CARDIAC SURGERY CSC CORE MAIN QUESTIONS
AND ANSWERS SURE A+
✔✔Which of the following is true concerning the use of aspirin following CABG surgery:
A. ASA is contraindicated because of the increased risk of bleeding from new grafts.
B. ASA is indicated for all CABG patients as an analgesic for postoperative pain control.
C. ASA is indicated for all CABG patients because of its antiplatelet effects and for
secondary prevention of coronary disease.
D. ASA is indicated for patients receiving arterial grafts but not venous grafts. - ✔✔C.
The use of ASA in the early postoperative period is used to offset platelet activation and
aggregation in the early postop period. ASA may result in improved graft patency;
decrease the incidence of perioperative MI, stroke, and acute kidney injury; and reduce
mortality. It is recommended that ASA be started within 6 hours postoperatively (after
mediastinal bleeding has stopped) and continued indefinitely for secondary prevention
in all CABG patients who do not have a contraindication to ASA.
✔✔Prosthetic heart valves are associated with all of the following complications
EXCEPT:
A. Endocarditis.
B. Systemic embolization.
C. High incidence of renal failure.
D. Hemolytic anemia.
E. Bleeding. - ✔✔C. Prosthetic valves are not directly associated with an increased risk
of renal failure, although renal failure can occur for several reasons following any type of
cardiac surgery.
Systemic embolization can occur with both mechanical and biological valves as a result
of thrombosis, vegetations, or left atrial thrombus (especially in the presence of atrial
fibrillation). The risk is twice as high with valves in the mitral position than those in the
aortic position.
Bleeding risk is higher with mechanical valves because of the need for chronic
anticoagulation.
Infective endocarditis occurs with equal frequency on mechanical and bioprosthetic
valves during the first postoperative year, but bioprosthetic valves have a higher risk
after18 months.
, Hemolytic anemia due to mechanical damage to RBCs can occur with mechanical
valves.
✔✔Atrial fibrillation is particularly dangerous in which of these patients:
A. Patient with preoperative LV dysfunction.
B. Patient with mitral valve replacement for mitral stenosis.
C. Patient with aortic valve replacement for aortic stenosis.
D. Patient who had 5-vessel CABG. - ✔✔C. Aortic stenosis causes left ventricular
hypertrophy with a stiff noncompliant LV and diastolic failure. A noncompliant LV
depends on atrial kick for adequate preload and stroke volume. Sinus rhythm or AV
pacing is especially important in this patient to maintain AV synchrony and adequate
preload. Atrial fibrillation results in a loss of atrial kick and can lead to profound
hemodynamic deterioration.
Atrial fibrillation can occur in any post operative cardiac surgery patient and is especially
common in mitral valve disease because of the increased atrial pressure and/or volume
that occurs. However, it is better tolerated in patients who do not have LV diastolic
dysfunction or LV hypertrophy.
✔✔Atrial fibrillation is an arrhythmia often seen in post-operative patients undergoing
CABG. Preoperative therapy for the reduction of post-operative atrial fibrillation includes
the following:
A. Preoperative administration of a beta blocker or amiodarone, and a statin.
B. Preoperative administration of sotalol and amiodarone.
C. Preoperative administration of a calcium channel blocker and a beta blocker.
D. Preoperative administration of a statin and digoxin. - ✔✔A. The standard therapy for
the reduction of postoperative atrial fibrillation is the initiation of beta blockers
preoperatively. Amiodarone can be used for prophylaxis in high risk patients who are
unable to receive beta blockers, but due to inconsistent clinical trial results, amiodarone
is not recommended as a routine strategy for the prevention of postoperative atrial
fibrillation. Preoperative statin therapy is known to reduce the risk of postoperative atrial
fibrillation and is also associated with a reduction in mortality associated with
postoperative atrial fibrillation.
✔✔Post-operative wound infection is a serious complication resulting in increased post-
operative mortality. Patient characteristics that place the patient at high risk for the
development of post-operative wound infections include all of the following EXCEPT:
A. Excessive use of electrocautery.
B. Race.
C. Obesity.
D. Diabetes.
E. End stage renal disease. - ✔✔B. Risk factors for the development of infection
include: obesity, diabetes, end stage renal disease, re-operation, excessive use of
electrocautery, prolonged mechanical ventilation, and use of both internal mammary
arteries (decreased blood flow to the sternum).
AND ANSWERS SURE A+
✔✔Which of the following is true concerning the use of aspirin following CABG surgery:
A. ASA is contraindicated because of the increased risk of bleeding from new grafts.
B. ASA is indicated for all CABG patients as an analgesic for postoperative pain control.
C. ASA is indicated for all CABG patients because of its antiplatelet effects and for
secondary prevention of coronary disease.
D. ASA is indicated for patients receiving arterial grafts but not venous grafts. - ✔✔C.
The use of ASA in the early postoperative period is used to offset platelet activation and
aggregation in the early postop period. ASA may result in improved graft patency;
decrease the incidence of perioperative MI, stroke, and acute kidney injury; and reduce
mortality. It is recommended that ASA be started within 6 hours postoperatively (after
mediastinal bleeding has stopped) and continued indefinitely for secondary prevention
in all CABG patients who do not have a contraindication to ASA.
✔✔Prosthetic heart valves are associated with all of the following complications
EXCEPT:
A. Endocarditis.
B. Systemic embolization.
C. High incidence of renal failure.
D. Hemolytic anemia.
E. Bleeding. - ✔✔C. Prosthetic valves are not directly associated with an increased risk
of renal failure, although renal failure can occur for several reasons following any type of
cardiac surgery.
Systemic embolization can occur with both mechanical and biological valves as a result
of thrombosis, vegetations, or left atrial thrombus (especially in the presence of atrial
fibrillation). The risk is twice as high with valves in the mitral position than those in the
aortic position.
Bleeding risk is higher with mechanical valves because of the need for chronic
anticoagulation.
Infective endocarditis occurs with equal frequency on mechanical and bioprosthetic
valves during the first postoperative year, but bioprosthetic valves have a higher risk
after18 months.
, Hemolytic anemia due to mechanical damage to RBCs can occur with mechanical
valves.
✔✔Atrial fibrillation is particularly dangerous in which of these patients:
A. Patient with preoperative LV dysfunction.
B. Patient with mitral valve replacement for mitral stenosis.
C. Patient with aortic valve replacement for aortic stenosis.
D. Patient who had 5-vessel CABG. - ✔✔C. Aortic stenosis causes left ventricular
hypertrophy with a stiff noncompliant LV and diastolic failure. A noncompliant LV
depends on atrial kick for adequate preload and stroke volume. Sinus rhythm or AV
pacing is especially important in this patient to maintain AV synchrony and adequate
preload. Atrial fibrillation results in a loss of atrial kick and can lead to profound
hemodynamic deterioration.
Atrial fibrillation can occur in any post operative cardiac surgery patient and is especially
common in mitral valve disease because of the increased atrial pressure and/or volume
that occurs. However, it is better tolerated in patients who do not have LV diastolic
dysfunction or LV hypertrophy.
✔✔Atrial fibrillation is an arrhythmia often seen in post-operative patients undergoing
CABG. Preoperative therapy for the reduction of post-operative atrial fibrillation includes
the following:
A. Preoperative administration of a beta blocker or amiodarone, and a statin.
B. Preoperative administration of sotalol and amiodarone.
C. Preoperative administration of a calcium channel blocker and a beta blocker.
D. Preoperative administration of a statin and digoxin. - ✔✔A. The standard therapy for
the reduction of postoperative atrial fibrillation is the initiation of beta blockers
preoperatively. Amiodarone can be used for prophylaxis in high risk patients who are
unable to receive beta blockers, but due to inconsistent clinical trial results, amiodarone
is not recommended as a routine strategy for the prevention of postoperative atrial
fibrillation. Preoperative statin therapy is known to reduce the risk of postoperative atrial
fibrillation and is also associated with a reduction in mortality associated with
postoperative atrial fibrillation.
✔✔Post-operative wound infection is a serious complication resulting in increased post-
operative mortality. Patient characteristics that place the patient at high risk for the
development of post-operative wound infections include all of the following EXCEPT:
A. Excessive use of electrocautery.
B. Race.
C. Obesity.
D. Diabetes.
E. End stage renal disease. - ✔✔B. Risk factors for the development of infection
include: obesity, diabetes, end stage renal disease, re-operation, excessive use of
electrocautery, prolonged mechanical ventilation, and use of both internal mammary
arteries (decreased blood flow to the sternum).
