Cardiac Patho

Question 1

What is the risk of perioperative MI in the general population?

Answer 1

0.3%

Question 2

What are the chances of perioperative reinfarction in a patient who had an MI < 3 months ago?

Answer 2

30%

Question 3

How long does the AHA recommend postponing elective surgery after MI?

Answer 3

4-6 weeks

Question 4

When are the chances of reinfarction highest?

Answer 4

Within 30 days of MI

Question 5

What are the NYHA classifications for heart failure?

Answer 5

Question 6

When should a heart failure patient be required to have a cardiac clearance?

Answer 6

If they’re NYHA 3 or 4 and undergoing intermediate to high risk procedures

Question 7

What is the calculation for coronary perfusion pressure?

Answer 7

Ao Diastolic - LVEDP

Question 8

Which leads are best at detecting ischemic changes?

Answer 8

II and V5

Question 9

How do patients with hypertension generally react to induction?

Answer 9

Hypotensive during induction, followed by hypertension with intubation

Question 10

What’s the difference between a hypertensive crisis and a hypertensive emergency?

Answer 10

Crisis: BP > 180/120

Emergency: HTN with end organ damage

Question 11

What are the components of Beck’s Triad?

Answer 11

Tamponade:

Hypotension
JVD
muffled heart sounds

Question 12

What are the clinical signs of tamponade?

Answer 12

1. Becks Triad
2. Pulsus Paradoxus
3. Kussmaul’s Sign
4. Reduced EKG voltage

Question 13

What is the optimal anesthetic for a patient with tamponade?

Answer 13

Ketamine

They rely on SNS tone. Don’t use anything that will reduce tone.

Question 14

Which general anesthetics preserve myocardial function?

Answer 14

Benzos
Opioids
Nitrous
Ketamine

Question 15

Patients at risk for bacterial endocarditis should receive prophylactic antibiotics before which procedures?

Answer 15

Dental procedures
Bronchs that perforate the mucosal lining
Biopsy of infectious lesions

Question 16

All patients who receive a cardiac stent go on what anticoagulant cocktail?

Answer 16

Aspirin and Plavix

Question 17

If a patient had an angioplasty but no stent, how long should they wait to have surgery?

Answer 17

2-4 weeks

Question 18

If a patient had a bare metal stent placed, how long should they wait to have surgery?

Answer 18

30 days (preferably 90)

Question 19

If a patient has a drug-eluting stent, how long should they wait to have surgery?

Answer 19

6-12 months, depending on the stent generation

Question 20

How long should a patient wait to have surgery after a CABG?

Answer 20

At least 6 weeks, preferably 90 days

Question 21

When should aspirin be stopped before surgery?

Answer 21

Should be continued if at all possible, if not 3 days

Question 22

When should plavix be stopped before surgery?

Answer 22

7 days

Question 23

What medication should you use to bridge patients on plavix?

Answer 23

NOT HEPARIN

Interestingly, heparin paradoxically increases platelet aggregation in stents

Question 24

In CABG patients, when is awareness most common?

Answer 24

Sternotomy

Question 25

What are four contraindications to IABP?

Answer 25

Severe Ao Regurg
PVD
Descending Ao Disease
Sepsis

Question 26

The tip of the IABP balloon should be positioned:

Answer 26

distal to the L subclavian artery

Question 27

When is surgical intervention recommended for a AAA?

Answer 27

> 5.5 cm

Question 28

What are the risk factors for AAAs?

Answer 28

Cigarette Smoking
Male Gender
Advanced Age

Question 29

Why are lumbar drains utilized in patients having AAA repairs?

Answer 29

Spinal perfusion is compromised because the artery of adamkiewicz is closed off. Reducing pressure in the spinal column means arterial flow meets less resistance, increasing perfusion

Question 30

What is the syndrome that can occur after AAA repair?

Answer 30

Beck’s Syndrome:
flaccid paralysis,
bowel and bladder dysfunction
Loss of pain and temperature sensation