Cardiac Flashcards
What are the criteria for diagnosing myocardial infarction?
Rise and/or fall of cardiac biomarkers (with at least one value > 99th percent of upper limit reference range) AND >1 of the following:
* Ischemic symptoms
* New ischemic ECG changes
* Image evidence of nonviable myocardium
* Imaging showing new regional wall motion abnormalities
What is the difference between ST-elevation MI and Non-ST-elevation MI?
ST-elevation MI has easily identified coronary lesions and benefits from emergent intervention such as percutaneous coronary intervention or thrombolytics, while Non-ST-elevation MI usually involves multiple coronary lesions and requires coronary angiography within days of symptoms.
What are the types of myocardial infarctions?
Types of MI’s:
* Type 1: Spontaneous, related to plaque erosion, rupture, fissuring, or dissection, can lead to STEMI or NONSTEMI.
* Type 2: Related to imbalance between myocardial oxygen supply and demand, can lead to NONSTEMI only.
Why is the distinction between Type 1 and Type 2 myocardial infarction important?
Type 1 MI is spontaneous and unpredictable, requiring preoperative interventions like plaque stabilization or statin therapy, while Type 2 occurs mainly with severe yet stable coronary artery disease.
What are the classifications of heart failure?
Classifications of heart failure:
* Systolic HF or HF with reduced ejection fraction
* Diastolic HF or HF with normal (preserved) ejection fraction.
What are the objectives in preoperative evaluation for heart failure?
Objectives:
* Assess current degree of compensation
* Determine underlying cause of HF
* Identify coexisting conditions
* Exclude a new HF diagnosis
* Confirm adherence to therapies.
What is indicated for preoperative ECG in patients?
Indicated for patients with:
* Known coronary heart disease
* Significant arrhythmia
* Peripheral arterial disease
* CVA
* Significant structural heart disease.
What is the significance of natriuretic peptides (BNP) in diagnosing heart failure?
Natriuretic peptides are released due to myocardial wall stretching:
* 0-100 pg/mL = HF unlikely
* 400 pg/mL = HF likely.
What are the management strategies for heart failure before surgery?
Management strategies:
* Treatment of hypertension
* Heart rate control
* Management of arrhythmias
* Diuresis for symptomatic improvement
* Correction of anemia.
When should ARBs, ACEIs, and Angiotensin II Inhibitors be managed around surgery?
Continue until 1 day before surgery and resume within 48 hours.
What is the recommended duration for dual antiplatelet therapy after angioplasty with drug-eluting stents?
6 months of dual antiplatelet therapy (DAPT) is recommended after angioplasty with drug-eluting stents.
What physical activity questions can assess functional capacity before surgery?
Questions to assess functional capacity:
* Can you climb two flights of stairs without stopping and without chest pain or shortness of breath?
* Can you walk two to four blocks on a level surface without having chest pain or shortness of breath?
What is the main disadvantage of an exercise stress test?
Unsuitable for patients with low effort capacity such as vascular, orthopedic, neurological issues, or abnormal ECG.
What are the common causes of heart failure?
Common causes include:
* Ischemic heart disease
* Hypertension
* Valvular heart disease
* Cardiomyopathies.
What is the definition of heart failure?
Defined as impaired ventricular filling or limited ventricular ejection where cardiac output declines below the minimum needed to meet the metabolic demands of the body.
What are the types of valvular disease mentioned?
Types of valvular disease:
* Stenotic Valvular Disease (e.g., aortic and mitral stenosis)
* Regurgitation Valvular Disease (e.g., mitral regurgitation).
When is echocardiography recommended?
Recommended for:
* New, suspected, decompensated heart failure
* Suspected valvular disease
* Poor functional capacity.
