Cardiothoracic Surgery
Core concepts
Know the indications and contraindications for coronary revascularization, the difference between elective, urgent, and emergent CABG, and the anatomy of graft conduits (LIMA to LAD, radial, saphenous vein). Understand cardiopulmonary bypass physiology: heparinization and ACT targets, cardioplegia, hypothermia, and the systemic inflammatory response. Valvular disease questions hinge on severity criteria and timing of intervention - symptomatic severe aortic stenosis, severe mitral regurgitation with symptoms or LV dysfunction, and endocarditis indications for early surgery (heart failure, uncontrolled infection, high embolic risk).
Thoracic topics
Lung cancer staging drives operative decisions: mediastinal staging before resection when nodes are enlarged, and the role of sublobar resection versus lobectomy for small peripheral tumors. Know the management of pneumothorax, empyema (early drainage, then decortication), and esophageal perforation (urgent source control).
Traps
- Confusing aortic dissection type A (surgical emergency) with type B (usually medical unless complicated).
- Assuming all severe AS needs surgery - asymptomatic patients without LV dysfunction may be watched.
- Forgetting that antiplatelet management around surgery is a common distractor.
- Mixing up post-op complications: tamponade presents with hypotension, elevated JVP, and pulsus paradoxus; low cardiac output after bypass has many causes.
Worked example
A patient with a 6 cm ascending aortic aneurysm and sudden tearing chest pain with a new AI murmur: this is a type A dissection until proven otherwise - operative emergency, not a workup question. Rule of thumb: acute chest pain plus pulse deficit or new regurgitant murmur equals dissection.
Study strategy
Link anatomy to conduit choice, and pair each valve lesion with its symptom threshold. Practice interpreting the difference between a stable post-op patient and one with early deterioration (bleeding, tamponade, arrhythmia).