Cardiac risk assessment

Question 1

What are the core components of the Goldman Risk Criteria?

Answer 1

Think - H CE GO

• H - History
• C - Cardiac Exam
• E - ECG
• G - General State
• O - Operative

Question 2

State the Goldman Risk Criteria history components

Answer 2

• Age > 70 (5 points)
• MI within 6 months (10 points)

Question 3

State the Goldman Risk Criteria cardiac exam components

Answer 3

• S3 heart sound / raised JVP (11 points)
• Significant aortic stenosis (3 points)

Question 4

State the Goldman Risk Criteria ECG components

Answer 4

• > 5 premature ventricular complexes / min (7 points)
• Any cardiac rhythm other than sinus (7 points)

Question 5

State the Goldman Risk Criteria general state component

Answer 5

• Poor medical condition (3 points)

Question 6

State the Goldman Risk Criteria operative components

Answer 6

• Peritoneal, thoracic or aortic surgery (3 points)
• Emergency surgery (4 points)

Question 7

What are the risk categorie of the Goldman Risk Criteria?

Answer 7

1. Low: 0 - 5 points (1% complication rate)
2. Medium: 6 - 12 points (7% complication rate)
3. Medium: 13 - 25 points (14% complication rate)
4. High: > 25 points (78% complication rate)

Question 8

What is the Goldman Risk Criteria?

Answer 8

A composite score taken from 11 different patient and operative features that correlate independently with risk for non-cardiac surgery.

Question 9

What is the Detsky (Modified) Index?

Answer 9

A composite score taken from 9 different patient and operative features that correlate independently with risk for non-cardiac surgery.

Question 10

What are the specific components of the Detsky (Modified) Index?

Answer 10

• Age > 70 (5)
• Prior MI
  
  • In the past 6 months (10)
  • At any point (5)
• Unstable angina in the past 6 months (10)
• Angina
  
  • Class III (10)
  • Class IV (20)
• Pulmonary Oedema
  
  • < 1 week ago (10)
  • Any history (5)
• Suspected AS (20)
• ECG
  
  • 5 premature complexes on ECG (5)
  • Any Rhythm other than sinus (5)
• Emergency surgery (10)
• Poor medical status (5)

Question 11

What are the risk categories of the Detsky (Modified) Index?

Answer 11

• 0 - 15 Low Risk
• 20 - 30 Moderate
• > 30 High Risk

Question 12

What are the single highest scoring features of the Detsky (Modified) Index?

Answer 12

• Stage IV angina (20 points)
• Critical AS (20 points)

Question 13

What are the single highest scoring features of the Goldman Risk Criteria?

Answer 13

• S3 heart sound / raised JVP (11 points)
• MI within 6 months (10 points)

Question 14

List 3 cardiovascular risk assessment tools for non-cardiac surgery

Answer 14

• The Goldman Risk Criteria (1977)
• The Detsky (Modified) Index (1986)
• The Lee (Revised) Index (1999)

Question 15

What are the features of the Lee (Revised) Index?

Answer 15

• High risk surgery
• Hx of IHD
• Hx of CCF
• Hx of cerebrovascular disease
• Pre-op insulin requirement for diabetes
• Pre-op serum creatinine >177 micromols/L

Question 16

What is DASI?

Answer 16

• The Duke Activity Status Index.
• A questionnaire that patients complete to estimate their exercise limitations.

Question 17

What is the main limitation of DASI?

Answer 17

It can be subjective and give falsely reassuring information.

Question 18

How can you use DASI to estimate peak VO₂

Answer 18

Peak VO₂ = (0.43 x DASI) + 9.6

Question 19

What is the maximum value that DASI can take?

Answer 19

58.2

Question 20

How many METs does completing 1 flight of stairs equate to?

Answer 20

4

Question 21

How many METs does strenuous physical activity equate to?

Answer 21

10

Question 22

How many METs does walking 100m on the flat equate to?

Answer 22

3

Question 23

What is a MET?

Answer 23

• a metabolic equivalent of task.
• 1 MET = basal metabolic rate = 3.5ml/kg/min VO₂

Question 24

What is the revised cardiac index?

Answer 24

Another name for the revised (Lee) index

Question 25

How many points on the revised cardiac index should prompt for cardiologist referral?

Answer 25

2