Ischaemic Heart Disease, Coronary Revascularisation, and Arrhythmia/Device Management — WACS Viva & Clinical Scenarios (Cardiothoracic)

Exam-style ischaemic heart disease, coronary revascularisation, and arrhythmia/device management viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 64-year-old male (ASA IV) with severe triple-vessel disease including 80% left main stem stenosis is scheduled for elective CABG. During induction with propofol and fentanyl, his blood pressure drops from 140/85 mmHg to 65/35 mmHg with an ST-depression of 3 mm in lead II. What is your immediate resuscitation algorithm?
• SCENARIO 2: A 55-year-old female undergoes Off-Pump Coronary Artery Bypass Grafting (OPCAB). During vertical displacement of the cardiac apex with an apical suction device to graft the posterior descending artery, she develops severe hypotension (MAP 45 mmHg), bradycardia, and a sharp rise in CVP. How do you identify and rectify the cause?
• SCENARIO 3: A 68-year-old male with an Implantable Cardioverter-Defibrillator (ICD) placed for sustained ventricular tachycardia is booked for urgent major thoracic surgery. Explain your preoperative device evaluation, intraoperative electromagnetic interference (EMI) mitigation, and emergency arrhythmia protocol.
• SCENARIO 4: A 50-year-old male 4 days post-anterior myocardial infarction develops sudden acute pulmonary oedema, a harsh pansystolic murmur, and profound cardiogenic shock (BP 70/40 mmHg) due to a post-infarct VSR. Outline your anaesthetic stabilization, invasive lines, and surgical bridge strategy.