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AFN Health Assessment > Cardiac Assessment > Flashcards

Cardiac Assessment Flashcards

1
Q

Nearly __ of 2 adults have hypertension

A

1

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2
Q

Chronic increase in BP leads to _______ and _______ dysfunction

A

LV hypertrophy

diastolic

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3
Q

Hypertension has a greater impact on _____ risk than MI risk

A

CVA

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4
Q

Increased perioperative risk with DBP >____

A

110

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5
Q

Risk MI ⬆ -% for every _ mmHg ⬆ diastolic BP

A

2-3%

1mmHg

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6
Q

_________ increases risk of ischemic heart disease (IHD)

A

Hypertension

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7
Q

Risk factors for primary hypertension

A 
Increased Age
Excessive Dietary Intake of Sodium
African American Race
Tobacco Use**
Alcohol Consumption of >2 drinks/day
Genetic/Family History
Obesity
Stress
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8
Q 
Medication noncompliance
Medication withdrawal
Accelerated hypertension in a patient with preexisting hypertension
Reno-vascular hypertension
Acute glomerulonephritis

Which type of HTN?

A

Acute HTN

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9
Q 
SBP>180 or DBP>130 mmHg
Requires immediate reduction
Persistent diastolic pressure > 130 mmHg associated with acute vascular damage
Evidence of end-organ damage
Brain
Heart
Kidneys
Retina

Which type of HTN?

A

Hypertensive crisis

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10
Q

Unable to achieve BP <140/90 despite treatment with >3 different anti-hypertensives at maximally tolerated dose
Increased interest in endothelin A antagonists; aldosterone antagonists and SNS targeted antagonists (including devices)
Focus on the renal system’s role in resistant hypertension

Which type of HTN?

A

Resistant HTN

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11
Q

Normal BP range

A

<120

<80

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12
Q

Pre-HTN range

A

120-139

80-89

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13
Q

Stage 1 HTN

A

140-159

90-99

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14
Q

Stage II HTN

A

160-179

100-109

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15
Q

Stage III HTN

A

180-209

110-119

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16
Q

Stage IV HTN

A

> 210

>120

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17
Q

Recommendation for Stage I & II for surgery

A

Proceed with anesthesia and surgery

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18
Q

Recommendation for Stage III for surgery

A

Consider postponing anesthesia and surgery, especially in patients with other cv risk factors and end-organ damage

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19
Q

Recommendation for Stage IV for surgery

A

Defer anesthesia and surgery whenever possible, begin appropriate anti-hypertensive therapy, and arrange for outpatient follow up or inpatient BP control

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20
Q

30% of adults in the United States have a plasma cholesterol level above _____ mg/dl

A

240

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21
Q

Plasma cholesterol concentration below _____ mg/dl would decrease the incidence of IHD 30% to 50%

A

200

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22
Q

Increase of ____-density lipoproteins worse than _____-density lipoproteins

A

Low

High

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23
Q 
Cholesterol Goals:
Total <\_\_\_\_
LDL <\_\_\_\_
HDL >\_\_\_
TG<\_\_\_
A

total <200
LDL <100
HDL >60
TG <150

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24
Q

Atherosclerosis fixed lesions > 75% causes what symptoms

A

exercise/stress induced symptoms (compensatory vasodilation can no longer meet metabolic needs)

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25
Q

Atherosclerosis fixed lesions > 90% causes what symptoms

A

symptoms at rest

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26
Q

Atherosclerosis plaque disruption physiology (acute coronary syndrome, ACS, anesthesia stress test)

A

Sympathetic surge causes shear forces on coronary plaque
Endothelial and systemic inflammation
Hypercoagulable state induced by surgical stress→ risk of thrombosis

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27
Q

Pt presents with ACS (any type) pre-op. Ok for surgery?

A

NO

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28
Q

Type of cardiac necrosis involves full or nearly full thickness of the ventricular wall along a single vessel distribution

A

Transmural

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29
Q

What type of anesthetics preferred for HTN pt?

A

Regional if possible

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30
Q

Type of cardiac necrosis

Necrosis limited to the inner 1/3 to _ of the ventricular wall
May extend beyond the distribution of one vessel
Usually due to plaque disruption then lysis of the thrombosis before transmural injury occurs
Or may be due to prolonged and severe reductions in SBP

A

Subendocardial

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31
Q

Type of MI due to plaque rupture, erosion, or dissection

Can be either a STEMI or NSTEMI

A

Type I

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32
Q

Type of MI due to imbalance of supply and demand
Usually an NSTEMI
Most common in the post operative phase

A

Type II

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33
Q

Which type of cholesterol attracts macrophages

A

LDL

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34
Q

Which type of cholesterol repels macrophages

A

HDL

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35
Q

Two types of stents

A

Drug-eluting

Bare metal

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36
Q

In pt with stents, caution on premature discontinuation of ___ _______ therapy

A

anti platelet

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37
Q

What type of stent

Mechanism of action: the implanted medication prevents neointimal proliferation but also stent endothelization = risk of thrombosis

A

Drug eluting stents

38
Q

____ LAD dominate pts have poorer prognosis’s with MI

A

Left dominate

39
Q

Duration of no surgery with DE stents

A

365 days

40
Q

Duration of no surgery with bare metal stents

A

30 days

41
Q

With BM stents, delay surgery optimally to __ months

A

3 months

42
Q

Timing post CABG for surgery, ok after ___ months

A

1 month

43
Q

Patients with a CABG within the previous 5 years and are clinically stable – is there a need for additional workup?

A

NO

44
Q

With CP originating from vasospasms, which drug is used to treat them and do you keep them on it perioperatively?

A

Calcium Channel Blockers

Yes

45
Q

Class of recommendation for revascularization:

evidence or general agreement that the procedure is useful, beneficial, and effective

A

Class I

46
Q

Class of recommendation for revascularization:

conflicting evidence – weight is in favor of intervention

A

Class IIa

47
Q

Class of recommendation for revascularization:

conflicting evidence but the weight is NOT in favor of intervention

A

Class IIb

48
Q

Class of recommendation for revascularization:

evidence that the treatment is not useful, beneficial or effective

A

Class II

49
Q

Class of recommendation for revascularization:

Risk of harm is high

A

Class III

50
Q

medication that should be continued preoperatively and:

Decrease oxygen consumption by reducing heart rate resulting in a lengthen time in diastole

Decrease myocardial contractility

Redistribution of blood flow to the subendocardium
Plaque stabilization

A

Beta-blockers

51
Q

Are you going to take pt off plavix periop?

A

NOOOO

52
Q

If pt comes in on anticoagulants what are the 2 things you should do

A

Communicate with cardiologist

Know WHY they are on it

53
Q

What type of drug?

HMG-CoA reductase inhibitors
Potential to decrease risk of MI in high-risk patients
0-30 days reduced risk of MI
1year – trend for decreased risk
Decrease cholesterol synthesis
Anti-inflammatory properties
Reduced CRP
Vasodilatory effects
Anti-thrombogenic
Timing: 1-2 months before surgery vs. shorter time before surgery
A

Statins

54
Q

What two risks with statins should you be aware of?

A

statin induced myopathy

rhabdomyolysis

55
Q

Which Glycoprotein IIb/IIIa inhibitor?

Long acting. Reversed only with platelet transfusion

Bleeding time returns to 75% of normal in 24 hours; risk of excessive bleeding 3-5%

A

Abciximab (ReoPro)

56
Q

Which Glycoprotein IIb/IIIa inhibitor?

Effects can not be reversed with plt transfusion

Bleeding time returns to 1.5 times normal within 6 hours

A

Eptifibatide (Integrilin)

57
Q

Which Glycoprotein IIb/IIIa inhibitor?

Plasma half-life of 2 hours; plt function returns to 90% of normal with 4-8 hours

A

Tirofiban (Aggrastat)

58
Q

With Glycoprotein IIb/IIIa inhibitors it is prudent to delay elective cases __-__ hours

A

24-48 hours

59
Q

Should you ideally hold antihypertensives before surgery?

A

Yes due to refractory hypotension

60
Q

This type of med has positive interactions between β-antagonists and CCBs

A

antihypertensives

61
Q

Warfarin: d/c __ days prior to surgery

A

5 days

62
Q

ASA: d/c __-__ days prior to surgery

A

7-10 days

63
Q

Thienopyridines: d/c __-__ days prior to surgery

A

5-7 days

64
Q

It can be reasonable to continue ___ and ___ if they are on it for heart failure (not necessarily just HTN)

A

ACEI

ARB

65
Q

What cardiac sound? closure of AV valves

A

S1

66
Q

What cardiac sound? closure of semilunar valves

A

S2

67
Q

What cardiac sound? signifies LV failure and/or volume overload lub-dub-ta or Kentucky

A

S3

68
Q

What cardiac sound? usually indicative of hypertrophic LV, AS, HOCM ta-lub-dub or Tennessee

A

S4

69
Q

Myocardial ischemia occurs most frequently in the ____ period

A

postop

70
Q

Equation for pressure

A

Tension/radius

71
Q

Presence of inflammatory markers (c-reactive protein) can indicate risk for

A

heart failure

72
Q

LVEDP

> ___ usually indicates some degree of ventricular dysfunction

A

> 15

73
Q

stroke volume/end diastolic volume = ________

A

Ejection fraction

74
Q

Normal EF = ___%

A

75%

75
Q

Heart failure EF < ___%

A

<40%

76
Q

RV or LV failure?

Systemic Congestion
Peripheral edema/anasarca
Ascites/hepatomegaly
Coagulopathy
Hepatojugular reflex
Precordial lift
Parasternal heave
A

RV failure

77
Q

RV or LV failure?

Pulmonary Congestion
Dyspnea /orthopnea
 PND
Poor peripheral perfusion
Dizziness, confusion, cool extremities
Fatigue
A

LV failure

78
Q

Dont start _____ on the day of surgery

A

Beta blockers

79
Q

Systolic or diastolic dysfunction?

Prevalent in elderly patients with hypertensive heart disease
Present in most patients with symptomatic heart failure but can occur in isolation
Better prognosis with DHF but the complication rate is the same
Very few RCTs regarding best medication regimen
Preserved EF with increased left ventricular filling pressure
Impaired relaxation and passive stiffness
THINK COMPLIANCE

A

Diastolic

80
Q

With diastolic failure,

Avoid _______
Avoid ______
Avoid _______

A

tachycardia
ischemia
hypertension

81
Q

Know what the frank-starling curve is

A

Intravascular volume curve reflecting the frank-starling mechanism (actin-myosin sheath in the sarcomere of myocardium that is elastic and contracts more forcefully with added intravascular volume until a certain point where they overstretch and cardiac performance is significantly decreased)

82
Q

If needed, check platelet count and ________ with anticoagulated pts

A

function

83
Q

What vasopressor for ACE/ARB induced hypotension?

A

Vasopressin

84
Q

Is pre op nitroglycerin still a thing?

A

NOOO

85
Q

Is pre op clonidine useful if the pt isn’t already on it?

A

Nope

86
Q

What is the worst thing (and try to prevent) for cardiac pts?

A

Tachycardia

87
Q

For both pain and anxiety you could use what drug?

A

Precedex

88
Q

Be cautious with these two meds (anxiety and pain)

A

Benzos & opioids

89
Q

Be cautious with these two meds (anxiety and pain)

A

Benzos & opioids

90
Q

Non cardiac surgery with new or worsened HF within __ weeks of surgery had a 2x greater risk of 30-day mortality and significantly increased risk of prolonged mechanical ventilation, sepsis, pneumonia , ARF, and cardiac arrest compared with a matched cohort of stable HF

A

4 weeks

AFN Health Assessment (12 decks)

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