Cardiac

Question 1

RCRI

Answer 1

History of ischaemic heart disease 1
History of congestive heart failure 1
History of cerebrovascular disease 1
Use of insulin therapy for
diabetes 1
Preoperative serum creatinine >177 micromoles/L 1
High-risk surgery 1

Oxford

Question 2

Who needs periop 12-lead ECG?

Answer 2

1. pt > 65 yo
2. intermediate risk surgery
3. risk factors of IHD

Oxford

Question 3

What are the 5 types of MI? %?

Answer 3

1. acute atherothrombotic coronary event (25%)
2. heterogeneous - imbalance of O2 supply and demand (75%)
3. SCD unexpected
4. ~ PCI
5. ~ cardiac death

Oxford

Question 4

Pharm therapy to reduce MACE risk

Answer 4

1. Continue long term beta blocker (dec myocardial O2 demand)
2. No - initial of bb 24h prior surgery
3. Continue PRN nitrate
4. Continue CCB - restart ASAP post op
5. ACE/ARB - do not protect against MACE (But improve MI and LV dysfx survival)
6. Statin - improve ST and LT outcome post non-cardiac and CABG (ESA/CCS)

Oxford

Question 5

AMI

Answer 5

1. myocardial cell death
2. due to prolonged ischaemia

clinical evidence + cTNT
1+ ischaemic feature
(1. sx 2. new ECG changes 3. new RWMA 4. new cor thrombus)

cTNT
- rise 3-4h post injury
- up for 10-14d
- need 1 level >99th percentile required for dx

Question 6

MINS
- definition
- incidence
- dx
- surveillance
- med mx

Answer 6

1. Px relevant
2. Myocardial injury
3. Due to ischaemia
4. 30d after non-cardiac sx
5. pt w or w/o MI

• 20% of patients having non-cardiac surgery
• > 90% MINS - no signs/sx of ischaemia
• 20% meet MI definition

dx
1. cTNT >65ng/L
2. <30d non-cardiac Sx
3. Not due to non-ischaemic cause (e.g. AF, sepsis)
4. Not nec - sx/ECG changes

daily TnT levels on D1,2,3

• LD aspirin + statin
• ACE-i if HTN
• Anticoag (maybe) (MANAGE trial)
• ?cor angio and revasc

Question 7

HF criteria

Answer 7

by 1. sx 2. LVEF 3. BNP/NT-proBNP 4. left heart enlargement/diastolic dysfx

<40% HFrEF
40-49% HFmrEF
50%+ HFpEF

Question 8

HF mx

Answer 8

1. delay sx progression
2. optimise sx mx/FRC
3. reduce mortality

Question 9

HF treatment

Answer 9

*best evidence for HFrEF