cause of a cardiac tumor?
P671

A

Metastasis

Section III Subspecialty Surgery P517 (11 decks)

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