OnlineMedEd: Surgery: Subspecialty - "CT Surgery"

Question 1

Aortic stenosis is most common in ____________.

Answer 1

old men with CAD

Question 2

Describe the presenting signs and symptoms of aortic stenosis.

Answer 2

• Angina
• Syncope
• Left-sided CHF (possible pulmonary edema and right-sided CHF)

Question 3

What murmur suggests aortic stenosis?

Answer 3

Crescendo-decrescendo systolic murmur over right 2nd intercostal space that radiates to the carotids

Question 4

Aortic stenosis is definitively diagnosed with ______________.

Answer 4

echocardiography

Question 5

Balloon valvuloplasty is used only for _____________ in aortic stenosis.

Answer 5

palliation

Question 6

The definitive treatment for aortic stenosis is ______________.

Answer 6

valve replacement

Question 7

Mitral regurgitation is caused by one of two things: _________________.

Answer 7

infection or infarction

Question 8

Mitral regurgitation is caused by rupture of _________ or ___________.

Answer 8

chordae tendonae; papillary muscle

Papillary muscle is more common.

Question 9

Review the murmur of mitral regurgitation.

Answer 9

• Holosystolic
• Apical
• Radiates to axilla

Question 10

Mitral regurgitation is diagnosed with ____________ and treated with _____________.

Answer 10

echocardiography; valve replacement

Question 11

Aortic insufficiency is caused by one of three things: _________________.

Answer 11

infection, infarction, aortic dissection

Question 12

Review the murmur of aortic insufficiency.

Answer 12

• Diastolic
• Decrescendo
• Heard over LEFT STERNAL BORDER (not right 2nd intercostal space)

Question 13

Aortic insufficiency is diagnosed with ____________ and treated with _____________.

Answer 13

echocardiography; valve replacement (may need CABG later due to occlusion of the ostia of the coronaries)

Question 14

Review the murmur of mitral stenosis.

Answer 14

• Diastolic
• Opening snap followed by rumbling murmur

Question 15

____________ can present with CHF or atrial fibrillation.

Answer 15

Mitral stenosis

Question 16

Why is balloon valvuloplasty an acceptable treatment for mitral stenosis?

Answer 16

1) Mitral stenosis is not calcific
2) Mitral stenosis presents in a younger person, and because valve replacements last only so long you do not want to repeat heart surgeries

Question 17

Which last longer, mechanical or bovine valves?

Answer 17

Mechanical (10 - 20 years)

Downside: they require anticoagulation, while bovine (10 years) ones don’t.

Question 18

Describe the anticoagulation regimen for mechanical valves.

Answer 18

• Warfarin

* Target INR of 2.5 - 3.5

Question 19

List the predisposing factors for CAD.

Answer 19

• Advanced age: M greater than 45, F greater than 45
• Obesity
• Smoking
• HLD
• Diabetes

Question 20

The triad of anginal pain is ________________.

Answer 20

substernal pain, worsens with exertion, improves with rest or nitrates

Question 21

Review the workup of acute chest pain.

Answer 21

1) EKG: if positive, take to cath lab urgently; if negative, do troponins
2) Troponins: if positive, take to cath lab soon; if negative, do stress test
3) Stress test: if positive, take to cath lab electively

Question 22

Greater than __________ vessels occluded needs to be treated with CABG.

Answer 22

2

Also, if the LAD is occluded then CABG is needed.