Adult Cardiac 3

What are current size criteria for thoracic aortic aneurysm replacement?

What gene is associated with bicupsid valve aneurysms?

Which of the following is true regarding acute type A aortic dissection?

What portion of the aorta is most commonly aneurysmal in patients with Marfan’s syndrome.

A 60yoM experienced chest pressure for 5 days prior to seeking medical attention. While undergoing work-up in the Emergency Department, he rapidly becomes hypotensive, loses pulses, and codes. In addition to acute ischemic cardiogenic shock, what diagnosis is also likely?

The most common location for a ventricular aneurysm is:

Which of the following is NOT a risk factor for left ventricular aneurysm formation following an ischemic event?

The most appropriate way to repair a posterobasilar ventricular aneurysm is:

You are taking a patient to the operating room for coronary artery bypass grafting (CABG) and surgical ventricular reconstruction (SVR). Transesophageal echocardiogram in the OR shows severe mitral regurgitation (MR). What is the best plan for the patient?

Which of the following is a contraindication to ventricular aneurysm repair?

Saphenous vein graft (SVG) patency is decreased by all of the following, except:

A 44-year old woman who works as an ICU nurse was recently hospitalized after suffering a submassive pulmonary embolism. She is concerned about developing chronic thromboembolic pulmonary hypertension and asks what symptoms she should look for. What do you tell her?

A 69-year-old woman with a past medical history of coronary artery was recently diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) and is being seen in your clinic for pulmonary thromboendarterectomy (PTE) evaluation. On work-up she was found to have a mean pulmonary artery pressure (mPAP) of 41 mmHg and pulmonary vascular resistance (PVR) of 1,100 dynes x s x cm^-5. An echocardiogram demonstrated a left ventricular ejection fraction of 45-50%. On consultation with the patient, which of the following would you explain is most likely to increase her risk for in-hospital and 1-year mortality?

You are called by the labor and delivery service and asked to consult on a patient with large, bilateral pulmonary embolisms (PE). The patient is a morbidly obese 32-year-old female who is now postoperative day 3 from Cesarean section. Earlier in the day, she developed acute shortness of breath and a CTA of the chest confirmed large bilateral PEs. On exam, her respiratory rate is 28 breaths per minute, her heart rate sinus tachycardia at 125 beats per minute, and her blood pressure is 105/62. An echocardiogram shows new onset moderate to severe tricuspid regurgitation. Your recommendation(s) is/are:

A 50-year-old obese male is 8 hours post CABG and mitral valve replacement. His chest tube output had been consistently 150 mL/hours since the patient left the operating room, but then suddenly decreased to 10 mL/hr since two hours ago. His initial cardiac index was 2.5 L/min/m2, now 1.2 L/min/m2. CVP was 12 mmHg, now 18 mmHg. HR currently is 130’s, BP 90/70. Lactic acid was 2, now 6. He has been requiring increasing doses of inotropes and pressors. A bedside echo was performed which was a poor study without significant effusion or “tamponade physiology”. What is the appropriate next step:

A 32-year-old male with a past medical history of non-Hodgkins lymphoma treated by thoracic radiation therapy 10 years prior presents with a one week history of dyspnea and lower-extremity edema. A transthoracic echocardiogram demonstrates a thickened pericardium along with a moderate pericardial effusion. Which of the following signs, if present, would clarify the diagnosis?

A 65-year-old male presents to clinic for surgical evaluation for a pericardiectomy. He reports symptoms including dyspnea at rest and leg-swelling. His past medical history is significant for non-small cell lung cancer in the left lower lobe that was successfully treated with radiotherapy in his 50s and chronic kidney disease. Labs are significant for a serum creatinine of 1.3. You opt to perform a pericardiectomy via a median sternotomy rather than a left thoracotomy due to the previous thoracic radiation. All of the following increase the patient’s risk for mortality EXCEPT:

The least common location of primary cancers which metastasize to the pericardium is:

A 59-year-old male with a history of restrictive cardiomyopathy secondary to endocardial fibrosis is referred to your clinic for further evaluation. The patient is currently undergoing maximal medical therapy including oral corticosteroids. Despite this, the patient endorses worsening dyspnea on exertion consistent with NYHA class III symptoms. Which of the following is the best next treatment option?

Which of the following can be used discern constrictive pericarditis from cardiac tamponade and restrictive cardiomyopathy?