Cardiac

Front 1

When was the 1st cardiopulmonary bypass done

Back 1

1953

Front 2

Wht is the usual route for surgery of heart

Back 2

Median sternotomy

Front 3

Wht drug is the pt supposed to receive before CPB

Back 3

Heparin

Front 4

Wht is commonly used for arterial cannulation for CPB?

Wht are the alternatives

Back 4

Femoral and axillary

Axillary artery has less chance of thromboembolic phenomenon

Front 5

Wht is cannulated for venous drainage.

Where is the cathether

Back 5

Front 6

How is blood drained to the CPB

Back 6

Front 7

Wht are myocardial protection methods, since coronary blood supply is cut off

Back 7

Front 8

Wht is the arrest agent in cardioplegic solutions

Back 8

Potassium

Front 9

Advantages of cold and warm cardioplegics

Back 9

Front 10

How long of ischaemia can the heart tolerate

Back 10

15 to 20 mins

Front 11

By how much does the metabolic rate of organ drops for every 7 degree drop in body temperature

Back 11

50 %

Front 12

what are the complications that can occur during CPB

Back 12

Difficulties can occur during

cannulation (aortic dissection or atrial injury),

at the start of CPB (oxygenator failure) and

at the end of CPB (coagulopathy)

Front 13

which surgeries can be done on a beating heart

Back 13

restricted to coronory artery bypass grafting (CABG)

Front 14

Which of the following is NOT a potential complication of cardiopulmonary bypass?

A Pulmonary embolism.

B Intestinal ischemia or infarction

C Post-cardiotomy syndrome.

D Neurological dysfunction.

E Bleeding disorders

Back 14

pulmonary embolism as pts are usually under the cover of heparin

Front 15

where do the coronary arteries arise from

Back 15

The coronary arteries are branches of the ascending aorta,arising from ostia in the aortic sinuses above the aortic valve,the right from the anterior sinus and the left from the left posterior sinus

Front 16

to wt is the graft of the left coronary artery anastomosed to and why?

which arteries are used for anastomosis

Back 16

The artery is inaccessible at its origin and therefore grafts are anastomosed to its branches, the left anterior descending artery (LAD) or anterior interventricular artery and obtuse/marginal (OM) branches of the circumflexartery.

Front 17

what decides dominance

Back 17

The question of anatomical dominance is determined by the artery that supplies the posterior descending artery.

90% is the RCA

Front 18

wht are the risk factors for ischaemic heart disease

Back 18

Front 19

wht is the 1st stage of atherosclerosis

Back 19

The fatty streak. The first evidence of atherosclerosis can be found in children 10–14 years of age

The streak consists of smooth muscle cells, which are filled with cholesterol, and foam cells.

Front 20

wht are the other stages of atherosclerosis

Back 20

● Fibrous plaque. A fbrous plaque consists of large numbers of smooth muscle cells, foam cells, and leukocytes. , it projects into vessels leading tolumen narrowing that

.● Complicated lesion. This occurs when the fibrous plaque ruptures provoking the formation of thrombus

Front 21

how is previous MI diagnosed in ECG

Back 21

Evidence of previous myocardial infarction (MI) is seen commonly, as Q waves and/or non-specific ST and T-wave changes

Front 22

what are the cariac enzymes used for diagnosis of ACS

Back 22

Standard enzyme measurement such as troponin, creatine kinase MB(CKMB) and lactate dehydrogenase (LDH) can aid diagnosis,as well as having prognostic implications

Front 23

wht test is used for dx myocardial ischemia

Back 23

Exercise tolerance testing (ETT) is a valuable technique for assessing myocardial ischaemia

physiological response to exercise as measured by the percentage of the maximum predicted heart rate achieved

Front 24

what radionuclide studies are used for cardiac perfusion

Back 24

The main type of radionuclide study used is myocardial perfusion scanning using specific radioisotopes (such as thallium201) to assess the significance of coronary disease and the viability of the myocardium.

Front 25

what is considered severe stenosis

Back 25

Any stenosis in an artery of >70% of the diameter (90% reduction of cross-sectional area) is considered ‘severe’

Front 26

how do we predict who will benefit from revascularization

Back 26

flow measurement across a stenotic area, using techniques such as fractional flow reserve (FFR), has been effective in predicting patients who are likely to benefit from revascularization

Front 27

coronary angiography summary

Back 27

Front 28

indications for surgery

Back 28

Front 29

Wht is done to body temperature during heart surgery

Back 29

Front 30

what is the difference in the way of timing PCI and CABG in treatment

Back 30

While the benefit from PCI in patients with non-ST segment elevation acute coronary syndrome(NSTE-ACS) is related to its early performance, the benefit from CABG is greatest when patients can undergo surgery after several days of medical stabilisation.

Front 31

complications of MI

Back 31

Ventricular septal rupture

Mitral valve papillary muscle necrosis causes acute mitral regurgitation

Ventricular aneurysm

Front 32

how is ventricular septal rupture presented and treated

Back 32

Ventricular septal rupture typically presents3–7 days after infarction with pulmonary oedema, a pansystolic murmur and hemodynamic instability.

The diagnosis is usually confirmed with echocardiography.

Repair is with a pericardial or artificial Dacron patch.

Front 33

how is Mitral valve papillary muscle necrosis treated

Back 33

Mitral valve papillary muscle necrosis causes acute mitral regurgitation, a pansystolic murmur and pulmonary oedema.

Diagnosis is made by echocardiography and right heart catheterization (showing large V waves).

Mitral valve replacement is usually necessary,

Front 34

wht are the two scores used for cardiac risk assessment

Back 34

the EuroSCORE II and STS score

Front 35

which graft is used most commonly and why?

how do we increase the patency of the graft

Back 35

The long saphenous vein is the most common vein used as a conduit as it is straightforward to harvest, provides good length and is easy to handle

lipid-lowering agents and antiplatelet agentssuch as low-dose aspirin can improve vein graft long-term

Front 36

wht is the conduit of choice for LAD

Back 36

The left internal mammary artery (LIMA), or internal thoracic artery, has become the conduit of choice for the LAD.

long-term patency rates of >98% have been reported, with improved long-term survival and fewer reoperations

Front 37

wht test should be performed for harvesting radial artery

wht are the alternatives

Back 37

In assessing a patient in whom a radial artery harvest is planned, an Allen’s test should be performed.

Alternative arterial bypass grafts include the gastroepiploic artery and the inferior epigastric artery.

Front 38

how do we perform allen test

Back 38

Front 39

wht is the most common arrhythmia post op?

wht is the treatment

Back 39

The most common postoperative arrhythmia is sinus tachycardia, closely followed by atrial fibrillation (AF)

Treatment includes correction of potassium (>4.5 mmol/L), the use of β-blockers, amiodarone or digoxin and, if necessary, cardioversion.

Front 40

what is the treatment of Bradycardia

Back 40

temporary pacing via epicardial pacing wires inserted intraoperatively

Front 41

wht is the cause of poor cardiac output state post op

Back 41

depressed myocardial contractility

reduced preload

increased afterload and

a disturbance in heart rate or rhythm.

Treatment is aimed at the underlying cause

Front 42

wht is to be done If low cardiac output persists despite inotropic support,

Back 42

Mechanical support can be achieved using intra-aortic balloon pump (IABP), ventricular assist device(VAD) or extracorporeal membrane oxygenation (ECMO)

Front 43

how does IABP works

Back 43

Front 44

wht is the difference between CPB and ECMO

Back 44

ECMO is another circulatory support device that is similar to CPB; however, ECMO can be established using venous-access only (called VV-ECMO) or venous and arterial access(VA-ECMO).

Front 45

incidence of wound infection in CABG

Back 45

0.5-2%

Front 46

mortality from CABG

Back 46

1-3%

Front 47

Coronary artery bypass surgery outcome

Back 47

Front 48

wht is Off-pump coronary artery surgery?

advantages

Back 48

CABG without the use of CPB

It offers the advantages that it avoids the physiological stress associated with CPB and, to some extent, the aortic manipulation that can lead to neurological injury through atherosclerotic embolization.

Front 49

wht devise is used to perform off pump coronary artery surgery

disadvantage of OPCAB

Back 49

octopus

the quality of anastomosis carried out on a beating heart and bloody field that can limit the surgeons vision

Front 50

wht incision is used for Minimally invasive direct coronary artery bypass (MIDCAB) surgery

Back 50

Through an anterior submammary incision