Viva 3

Cardiac surgery

Scenario:  A seventy-two (72) year old ex-heavy smoker underwent “on-pump”  coronary  artery bypass grafting  (LIMA to LAD, RIMA to RCA, free radial  to Circumflex).   His preoperative left ventricular   function  was  normal.     It  was  not  possible  to  achieve  satisfactory   retrograde cardioplegia so anterograde cardioplegia was employed.
He received a total intravenous anaesthetic technique with propofol and remifentanil.  There were no specific problems separating  from cardiopulmonary bypass but a new Right Bundle Branch Block was noted on his ECG.
In transit to the ICU he was noted to be awake and obeying commands.
Soon after arrival  in ICU, he became agitated, dysynchronous with the ventilator and developed marked systemic hypotension.
Here are his first haemodynamic measurements in ICU.

Heart rate

100 reg

Systolic blood pressure

85

Mean arterial pressure

55

Systemic vascular resistance

809

Diastolic blood pressure

40

Systemic vascular resistance index

1600

Pulmonary capillary wedge pressure

20

Cardiac Ouput

2.7

Cardiac Index

1.5

Pulmonary artery systolic pressure

60

Pulmonary vascular resistance

590

Mean pulmonary artery pressure

40

Pulmonary vascular resistance index

1070

Pulmonary artery diastolic pressure

30

Central venous pressure

25

Introductory Question: How do you interpret these results?

Twenty out of twenty-three candidates passed this section.

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.