2025 ECG Quiz 7

Question 1

Characteristics of an effective Pre Op

Answer 1

Medical history and physical examination

Medications

Allergies

Responses and reactions to previous
anesthetics

Estimation of risk

Determine the need for specific testing
or treatment

Question 2

ASA status

Answer 2

Patients with Cardiac history typically jump to ASA 3… but not always

Question 3

Obtaining
cardiovascular
history

Answer 3

Focus on determining the need for further cardiac evaluation

Risk-benefit analysis
Elective?
Need more tests to optimize? Does getting extra testing change anything for the patient?
Changes in symptoms?

Patients with extensive CAD, recent MI, or ventricular dysfunction are at greatest risk.

Chronic stable angina, history of CABG, or coronary angioplasty does not seem to increase perioperative
risk.

Patients on chronic beta blockers should continue treatment in the perioperative period

Most important symptoms to look
out for include
* Chest pains
* Dyspnea
* Poor exercise tolerance (walk up stairs not getting out of breath?)
* Syncope/near syncope

Patients with severe CAD may be
asymptomatic if they lead a
sedentary lifestyle

MI - last 6 months increase risk significantly

Question 4

Preoperative physical examination

Answer 4

A PET MONKEY???

Emergency surgery patients with a history of recent, unstable angina
should have cardiac enzyme testing completed to rule out MI
* Troponin: normal range: below 0.04 ng/ml, probable heart attack: above 0.40
ng/ml
* Creatine kinase (MB isoenzyme): normal range is 22 to 198 U/L, higher
amounts indicate muscle damage
* Lactate dehydrogenase (type 1 isoenzyme): normal range: 140 units per liter
(U/L) to 280 U/L for adults and tend to be higher for children and teens.

Baseline ECG may be normal in 25—50% of patients with CAD, but no
prior MI

Question 5

Cardiac testing

Answer 5

Holter monitoring
* Used to evaluate arrythmias, antiarrhythmic drug therapy, and severity and frequency of ischemic
episodes
* Frequent ischemic episode on preoperative Holter monitoring are associated with similar episodes
perioperatively
* Excellent negative predictive value for postoperative cardiac complications

Exercise ECG
* Useful for determining functional capacity and detecting myocardial ischemia
* Ischemic episodes at low levels of exercise is associated with perioperative risk

Myocardial perfusion scans/imaging
* Uses thallium-201, or technetium-99m
* Used to evaluate patients who cannot exercise
* Induce cardiovascular response to exercise with intravenous coronary dilator such as adenosine.
* Able to locate and quantitate ischemic areas or scarring
* Utilizes MRI, PET, and CT scans

Question 6

Cardiac Testing: Echocardiography

Answer 6

Gold Standard

Usually at rest, or stress test with dobutamine

Transthoracic = TTE

Transesophageal = TEE = better

Question 7

Cardiac testing: Coronary Angiography

Answer 7

Only true way to tell if CAD exists

Question 8

Premedication

Answer 8

Focus on alleviating fear, anxiety, and pain

Goal is to prevent sympathetic activation, lower myocardial oxygen demand

Proceed cautiously, overmedication is extremely dangerous

Benzodiazepines and opioids are routinely used

Patients with poor ventricular or pulmonary function should receive
reduced doses

Sudden withdrawal of antianginal meds, namely beta blockers may result in a sudden rebound in ischemic episodes

Question 9

Cardiovascular health x anesthesia x type of
surgery

Answer 9

Cardiovascular complications account for 25% to 50% of deaths
following noncardiac surgery

Patients with compromised cardiovascular status, such as HTN, may
be labile intraoperatively

Elective non-cardiac surgery is not recommended within 4-6 weeks following bare metal stent placement, or within 12 months of drugeluding
stent placement.

Hypertension, ischemic disease, congenital, and valvular heart
disease are a major cause of perioperative morbidity and mortality.

Most anesthetic agents cause cardiac depression, vasodilation, or
both

Response to surgical stimulation and the circulatory effects of
anesthetic agents, endotracheal intubation, positive-pressure
ventilation, blood loss, fluid shifts, and alterations in body
temperature impose additional burdens on an often already
compromised cardiovascular system.