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Flashcards in 201-300 Deck (68)
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1

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

Zubiate- Kay procedure 

JTCVS 1976 

2

Tachy-brady syndrome 

PAT/flutter/ fibrillation followed by symptomatic pauses 

3

Carotid sinus syndrome 

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 

4

Treatment of Carotid sinus syndrome 

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

 

PPM may not resolve the vasodepressor response 

5

Electrode testing 

Pacing threshold (atrial / ventricle) 

Sensing threshold (atria / ventricle) 

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 

6

CHADS2 score 

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 

7

Atrial fibrillation - criteria for: 

Isolated vs  recurrent vs  paroxysmal vs persistent vs permanent 

  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 

8

Common causes of atrial fibrillation 

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

9

what are the AHA guidelines for afib and anticoagulation 

All patients with recurrent afib 

Paroxysmal 

Persistent 

Permanent 

10

INR Goal for afib with a mechanical valve 

2.5-3.5 

11

In considering INR, what are high risk factors for thromboembolism 

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

12

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

Afib + either 

1 high-risk factor 

> 1 Moderate risk factor 

13

What are the risk factors for atrial fibrillation following cardiac surgery 

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

14

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

Atria > 5 cm 

Afib > 5 years 

15

Ligament of Marshall 

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. 

16

Heart Rate identification of atrial fibrillation 

Typically a variable block 

2:1, 3:1, 4:1 

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

17

Class I Antiarrhythmic 

Class I: 

1a:   Quinidine, procainamide disopyramide 

1b:   Lidocaine, phenytoin 

1c:    Flecainide, propafenone  

18

Class IV Antiarrhythmic 

Slow calcium channel 

Verapamil, diltiasem, adenosine 

19

Coronary artery concerns with surgical ablation 

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

20

Tetralogy of Fallot 

key elements to ask about the ECHO 

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

21

causes of shock in a patient s/p bullectomy 

and how to work up 

Tension ptx 

- check ct not clamped 

- intubate 

- large bore IV 

MI 

PE 

septic shock 

22

Initial treatment of massive PE 

70 u/kg bolus 

heparin infusion 20u/kg/hr 

Goal PTT 50-70 

23

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

1. Thrombolytics 

2. Percutaneous mechanical removal 

3. Pulmonary thrombectomy 

4. VA ECMO 

24

Survival of PE patients in shock vs not shock

Mortality 

Shock: 52% 

Not schock: 15% 

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