Case 13 Part 4



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What's inside?


 

Coronary artery bypass surgery
Scarring
Brachiocephalic vein, left
Superior vena cava
Pacemaker – defibrillator wires
Pulmonary artery
Saphenous vein graft
Lungs



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Discussion Questions


 

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1. What organs are visible?
 
 
2. Why is there so much scarring over the heart?
 
 
3. What surgeries has this patient had?
 
 
4. What is the difference between a pacemaker and defibrillator?
 
 
5. What named vessel has been opened to reveal the wire?
 
 
6. Where, most likely, would the wire attach in the heart?
 
 
7. What long term complications can occur related to the wire? Did the patient have any of these?
 
 
8. The video identifies a coronary artery bypass graft. Is it a saphenous vein graft or a left internal mammary artery graft? Where did the graft attach proximally? Based on its position over the heart, which vessel could it be bypassing?
 
 
9. Jump to interactive video. Pause the video and imagine the heart below the scarring. Sketch the outline of the heart, great vessels, anterior descending, left circumflex and right coronary arteries. Add the graft. Include its proximal and distal anastomoses. Add plaque into the bypassed vessel.
 
 
10. What great vessel is opened for assessment near the end of the video?
 
 
11. The physician puts a forceps into the great vessel and passes it towards the right of the patient. What named vessel(s) does the forceps tip pass through? Where does the tip end up after being fully inserted?
 
 
12. Was a pulmonary embolism identified?




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