CT

Question 1

Coronary venous position in relation to artery ?

Answer 1

Ant cardiac vein - RCA
Great cardiac vein - LAD
Middle cardiac vein - PDA (from RCA)

Question 2

Pulmonary vein stenosis is a risk with … ablation therapy for AF

Answer 2

Radio frequency > cryotherapy (however cryo has more recurrence rate of arrhythmias)

Question 3

IJ placement marks?

Answer 3

Between 2 heads of SCM just sup to clavicle with needle directed toward ipsilateral nipple

Question 4

Normal CVP tracing summary

a -> c -> x -> v -> y

Answer 4

a wave: (A)trial contraction, absent in atrial fibrillation

c wave: (C)losure of TV.
bulging into RA during RV isovolumetric contraction

x descent: rela(X)action of RA.
TV descends into RV with ventricular ejection and atrial relaxation

v wave: (V)illing or filling of the RA

y descent: atrial empt(Y)ing into RV through open TV

Question 5

High risk conditions for infective endocarditis are who should receive prophylaxis before dental, respiratory mucosa, or procedure involving infected skin

Answer 5

prosthetic cardiac valves,
history of infective endocarditis
unrepaired cyanotic CHD
completely repaired congenital heart defect during the first 6 months after the procedure
repaired CHD with residual defects at or adjacent to the site of prosthetic material
cardiac transplantation recipients with cardiac valvular disease.

Question 6

The goal for general anesthesia induction in the patient with cardiac tamponade is to

Answer 6

keep the heart fast (quick heart rate), full (maximize preload by maintain spontaneous ventilation and avoiding PEEP), and forward (avoiding cardiac depressants).

Question 7

Would you choice Katamine or propofol as induction agent for cardiac tamponade patients?

Answer 7

Propofol leads to decreased venous and systemic pressures in addition to exhibiting some myocardial depressant effects. Further, it blunts the baroreceptor reflex and would not allow for increased heart rate as a physiologic response.

Ketamine is the drug of choice for cardiac tamponade induction. Its maintenance of spontaneous ventilation and sympathomimetic effects without compromising hemodynamic goals make it the ideal agent for induction of general anesthesia for a patient in acute cardiac tamponade.

Question 8

Blood supply to anterior and (anterio)septal LV?

Answer 8

LAD

Question 9

Blood supply to inferior, (inferio)lateral, and (inferio)septal of LV?

Answer 9

RCA, (the septum spllied by LAD, so here the inferioseptal supplied by LAD and RCA).

Question 10

Blood supply to inferio(lateral) and Anterio(lateral) of LV?

Answer 10

LCx artery. (remember the inferior side of LV supplied by RCA, so here the inferiolateral supplied by both RCA and LCx).

Question 11

where is the site of radio-frequency ablation for atrial flutter?

Answer 11

isthmus between IVC and tricuspid annulus (caivotricuspid isthmus)

Question 12

Alpha-star vs pH-stat blood gas management

Answer 12

Alpha maintains normocarbia and normal pH based on the assumption that the patient is 37 C

pH-stat maintains normocarbia and normal pH based on actual temp of patient

So in pH-stat management the CPB circuit infuses CO2 into the blood to maintain normal pHat whatever the Temp. (The increase CO2 causes increase CBF)

Question 13

When is the left ventricular get refused ?

Answer 13

During diastole when aortic diastolic pressure is higher then LVEDP (preload)

Question 14

The most sensitive lead for arrhythmia? And what’s for ischemi

Answer 14

Lead 2 and V4

For ischemi V5

Question 15

For patient with post MI and intervention, when elective surgery can be done?

Answer 15

After medical management-> wait 30 days

If bare metal -> 30 days
If drug Eluting -> 6 months

After balloonplasty?

Question 16

IE ppx antibiotics for ?

Undergoing; gingival, RS, or prosthetic valve procedure.

Other would be …

Answer 16

Prosthetic valves
Previous IE
Valvulopathy in transplanted heart
CHD (unrepaired cynotic, residual defect, or who have prosthetic material during the first 6 months after procedure)

GU or GI procedure if there is active infection, or procedure on infected skin/muscle

Question 17

ARDS Treatment goal

Answer 17

The goal is to sustain the partial pressure of arterial oxygen at 55-80 mm Hg or the oxygen saturation at 88%-95% while also maintaining:

Low tidal volumes at 6-8 mL/kg predicted weight
Respiratory rate <35/min
Plateau pressure <30 cm H2O
Fraction of inspired oxygen (FiO2) <60%

Question 18

Landmark of line placement for

IJV
Femoral vein
Subclavian vein

Answer 18

IJV:
Btw stern also and clavicular heads of SCM muscle. The JIV is lateral to carotid artery.

Femoral vein:
Medial to the femoral artery at the femoral crease

Subclavian vein:
Midpoint of clavicle with needle directed towards the suprasternal notch.

Question 19

The RV is perfused during …

Answer 19

both systole and diastole whereas the LV is perfused during diastole only.

Question 20

Right sided coronary vs left sided coronary perfusion pressure equals too?

Answer 20

Right-sided coronary perfusion pressure during systole is equal to the difference between aortic systolic pressure and RVEDP.

Right-sided coronary perfusion pressure during diastole is equal to the difference between aortic diastolic pressure and RVEDP.

and because the LV prefused during diastole, left-sided coronary perfusion pressure is the difference between aortic diastolic pressure and left ventricular end-diastolic pressure (LVEDP).

Coronary perfusion pressure is improved by REDUCING both RVEDP and LVEDP.

Question 21

What medications should be avoided in SVT due to WPW?

Answer 21

Atrioventricular (AV) nodal blocking agents should be avoided as they increase conduction through the accessory pathway that may lead to ventricular fibrillation and subsequent cardiac arrest.

Can be safely managed with procainamide.

Question 22

Maneuvers reduces the shear force exerted on the stent-graft during deployment are ?

Answer 22

To avoid the windsock effect, hypotension, rapid ventricular pacing, or transient asystole can be employed.

Question 23

What shift expected of Positive lusitropy results on the myocardial pressure-volume loop.

Answer 23

Positive lusitropy results in a rightward shift of the diastolic filling phase on the myocardial pressure-volume loop. This results in increased CPP, LVEDV, and SV.

Question 24

The following diagnoses should be considered in patients with a large R wave in lead V1:

Answer 24

1) Right ventricular hypertrophy
2) Posterior wall MI
3) Wolff-Parkinson-White syndrome
4) Muscular dystrophy
5) Right atrial enlargement
6) Right ventricular strain with ST-T wave abnormalities