Cardiac Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Cardiac Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations

A 57-year-old man with a history of Wolff-Parkinson-White syndrome, rheumatoid arthritis, BPH, and Budd-Chiari syndrome undergoes minimally invasive mitral valve repair. Shortly after surgery, he develops bradycardia, hypotension, hypoxemia, and new ST changes on ECG, with echocardiography revealing lateral wall hypokinesis. Which clinical findings and anatomical considerations should guide your immediate management in this complex postoperative scenario? VIDEO INFO Category: Cardiac Anatomy, Human Anatomy, USMLE Step 1 Difficulty: Moderate - Intermediate level - Requires solid foundational knowledge Question Type: Management - Clinical management decisions Case Type: Critical Condition Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 57-year-old man with Wolff-Parkinson-White syndrome (ablation 10 years ago), rheumatoid arthritis on methotrexate, benign prostatic hyperplasia, and Budd-Chiari syndrome status post TIPS undergoes elective minimally invasive mitral valve repair for severe degenerative MR. Intraoperative course is uneventful with annuloplasty ring placement.... OPTIONS A. Immediate coronary angiography with readiness for percutaneous revascularization of the left circumflex artery compromised along the mitral annular course. B. High-dose inotropes with vasopressors and intra-aortic balloon counterpulsation, observing 12-24 hours for spontaneous resolution of lateral wall ischemia after surgical valve repair. C. Return to the operating room for empiric suture removal without angiography, postponing any coronary imaging until postoperative day 2. D. Telemetry only and serial troponins, reserving imaging for persistent ST-segment deviations after 48 hours. CORRECT ANSWER A. Immediate coronary angiography with readiness for percutaneous revascularization of the left circumflex artery compromised along the mitral annular course. EXPLANATION The correct answer is "Immediate coronary angiography with readiness for percutaneous revascularization of the left circumflex artery compromised along the mitral annular course." Post-mitral repair lateral wall ischemia with junctional bradycardia and rising enzymes strongly suggests iatrogenic LCx compromise where the artery courses in the left AV groove adjacent to the posterior mitral annulus. Bedside echo shows new severe lateral hypokinesis. Angiography is urgent to confirm injury (suture entrapment, kinking, occlusion) and enable PCI or surgical bailout. "High-dose inotropes with vasopressors and intra-aortic balloon counterpulsation, observing 12-24 hours for spontaneous resolution of lateral wall ischemia after surgical valve repair." is incorrect because delay risks infarction; mechanical support without revascularization does not treat the cause. "Return to the operating room for empiric suture removal without angiography, postponing any coronary imaging until postoperative day 2." is incorrect because it is blind and delays definitive diagnosis; angiography localizes the lesion and may obviate reoperation.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------