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LS CV Oral Review > 201-300 > Flashcards

201-300 Flashcards

(68 cards)

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1
Q

Surgical treatment of aneurysm of the ascending aorta with aortic insufficiency and marked displacement of the coronary ostia with a saphenous vein graft.

A

Zubiate- Kay procedure

JTCVS 1976

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2
Q

Tachy-brady syndrome

A

PAT/flutter/ fibrillation followed by symptomatic pauses

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3
Q

Carotid sinus syndrome

A

Hyperactive carotid sinus reflex

a. carotid sinus stimulation - cardiac asystole > 3 seconds
b. carotid sinus syndrome - hyperactive reflex _ production of symptoms with carotid sinus stimulation

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4
Q

Treatment of Carotid sinus syndrome

A

Pacemaker therapy - for patients with a cardioinhibitory response (syncope)

PPM may not resolve the vasodepressor response

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5
Q

Electrode testing

Pacing threshold (atrial / ventricle)

Sensing threshold (atria / ventricle)

A

pacing threshold = lowest voltage to produced depolarization

  • Atrial - 1.0V or less
  • Ventricular - 0.3V or less

Sensing threshold - Ability to identify depolarization

  • Atrial p wave - 2mv or more
  • Ventricular QRS: 5 mv or more
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6
Q

CHADS2 score

A

C - Congestive heart failure (1)

H - Hypertension (1)

A - Age 65-74 (1), >75 (2)

D - Diabetes - 1

S - Prior Stroke or TIA (2)

V - Vascular (1)

S - sex (female -1)

Max sore 9

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7
Q

Atrial fibrillation - criteria for:

Isolated vs recurrent vs paroxysmal vs persistent vs permanent

A
  1. Isolated - a single episode
  2. recurrent > 2 episodes
    • Paroxysmal - lasts < 7 days and reverts spontaneously
    • persistent - does not terminate spontenously - requires Rx or DC cardioversion
    • Permanent - does not revert
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8
Q

Common causes of atrial fibrillation

A
  1. idiopathic
  2. Mitral valve and subsequent LA dilation
  3. Ischemic heart disease
  4. HTN
  5. Post-cardiac surgery
  6. Alcohol
  7. Thyrotoxicosis
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9
Q

what are the AHA guidelines for afib and anticoagulation

A

All patients with recurrent afib

Paroxysmal

Persistent

Permanent

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10
Q

INR Goal for afib with a mechanical valve

A

2.5-3.5

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11
Q

In considering INR, what are high risk factors for thromboembolism

A
  1. Stroke
  2. TIA
  3. Systemic embolism
  4. Rheumatic heart disease
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12
Q

For what a fib patients should the INR goal be between 2.0 and 3.0

A

Afib + either

1 high-risk factor

> 1 Moderate risk factor

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13
Q

What are the risk factors for atrial fibrillation following cardiac surgery

A
  1. Age
  2. beta-blocker withdraw
  3. Electrolyte imbalance
  4. Hypoxia
  5. Ischemia
  6. Pericardial effusion
  7. infection
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14
Q

In general, in what patients is a Maze procedure less successful

A

Atria > 5 cm

Afib > 5 years

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15
Q

Ligament of Marshall

A

The ligament of Marshall (LOM)

located on the epicardium between the left atrial appendage and the left pulmonary veins.

The corresponding endocardial structure is the left lateral ridge.

LOM is a source of paroxysmal AF, and may activate at fast rates during persistent AF.

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16
Q

Heart Rate identification of atrial fibrillation

A

Typically a variable block

2:1, 3:1, 4:1

Atrial rate of 300 bpm, with a V response of 150, 100, 75

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17
Q

Class I Antiarrhythmic

A

Class I:

1a: Quinidine, procainamide disopyramide
1b: Lidocaine, phenytoin
1c: Flecainide, propafenone

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18
Q

Class IV Antiarrhythmic

A

Slow calcium channel

Verapamil, diltiasem, adenosine

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19
Q

Coronary artery concerns with surgical ablation

A

Left dominant patients are at increased risk of injury when ablating close to the coronary sinus

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20
Q

Tetralogy of Fallot

key elements to ask about the ECHO

A
  1. what is the status of the RVOT + Pulmonary valve
  2. Pulm atresia/stenosis
  3. are the PA’s confluent or MAPCA
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21
Q

causes of shock in a patient s/p bullectomy

and how to work up

A

Tension ptx

  • check ct not clamped
  • intubate
  • large bore IV

MI

PE

septic shock

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22
Q

Initial treatment of massive PE

A

70 u/kg bolus

heparin infusion 20u/kg/hr

Goal PTT 50-70

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23
Q

Options if a patient with massive PE if they do not stabilize after starting anticoagulation

A
  1. Thrombolytics
  2. Percutaneous mechanical removal
  3. Pulmonary thrombectomy
  4. VA ECMO
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24
Q

Survival of PE patients in shock vs not shock

A

Mortality

Shock: 52%

Not schock: 15%

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25
Indications for surgical embolectomy
1. Hemodynamic collapse with unlikely patient survival 2. unequivocal PE in the main or lobar PA resulting in significant impairment of gas exchange 3. unstable patient with absolute contraindication for thrombolytic or anticoagulation 4. risk of potential pulmonary embolism by large RA or RV clot
26
Prognosis of post MI VSD
**Poor** * 25% in 24 hours * 50% in one week * 80% in one month * 97% in one year
27
preoperative management of post MI VSD
Reduce afterload to reduce left to right shunt Maintain adequate output with inotropes and or IABP
28
Most common levels of the Artery of Adamkiewicz
T8-T12
29
Major complications associated with aortic aneurysm disease
Stroke: 2-11% paraplegia 2-20% Renal failure: 3-15% Pulmonary failure: 20-30%
30
2010 AHA/STS Guidelines for stenting of the thoacic aorta
Class 1: acute, traumatic, ischemic type B Class IIa; symptomatic PAU/IMH chronic traumatic dege
31
Aorta Endovascular zone
0 - ascending to innominate 1 - inominate to the the subclavin 2 - left cartoid to the left subclavian 3- Left sc to proimal descending 4 - descending
32
Types of endograft leak
5 types ## Footnote Type 1 - leak at the ends of the graft Type 2: sac filling via branch vessel Type 3: defect in the graft fabric Type IV: porous graft (intentional leak) Type V - endotension
33
Type 1 Endovascular leak
Type 1: leak at the graft ends 1a proximal 1b distal 1c iliac occluder
34
Type II endovascular leak
Type II: sac filling via vascular branch IIa: single vessel IIb: two vessels
35
Type III Endovascular leak
leak through a defect in the graft fabric IIIa - junctional separation of the modular components IIIb fracture or hole involving the endograft
36
Type Iv endovascular leak
generally due to a porous graft (design of the graft)
37
Type V endoleak
due to endotension
38
Endovascular zone? Ascending to innominate
Zone 0 Ascending to innominae
39
Endovascular zone Innominate to left carotid
zone 1
40
Endovascular zone Left carotid to left subclavian
zone 2
41
Endovascular zone left subclavian to descending aorta
zone 3
42
Endovascular zone Descending aorta
zone 4
43
what type of endoleak requires intervention
Type I and III will need intervention
44
what type of endovascular leas is the most common
type II back bleeding from branch vessels
45
how to decompress the heart during descending left heart bypass
Left superior pulmonary vein or LV Apex
46
Post descending repair ICP /MAP goals
Keep the ICP \< 10 Do not drain more CSF than 20ml/hr MAP \> 80-90
47
Components of Del Nido Cardioplegia
Components of the crystalloid solution include: 1. Plasmalyte A 2. sodium bicarbonate 3. mannitol (decreases myocardial edema and acts as a free radical scavenger), 4. potassium (depolarization), 5. lidocaine (maintains arrest in a hyperpolarized state) 6. magnesium
48
MUF
modified ultrafiltration Used to minimize total body oedema
49
Root cardioplegia needle size kids / adults
Kids \> 5kg- 18g angiocath Bigger: 12-16g
50
Retograde cardioplegia catheter size Adult Pediatric neonate
Adult : 15 Kid : 9 - 13 Neonate: 6
51
Fench to mm conversion
1F = 0.33 mm 8F - 2.64 mm
52
Correlation between Edwards 24-, 22-, 19-, and 18-F sheaths and mm size
24-, 22-, 19-, and 18-F sheaths 9.2, 8.4, 7.5, and 7.2 mm, respectively. notice 19--\> 18 is 0.3
53
Incidence of HIT in patients who undergocardiac surgery
1The overall incidence of HIT in patients who undergo cardiac surgery ranges from _0.1% to 3%_ .
54
Factors Strongly associaed with HIT
* Female sex * atrial fibrillation * congestive heart failure * chronic kidney disease * chronic liver disease
55
Effect of HIT on mortality after Cardiac surgery
No HIT: 4.5% + HIT: 11% Any thrombocytopenia: 4% HIT in post cardiac patients can thus result in more than 50% increase in mortality
56
What type of thrombosis is most common in patients with HIT?
Arterial thrombosis is more common than venous thrombosis in cardiac patients with HIT
57
Timing of CABG Post MI
EF \> 30% - proceed any point after MI completed EF \< 30% stabalize recover for 7 days after MI
58
How to differentiatte the cause of TR based on RV pressures
If RVs is \> 60 mmHg then tricuspid regurigation in functional and due to left sided heart pressure if the RVs \> 40 then there is a substantial organic component
59
If there is no gradient between the RA to PA diastolic ...
the the RV likely has severe dysfunction tricuspid valve replacement will likely not help
60
RVESA and tricuspid regurgitation
if RVESA is \< 20 cm2 then RV function is preserved or if change in area \< 35% then reduced function
61
criteria for prompting imaging of the chest in trauma
Nexus Criteria (similar to spine) _\>= 1 should have imaging_ 1. Age \> 60 2. Rapid decelleration 1. fall \> 20 feet 2. MVC \> 40 mph 3. Chest pain 4. Intoxication 5. Altered Mendtal Status 6. Distracting Injury 7. TTP
62
Clamp and sew surgical repair of traumatic aortic injury - time limit for clamp and sew
Cross clamp time \>30 minutes is associated with a paraplegia rate of 15-30%
63
Significant mediastinal injury - what should you not forget to do?
EGD. particularly gun shot wounds, may be associated with multiple other injuries. need to be suspicious for an esophageal injury. EGD should be done prior to closing the chest.
64
Definition of FFR
pressure in the post stenotic area of a coronary artery to pressure in the ascending aorta -at Maximal coronary vascular pharmacologic dilation
65
What FFR indiciates significat coronary artery stenosis
An FFR less than 0.8 is significant for coronary artery stenosis
66
What was the FAME study? What did it show ?
Functional Flow Reserve vs Angiography for Multivessel Evaluation (FAME) FFR was negative : * in 90% stenosis - in 4% of cases * in 71-90% stenosis - 20% of cases * in 51 - 70% stenosis - 65% of cases
67
David-Feindel formula
To determine the size of a graft for a David procedure diameter = [2x (Hcusp x 2/3)] + 6-8mm
68
nodule of Arantius.
Nodule at the free edge of the aortic leaflet.

LS CV Oral Review (6 decks)

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