Cardiac Patho Flashcards
What is the risk of perioperative MI in the general population?
0.3%
What are the chances of perioperative reinfarction in a patient who had an MI < 3 months ago?
30%
How long does the AHA recommend postponing elective surgery after MI?
4-6 weeks
When are the chances of reinfarction highest?
Within 30 days of MI
What are the NYHA classifications for heart failure?
When should a heart failure patient be required to have a cardiac clearance?
If they’re NYHA 3 or 4 and undergoing intermediate to high risk procedures
What is the calculation for coronary perfusion pressure?
Ao Diastolic - LVEDP
Which leads are best at detecting ischemic changes?
II and V5
How do patients with hypertension generally react to induction?
Hypotensive during induction, followed by hypertension with intubation
What’s the difference between a hypertensive crisis and a hypertensive emergency?
Crisis: BP > 180/120
Emergency: HTN with end organ damage
What are the components of Beck’s Triad?
Tamponade:
Hypotension
JVD
muffled heart sounds
What are the clinical signs of tamponade?
- Becks Triad
- Pulsus Paradoxus
- Kussmaul’s Sign
- Reduced EKG voltage
What is the optimal anesthetic for a patient with tamponade?
Ketamine
They rely on SNS tone. Don’t use anything that will reduce tone.
Which general anesthetics preserve myocardial function?
Benzos
Opioids
Nitrous
Ketamine
Patients at risk for bacterial endocarditis should receive prophylactic antibiotics before which procedures?
Dental procedures
Bronchs that perforate the mucosal lining
Biopsy of infectious lesions
All patients who receive a cardiac stent go on what anticoagulant cocktail?
Aspirin and Plavix
If a patient had an angioplasty but no stent, how long should they wait to have surgery?
2-4 weeks
If a patient had a bare metal stent placed, how long should they wait to have surgery?
30 days (preferably 90)
If a patient has a drug-eluting stent, how long should they wait to have surgery?
6-12 months, depending on the stent generation
How long should a patient wait to have surgery after a CABG?
At least 6 weeks, preferably 90 days
When should aspirin be stopped before surgery?
Should be continued if at all possible, if not 3 days
When should plavix be stopped before surgery?
7 days
What medication should you use to bridge patients on plavix?
NOT HEPARIN
Interestingly, heparin paradoxically increases platelet aggregation in stents
In CABG patients, when is awareness most common?
Sternotomy
What are four contraindications to IABP?
Severe Ao Regurg
PVD
Descending Ao Disease
Sepsis
The tip of the IABP balloon should be positioned:
distal to the L subclavian artery
When is surgical intervention recommended for a AAA?
> 5.5 cm
What are the risk factors for AAAs?
Cigarette Smoking
Male Gender
Advanced Age
Why are lumbar drains utilized in patients having AAA repairs?
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
What is the syndrome that can occur after AAA repair?
Beck’s Syndrome:
flaccid paralysis,
bowel and bladder dysfunction
Loss of pain and temperature sensation
