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HA oral > Cardiac > Flashcards

Cardiac Flashcards

1
Q

goal of assessment

A

to learn the severity
progression
functional limitations

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2
Q

Exercise tolerance

A 
MET: metabolic equivalent of tasks:  need to be >4
1: basic metabolic needs 
1-4getting dressed
4-10: climbing the stairs
>10: strenuous sport
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3
Q

Cardiac hx

A 
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
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4
Q

what cardiac meds are you on?

A 
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
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5
Q

Cardiac Physical exam

A 
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
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6
Q

Testing for HF

A

ECG
ECHO: LV EF
CXR: pulm edema
Labs: Chem7, BUN/Cr, PT/INR (if on Coumadin), BNP

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7
Q

testing with HTN

A

long standing need:
ECG
BUN/cr
Chem7 if on diuretics

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8
Q

ECG clinical risk factors:

A

ischemic heart disease, HF, DM, CVD, renal insufficiency

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9
Q

ECG when to do it

A
  • 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
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10
Q

ECG shows what

A 
resting HR
STEMI: prior MI, acute: ST elevation/depression, T wave inversion
axis deviation: LVH?
arrhythmias 
BBB
Pacemaking function
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11
Q

cardiac : CXR

A

concerned about pulm edema, possible effusion, cardiomegaly

order if: >75yo hx CHF or symptomatic CVD

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12
Q

Cardiac: labs

A 
BUN/Cr
Hbg/Hct
K
Abg
PT/INR
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13
Q

Stress test is what

A

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

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14
Q

Cardiac clinical risk factors:

A

ischemic heart disease, HF, DM, CVD, renal insufficiency

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15
Q

when to order Stress test

A
  • 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.
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16
Q

Cardiac clinical risk factors: 5

A

ischemic heart disease, HF, DM, CVD, renal insufficiency

17
Q

ECHO 5

A 
chambers: measure dimension, enlargement
EF: measures vent systolic
wall motion 
valves: structure/motion 
Pericardial fluid
18
Q

ECHO under stress

A

looking for all motion under stress

19
Q

when to order an ECHO

A

HF- with worsening dyspnea, or other changes
dyspnea with out origin
AS

20
Q

Angiography

A 
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
21
Q

when to order pre op angio???

A

STEMI
stable CAD with L main
stable 3 vessel disease
2 vessel with signif prox LAD lesion and EF

22
Q

stenting, when can have surg

A

Balloon angio >14 day
Bare metal stent >30 days
drug stent > 365day

23
Q

Cardiac other: preop considerations

A

Subacute Bacterial Endocarditis prophylaxis?
positioning, can they handle that effect on CV
monitoring: aline, CVP, PAC, TEE

24
Q

Clinic predictors of inc CV risk: minor

A

uncontrolled HTN
abn ECG
low function capacity

25
Q

Clinic predictors of inc CV risk: intermediate

A 
DM
chronic renal insufficiency 
CAD
CVD
HF: compensated 
prior MI greater than 1 month ago
stable angina
26
Q

Clinic predictors of inc CV risk: major

A 
active heart condition 
unstable angina/coronary syndrome 
acute, recent MI less than 1 month ago
decompensated HF/ LV failure
signif arrythmias
severe valvular disease
27
Q

cardiac diseases look at notes!! back of hand written sheet

A

heart

HA oral (9 decks)

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