Previous exam 2006 Flashcards
What are levels of evidence
Level of Evidence A: data derived from multiple randomized clinical trials of meta-analyses
Level of Evidence B: data from a single randomized trial, or nonrandomized studies
Level of Evidence C: only consensus opinion of experts, cases studies, or standard-of-care.
Female with right heart dysfunction now post op MVR with PA pressures 85/50. What are 4 specific interventions you would do
Principles:
Optimize preload
Minimize afterload (particulary the RV)
4 specific interventions
Administer fluid for PCWP 15 to 20
Nitroglycerine/nitroprussed for afterload reduction
Mirinone for reduction of PAP, inotropy, lusitropy
Inhaled nitric oxide
optimize O2/pH/Co2
Patient with RCA infarction post CABG–cannot wean from RVAD. List 3 possible recovery pathways
Bridge to recovery
Long-term VAD
Bridge to transplant
What is a protocol for weaning off RVAD
Start to wean when CI > 2.9 and no increase in PCWP when flow rate dropped by 50%. Then drop 25% further and assess PCWP.
How do you calculate pulmonary vascular resistnace
Mean PA pressure - LA pressure divuded by CO
measures in Dynes.
What degree of PVR do you intervene
PVR > 80 do not repair
PVR 6 to 8 do vasodilatory challenge
PVR < 6 then it’s ok
LVAD placement, output falls 12 hours after surgery: Give 4 possible cuases
Bleeding as a result of tamponade
RV failure
Device failure
Hypovolemia
4 clinical features of tamponade
Hypotension
Tachycardia
Low urine output
cold peripheral
4 hemodynamic features of tamponade
increased filling pressures equalization of filling pressures pulsus paradoxus low cardiac output Right atrium and right ventricular increased JVP respiratory variation in TV/MV inflow CVO tracing: attenuated y descent (reduced atrial filling) with or without prominent x
List 5 ways to assess athersclerosis of the aorta
Palpatin chest x-ray aortogram CT chest TEE Epiaortic echo
5 ways of dealing with porcelain aorta identified in the OR
cancel the case
Off pump LITA, RITA, with SVG with prximal contructed to LITA or innominate artery
Off pump beating assisted (cannulate femorial or axillary artery) and use off pump technique
Fibrillatory arrest–provided no AI
May perform only LIMA to LAD and do PCI to remainder
Replacing the ascending aorta under circulatory arrest and then do CABG
For off pump CABG lsit 3 things that are equivocal and list 5 things that are less with OPCABG
3 things that are equivocal 30 day mortality stroke rate myocardial infarction 5 things that are less with OPCABG post op AF red cell transfusion less inotropes length of stay few distalas
3 advantages of bicaval anastomosis in transplant
Less TR and MR
Less atrial arrhythmias and conduction disturbance
shorter hospital stay
reduced postoperative dependence on diuretics
Less RV dysfunction
List 6 clinical bedside test
No response to pain apnea absecene of brain stem reflexes (doll's eyes, caloric reflex test, pupils dilated) Bedside ECG sensory evoked potentials ensure no metabolic disturbances, pharmacologic agents, and hypothermia cerebral angiography radionuclide cortical blood flow studies
10 complications of open PDA ligation
recurrent laryngeal nerve damage chylothorax pnneumothorax hemothorax coarctatoin phrenic nerve injury ligation of PA, aorta residual flow rupture/hemorrhage infection death embolization
What is management of intra mural hematoma from LSCA to diaphragm;
IMH secondary to rupture of the vasa vasorum
Treat like type B dissection (BP control, operation for complication of type B such as contained rupture, malperfusion, progressive enlargement, persistent pain, and persistent hypetension
List 3 general physiologic derangements that can lead to tissue hypoxia and give an example of each
Low cardiac output (decrease deliver)
Anemia (decrease oxygen carrying capacity)
Hypoxemia: DO2 = Co x Hg x Sao2 + paO2
List 5 ways to repair the anterior leaflet of the mitral valve
triangular resection chordal transfer neochordiae alfieri stitch papillary muscle sliding or shortening chordal transpositoin from posterior leaflet
