Cardiac Surgical Patient - Quiz 1

Question 1

What are considered high risk for death/MI surgeries for the cardiac patient?

Answer 1

>5% risk

Aortic Surgery & Vascular Surgery

Question 2

What surgeries are intermediate risks for the cardiac patient?

Answer 2

1-5% risk

Intraperitoneal
Transplant
Peripheral Artery Angioplasty
Endovascular Aneurysm Repair
Head & Neck
Neuro/Ortho
Intrathoracic
Major Urologic

Question 3

What are 2 of the main questions asked in determining functional capacity?

Answer 3

1. Can you walk 4 blocks w/o stopping?
2. Can you go up 2 flights of stairs w/o stopping –> if not = 82% risk for postop complications

Question 4

What is considered Poor Functional Capacity?

Answer 4

1 MET

Self-care

Walking indoors

Walking 1-2 blocks really slow

Question 5

What is considered Good Functional Capacity?

Answer 5

4 METs

Light Housework

Stairs w/o stopping

Brisk walking

Short run

Light sports

Question 6

What are the clinical risk factors for CV surgery?

Answer 6

Poor LV Function
CHF
Unstable Angina
Past MI
Age > 65
Obesity
Reoperation
Emegency Surgery
Uncontrolled Illness

Question 7

What is associated w/ the highest risk for PeriOperative MI?

Answer 7

Unstable Angina

Question 8

An MI in the past > 6 months increases PeriOp risk of infarction by ______

Answer 8

6%

Question 9

An MI in the past b/t 3-6 months increases PeriOp risk of infraction by ______

Answer 9

15%

Question 10

An MI in the past 3 months increases PeriOp risk of infraction by ______

Answer 10

30%

Question 11

When is the highest risk period for a surgical patient who had an MI?

Answer 11

Within 30 days of the MI –> need to wait at least 4-6 weeks after MI

Question 12

Which kind of heart stent has a decreased rate of restenosis?

Answer 12

Drug Eluting Stent

Question 13

How long should Aspirin & Plavix be continued after coronary revascularization?

Answer 13

Aspirin: indefinitely

Plavix: at least 1 yr.

Question 14

How long should a patient wait before having elective surgery if they’ve had a bare metal stent or drug eluting stend placed?

Answer 14

Bare Metal: 6 weeks

Drug Eluting: 12 months

Question 15

What should be obtained for the surgical patient who has valvular stenosis?

Answer 15

Recent Echo to estimate EF

Question 16

Which valvular disorder poses the greatest risk for a patient undergoing noncardiac surgery?

Answer 16

Severe Aortic Stenosis w/ cross sectional area < 1 cm²

Question 17

Which drugs are used for a pharmacologic stress test?

Answer 17

Adenosine & Dobutamine

Question 18

What makes the risk for Electromagnetic interference low in regards to a patient w/ a pacemaker or AICD?

Answer 18

Device < 10 yrs old

&

Cautery > 15 cm from lead

Question 19

What are the cardioprotective attributes of statins?

Answer 19

↑Endothelial Function

↑Plaque Stability

↓Vascular Inflammation

Question 20

When should statins be started before high risk surgeries?

Answer 20

30 days - 1 week before surgery & continue peri-operatively

Question 21

Why are B-Blockers given for high risk surgeries?

Answer 21

Restore O₂ supply/demand mismatch

↓PeriOperative Ischemia

Redistribute blood flow to Subendocardium

Stabilizes Plaques

↑V-Fib Threshold

Question 22

How should B-Blockers be managed for high risk surgeries?

Answer 22

Start b/t 30 days - 1 week before surgery

Avoid starting high dosage

Continue previous therapy & post-op for a month

HR goal = 60-65

Question 23

Why are ACE Inhibitors important for the cardiac surgery patient?

Answer 23

↓PeriOperative HF, MI, and Death in pts w/ LV dysfunction

Longer half-life than B-Blockers

Question 24

How should ACE Inhibitors be managed for cardiac surgery?

Answer 24

Hold 1-2 days before surgery d/t refractory hypotension

May decrease effectiveness of Ephedrine