Adult Cardiac 10

Early graft occlusion occurs within the first 30 days after surgery. All of the following regarding early graft occlusion are true EXCEPT

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

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

All of the following are potential effects of skeletonizing the IMA EXCEPT:

What are significant limitations of radial artery grafts

Relative contraindications to use of LIMA as graft include all EXCEPT:

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?

What are the specific advantages of IMA graft as opposed to other arterial or vein grafts?

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

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?

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?

It is widely accepted that the use of cardiopulmonary bypass activates both the intrinsic and extrinsic coagulation cascades. Which of the following plasma proteins are not associated with the production of inflammatory mediators observed?

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?

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?

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?

76-year-old male is s/p aortic aneurysm repair with a synthetic graft extubated on POD#1. His Swan Ganz catheter shows the follow hemodynamic parameters on POD#2: CVP14, PCWP 18, mixed venous saturation of 45%. Which of the following is the next best step in management?

55-year-old female with a h/o atrial fibrillation, rheumatic heart disease, now s/p MVR, has been externally paced for the 1st post operative day and gradually weaned off on day 2 as the rate was decreased to 40. On POD#3 the telemetry showed 5 episodes of 2.5-4 second pauses. EKG showed NSR. The patient has no complaints. What is the next best step in management?

62 y/o female with a h/o HF with systolic dysfunction and chronic atrial fibrillation was recently started on a new medication to help with symptoms. This medication increases intracellular calcium causing an inotropic effect through an indirect mechanism. What is the most likely mechanism of action for this drug?

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?

76-year-old female with a h/o hypertension now s/p 2 vessel CABG/AVR is found to have a BP of 175/85 and HR in the 90’s on the first postoperative day. Hemodynamic parameters show a CVP of 14, CO of 3.5L/min and SVR around 2000. Physical exam reveals bibasilar crackles, 2+ distal pulses otherwise unremarkable. What is the next best step in management?