Adult Cardiac 1

1. A 72-year-old female is visiting her son from India and complains of chest pain. She is taken to an ER and diagnosed with gastritis. She mentions that she has had several episodes of rectal bleeding in the past two years. A GI work up shows AV malformations. On further questioning she seems to be symptomatic due to her AS. She also reports 4 episodes of syncope in the last 6 months. During workup of chest pain she gets an EKG, which shows severe LVH but no MI. A TTE shows severe aortic stenosis. You are consulted prior to discharge. Best plan of management is to:

2. Indications for coronary artery bypass graft (CABG) surgery include all of the following except:

3. A 63 year-old female is undergoing aortic root reconstruction for an ascending aortic aneurysm with root involvement. You decide to administer cardioplegia directly into the coronary ostia. Which of the following are not true regarding cardioprotective strategies during cardiopulmonary bypass?

4. During aortic valve surgery

5. While performing a mitral valve replacement, there is a sudden drop in venous pressures on the bypass circuit. You are cannulated using a bi-caval method. Initial assessment of the cannulas show no abnormalities. Which of the following maneuvers would not be beneficial in assessing the reason for your decreased drainage?

6. 70-year-old male is currently in the operating room for a CABG/MVR. After he comes off bypass, his C.I. is noted to be 1.5. Intraoperative echocardiogram shows good valve function and no wall motion abnormalities. HR is 85, CVP is 16 PCWP is 19 and SVR of 800 when completely off bypass with a C.I. increasing slightly to 1.6 after several minutes. What is the next best step in management?

7. Which structure is at risk of injury during a trans-septal approach for mitral valve surgery?

17. You are performing an aortic valve replacement on a 67yo female with severe aortic stenosis and cannulate the aorta in the usual fashion after performing an epi-aortic ultrasound. Unfortunately, a large hematoma begins to develop in conjunction with high arterial line pressures and you suspect an iatrogenic Type A aortic dissection. What is an appropriate next step?

9. During Acute MI or massive PE, which structures prevents over distension of the right ventricle?

10. Which of the following is NOT an indicator that a cannula-induced aortic dissection may have occurred?

11. Medical management of CAD include all of the following EXCEPT:

12. After performing an uncomplicated CABG on a 47yo M with CAD, anesthesiology administers a test-dose of protamine. Shortly after this, the patient has profound hypotension and you suspect a Type 1 protamine reaction. Which of the following regarding protamine reactions is correct?

13. 72-year-old male undergoes CABG with vein graft and returns to cardiology clinic 5 years later with angina. What is the likely mechanism?

14. CABG is preferable to PCI in which of the following scenarios?

15. A 56 yo male is undergoing CABG for 3 –vessel disease. At the time of separation from CPB, which of the following parameters must be present?

16. 81-year-old patient post-operative day 3 from CABG is found to have an abnormally fast heart rate on telemetry. The patient feels palpitations but is otherwise asymptomatic. EKG showed HR of 145, narrow QRS but irregularly irregular. The patient’s comorbid conditions include a long history of COPD, symptomatic asthma and constipation. What is the next best step in the management of this patients’ condition?

17. During mitral valve surgery, the circumflex artery is at risk of injury at

18. On bypass, a high line pressure may be due to:

19. In the absence of known preoperative pulmonary hypertension, the pulmonary artery pressure after cardiopulmonary bypass should be

20. What is the maximum acceptable arterial cannula pressure gradient?