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Flashcards in 1-100 Deck (101)
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1

what makes an aortic dissection "Complicated" 

Complicated dissection is those with: 

  • persistent pain 
  • thoracoabdominal mal perfusion 
  • impending rupture 

2

sizing of the graft for a valve-sparing root 

1. Estimated annulus 

2. Dacron graft size 

Aortic annulus ~ 2/3 cusps height x 2
Dacron graft ~ 2/3 cusps height x 2 + LVOT thickness

3

DeBakey type 1 aneurysm 

Ascending and descending aorta 

4

Signs of mitral stenosis 

  1. Low volume pulse pressure
  2. Irregular pulse
  3. Tapping non-displaced apex beat
  4. Loud S1 heart sound
  5. Opening snap Mid diastolic rumbling heart loudest at the apex
  6. Pulmonary HTN
    1. Mitral facies : Rosy cheeks while the rest of the face is cyanotic
    2. Central cyanosis
    3. Loud P2 heart sound
    4. TR – pan systolic murmur at right sternal edge
    5. Pulmonary Regurgitation: Grahm Steel early systolic murmur on inspiration

5

Social history questions for aortic dissection 

physical exam 

Query the use of amphetamines or coccaine 

 

Physical: 

Skeletal to diagnose CT disease 

Vascular exam should be documented 

6

Medical treatment of a type B dissection 

a. Beta - blocker ( esmolol or labetolol) 

b. vasodilator (nipride) 

7

what territory does ECG lead I represent 

anterolateral

8

Severe mitral regurgitation in an asymptomatic patient direction

of treatment 

  1. if LVEF > 60, LVESD < 40 and liklihood of repair > 95% with expected mortality < 1% --> Repair 
  2. if new onset afib or PASP > 50 and liklihood of repair > 95% and expected mortality < 1% --> Repair 
  3. if LVEF 30-60% or LVESD > 40 -->"mitral surgery"

Per Boling: 

LVEF < 60%,  PAP > 50, LVESD > 40, AF 

If > 95% repair, <1%, mortality 

9

MVA for Moderate MS 

MS (mitral valve area 1.6 cm2 to 2.0 cm2)

10

the direction of the jet with a restricted leaflet 

jet will be toward the restricted leaflet 

11

Ghent criteria 

Minor Skeletal Criteria 

  1. Pectus excavatum of moderate severity
  2. Joint hypermobility
  3. Highly arched palate with crowding of teeth
  4. Facial appearance:
    • dolichocephaly
    • malar hypoplasia
    • enophthalmos
    • retrognathia
    • down-slating palpebral fissures

12

Low Risk Pulmonary Embolism 

Embolism without the presence of :

  1. shock 
  2. hypotension 
  3. RV dysfunction 
  4. Myocardial injury 

13

Diagnostic criteria for STEMI 

Angina sx for > 20 min 

with 

ST elevation > 1mm  in 2 contigous leads 

or 

LBBB 

14

Method of selecting a tricuspid ring size 

1. Using a sizer: 

septal leaflet and the surface area of leaflet tissue from the anterior pap muscle 

 

2. Approximately 

30-32 for a female 

32-34 for a male 

15

Reccomendation 

Mitral stenosis patient 

symptomatic 

MVA < 1.5cm2 

Wilkins < 8

No LA thrombus 

No MR 

Class 1: PMBC 

16

Anteroseptal ECG leads 

V1 and V2 

17

IIb/IIIa inhibitors 

when should they be discontinued 

  1. Eptifibatide (integrillin) - IIb/IIIa Inhibitor - 2-4 hr 
  2. Tirofiban ( Aggrastat) - IIb/IIIa inhibitor -2 -4 hours 
  3. Abciximab (Repro) - IIb/IIIa inhibitor  -12 hours 

EAT ! 

18

Crawford Type IV aneurysm 

Extends from the diaphragm to below the renal arteries 

19

what territory does V6 represent? 

anterolateral

20

Ghent Criteria 

Pulmonary minor criteria 

Spontaneous PTx 

Apical Blebs 

21

Type B aortic dissection - 

Medical vs Surgical management 

what is the rate of surgical reintervention 

Equivalent 

22

Fondaparinux trade name 

Arixtra 

23

Ghent criteria 

minor skin criteria 

  1. Strech marks not associated with weight changes 
  2. Recurrent incisional hernia 

24

Ghent Criteria: 

Major family history Criteria 

  1. Having a first-degree relative (parent, child, or sibling) who meets these diagnostic criteria independently
  2. Presence of a mutation in FBN1 known to cause the Marfan syndrome
  3. Presence of a haplotype around FBN1, inherited by descent, known to be associated with unequivocally diagnosed Marfan syndrome in the family

25

Posterior medial papillary muscle 

blood supply 

PM pap muscle is more vulnerable because of its single blood supply: 

RCA for right dominant 

cx for left dominant 

26

DeBakey IIIa aneurysm 

Confined to the thoracic descending aorta alone 

27

"theme" of fibroelastic defficiency mitral repair 

No resection or limited resection 

28

which ECG lead is the ground? 

Right Leg

29

Ghent Criteria 

Minor CV Criteria 

  1. Mitral valve prolapse with or without mitral valve regurgitation
  2. Dilatation of the main pulmonary artery, in the absence of valvular or peripheral pulmonic stenosis or any other obvious cause in patients age < 40 years
  3. Calcification of the mitral annulus in patients age < 40 years
  4. Dilatation of dissection of the descending thoracic or abdominal aorta in patients age < 50 years

30

"theme" to Barlow's repair 

Barlow's - remove tissue 

Tissue dissection and leaflet displacement