Cardiac Flashcards
goal of assessment
to learn the severity
progression
functional limitations
Exercise tolerance
MET: metabolic equivalent of tasks: need to be >4 1: basic metabolic needs 1-4getting dressed 4-10: climbing the stairs >10: strenuous sport
Cardiac hx
do you have/had problems with your heart... can you walk up stairs without SOB Pain Exercise tolerance SOB- when ? with exertion? CP-when, doing what, tx, have those symptoms changed recently MI HTN Valve problems Irregular heart beat, abn ECG Pacemaker/ICD HF Stroke, high cholesterol, CAD cardiac surg, stents? Cardiologist DM, estrogen status, syncope WHAT MEDS
what cardiac meds are you on?
Bblockers- continue CCB ACEI and ARB- dc Diuretics- dc (check K) Coumadin- dc 4-5 days before surg INR >1.5 LMWH- dc 12hrs preop ASA- dc 10 days before surg Statins Nitrates Antiarrhythmics Digoxin
Cardiac Physical exam
Overall appearance: obesity, SOB, sternal incision, pacemaker box, edema Heart sounds A 2ics Rsb P 2ics Lsb T 4ics Lsb M 5ics Lmcl Breath sounds: rales-CHF, SOB, effort Extremities: palpate pulses, peripheral edema, clubbing skin color Neck: look at JVD, carotid bruit VS: BP both arms, HR, O2sat
Testing for HF
ECG
ECHO: LV EF
CXR: pulm edema
Labs: Chem7, BUN/Cr, PT/INR (if on Coumadin), BNP
testing with HTN
long standing need:
ECG
BUN/cr
Chem7 if on diuretics
ECG clinical risk factors:
ischemic heart disease, HF, DM, CVD, renal insufficiency
ECG when to do it
- all vascular surg
- known CAD, Cerebralvascular disease, PAD and having intermediate vascular surg
- have 1 more more clinical risk factors and having intermediate vascular surg
- DONT do on low risk, asymptomatic
ECG shows what
resting HR STEMI: prior MI, acute: ST elevation/depression, T wave inversion axis deviation: LVH? arrhythmias BBB Pacemaking function
cardiac : CXR
concerned about pulm edema, possible effusion, cardiomegaly
order if: >75yo hx CHF or symptomatic CVD
Cardiac: labs
BUN/Cr Hbg/Hct K Abg PT/INR
Stress test is what
objective measure of Function Capacity
look for ischemia with increased HR/BP
exercise or pharm (thallium with Dipyridamile or adenosine)
area of dec perfusion called cold spot only during stress show ischemia–old MI
Cardiac clinical risk factors:
ischemic heart disease, HF, DM, CVD, renal insufficiency
when to order Stress test
- Active Cardiac Condition: unstable angina, recent MI, decompensated HF, severe valvular dx, and signif arrhythmias
- 3 or more risk factors and poor functional capacity having vascular surg.
Cardiac clinical risk factors: 5
ischemic heart disease, HF, DM, CVD, renal insufficiency
ECHO 5
chambers: measure dimension, enlargement EF: measures vent systolic wall motion valves: structure/motion Pericardial fluid
ECHO under stress
looking for all motion under stress
when to order an ECHO
HF- with worsening dyspnea, or other changes
dyspnea with out origin
AS
Angiography
gold standard for coronary anatomy and for undergoing heart surg SHOWS: obstruction adequacy of angioplasty, grafts coronary spasms Valve size, gradient LV pressure, volume, EF and dysfunction CO, SVR PA pressure
when to order pre op angio???
STEMI
stable CAD with L main
stable 3 vessel disease
2 vessel with signif prox LAD lesion and EF
stenting, when can have surg
Balloon angio >14 day
Bare metal stent >30 days
drug stent > 365day
Cardiac other: preop considerations
Subacute Bacterial Endocarditis prophylaxis?
positioning, can they handle that effect on CV
monitoring: aline, CVP, PAC, TEE
Clinic predictors of inc CV risk: minor
uncontrolled HTN
abn ECG
low function capacity
Clinic predictors of inc CV risk: intermediate
DM chronic renal insufficiency CAD CVD HF: compensated prior MI greater than 1 month ago stable angina
Clinic predictors of inc CV risk: major
active heart condition unstable angina/coronary syndrome acute, recent MI less than 1 month ago decompensated HF/ LV failure signif arrythmias severe valvular disease
cardiac diseases look at notes!! back of hand written sheet
heart
