Coronary artery

Question 1

A common complication associated with bilateral internal mammary artery (BIMA)

Answer 1

Higher incidence of sternal wound infection

Question 2

Which is better, skeletonized or pedicled IMA?

Answer 2

Skeletonized is better in terms of post-op pain and dysesthesia. But the flow and reactivity is similar in both.

Question 3

Spontaneous coronary artery dissection is more common in

Answer 3

More common in women (70%)

Pregnancy (25% of all cases)

Question 4

Which vessel is more commonly involved with spontaneous coronary artery dissection

Answer 4

LAD is the most commonly involved single vessel

20% of cases have multivessel dissections

Question 5

Recurrence rate of Spontaneous coronary artery dissection

Answer 5

20%

Question 6

Conservative therapy of stable patients at the initial diagnosis of spontaneous coronary artery dissection

Answer 6

Heparin
Antiplatelet drugs
prophylactic IABP
Of note, there is no consistent treatment algorithm.

Question 7

Management of decompensating patients with spontaneous coronary artery dissection

Answer 7

PCI and/or CABG

Question 8

Transmyocardial laser revascularization

Answer 8

No survival benefit, better quality of life
CO2 laser is more effective than other lasers
Not used in University of washington

Question 9

Mech of action of Transmyocardial laser revascularization

Answer 9

Neoangiogenesis
Cardiac denervation
Mech wall stress reduction secondary to the network of resulting scars

Question 10

Indication for Transmyocardial laser revascularization

Answer 10

a. Medically Refractory class III/IV angina (including Ranolazine sodium channel inhibitors) and EF > 30%
b. Regions of the myocardium with reversible ischemia that is not amenable to PCI or CABG.

Question 11

CABG with valvulopathy (mitral or tricuspid)

Answer 11

Echo to assess severity of mitral and tricuspid valve regurg for possible concomitant valve surgery

Question 12

Post op ST and T-wave changes after CABG

Answer 12

Usually benign
If concern for spasm: nitroglycerin drip
IABP if in shock of hypotensive
May need operative revision

Question 13

Survival benefit from PCI and CABG within ___ hours of onset of symptoms of STEMI

Answer 13

6

Question 14

In patients with acute STEMI and is on cardiogenic shock who had a failed primary PCI, next step?

Answer 14

emergency CABG. Avoid thrombolytics, as bleeding risk is prohibitively high.