Fellowship - cardiac

Question 1

Describe the rationale for the use of deep hypothermic circulatory arrest and outline the pathophysiological consequences of this technique (44.3%)

Question 2

You are asked to provide anaesthesia for cardioversion for a 60-year-old male with atrial fibrillation. Which factors influence the success of the cardioversion, and a safe outcome?

Question 3

(a) Describe the common classification code for permanent pacemakers. (30%)(b) Outline the principles involved in the perioperative management of patients with a permanent pacemaker. (70%)

Question 4

Outline the considerations for successful weaning from cardiopulmonary bypass after coronary artery graft surgery.

Question 5

1. What are the prerequisites for separation from standard cardiopulmonary bypass after uneventful coronary artery bypass surgery? (50%) 2. What are the likely causes of hypotension in the immediate post-separation period? (50%)

Question 6

A patient who is 6 weeks post cardiac surgery has a pericardial effusion requiring treatment. Outline the symptoms and signs of this condition. (70%) Which of these features would trigger an urgent intervention? (30%)

Question 7

A 55-year-old patient with atrial fibrillation (AF) requires general anaesthesia in the cardiac catheter laboratory for electrophysiological (EP) study and catheter ablation. Discuss the principles of remote location anaesthesia relevant to this case.

Question 8

An otherwise well 35-year-old woman is scheduled for ablation of an accessory atrioventricular pathway in the Cardiac Electrophysiology laboratory. What are the implications for anaesthesia and how would you manage them?

Question 9

There is a 70-year-old female on your emergency list for an urgent laparotomy. She was involved in a motor vehicle accident this morning and sustained multiple trauma. Her medications include clopidogrel to cover the insertion of bare metal stents into her coronary arteries 2 months ago. Describe the mechanism and duration of action of clopidogrel. (30%) What are the major considerations for the perioperative period in view of the patient’s stent? (70%)

Question 10

A 65yo male presents in PAC. He is scheduled for fem-pop bypass surgery for PVD in 4 days time. He has ischaemic rest pain in his leg. Evaluate the usefulness of initiating therapy with beta-blockers to reduce the incidence of perioperative myocardial infarction in this man.

Question 11

A patient with an AICD with biventricular pacing presents for elective surgery. Describe how the presence of this device influences your perioperative management of this patient.

Question 12

Describe how the ECG should be used to monitor for intraoperative myocardial ischemia in a patient with ischemic heart disease.

Question 13

A 56 year old diabetic is scheduled for laparoscopic nephrectomy. This is his pre-operative 12 lead ECG. Ten minutes into the procedure his BP is 70/30 and his ECG lead 2 monitor looks like this. (Shows CHB). What does ECG 1 show? What Does ECG2 show? Outline your management of the situation associated with ECG 2.

Question 14

The first patient on your orthopaedic list tomorrow is scheduled for left total hip replacement. He has an implanted (permanent) cardiac pacemaker. Discuss the relevant factors in your pre-anaesthetic assessment of this patient.

Question 15

List the causes of acute atrial fibrillation in the perioperative period. Describe your management of acute atrial fibrillation which occurs in the PACU (Post-anaesthesia Care Unit) in a patient who has had a total hip replacement.

Question 16

Critically evaluate the use of Beta blockers in the perioperative period to prevent myocardial infarction.

Question 17

Critically evaluate the role of cardioversion in the management of intraoperative arrythmias.

Question 18

How would you assess the severity of cardiac failure in a 75 year old man presenting for joint replacement surgery? Include any relevant investigations.

Question 19

What is the role for radionucleotide imaging in the assessment of ischaemic heart disease prior to general anaesthesia for non-cardiac surgery?

Question 20

A 50yo patient with a past history of well controlled ischaemic heart disease is anaesthetised for an emergency laparotomy. Thirty minutes into the surgery, you notice new ST segment depression on the ECG. Describe your management.

Question 21

Discuss the methods available for investigating a clinical suspicion of acute postoperative MI.

Question 22

“A 63 yo man who lives independently, presents with a perforated ulcer requiring laparotomy. He has been treated for cardiac failure for 5 years. How would you assess the severity of his cardiac failure at the bedside?
Justify your choice of deep venous thrombosis prophylaxis.
How would you manage him if he developed pulmonary oedema during his surgery?”

Question 23

What is the role for radionuclide imaging in the assessment of ischaemic heart disease prior to general anaesthesia for non-cardiac surgery?

Question 24

“A 59 yo patient presents for the first time with a subacute bowel obstruction requiring laparotomy in the next two or three days. You are asked by the surgeon to review the patient because on admission his blood pressure is 210/120. Hypertension has not been previously diagnosed in this man and he is on no medications.
Describe your assessment of his hypertension by history and examination.
How would you proceed with investigation of his hypertension if no cause was apparent from the assessment described above?”

Question 25

A man is to have a left shoulder arthroplasty under general anaesthesia. He has a permanent pacemaker located subcutaneously under the left clavicle. How would you assess this aspect of his condition pre-operatively? What precautions would you take to prevent malfunction of the pacemaker?;