CARDIAC2 ASSESSMENT Flashcards
WHAT ARE 4 THINGS WE ARE CONCERNED ABOUT IN THE CARDIAC PT?
CORONARY DISEASE…..PLAQUE MI CVA
VALVULAR DISEASE….AORTIC STENOSIS
ARRYTHMIAS
VOLUME STATUS…EF…CHF
WHAT ARE IMPORTANT PREDICTORS OF CARDIAC RISK?
RECENT MI (LESS THAN 6 MO.)…..CANCEL SURGERY!
REMOTE (PAST) HX OF MI….DELAY SURG FOR 6 MO.
HX OF CHF
EMERGENT SURG INCREASES RISK 2-5X
NONSINUS RHYTHM
WHAT IS THE CURRENT BEST GUIDELINE TO DETERMINE CV STATUS/RISK? AND WHAT DOES IT EVALUATE?
ACC GUIDELINE. IT EVALUATES: TYPE OF SURG PROCEDURE, URGENCY OF SURGER, RECENT CARDIAC INTERVENTIONS AND EVALUATION, INCORPORATED CLINICAL PREDICTORS OF CARDIAC RISK FROM ACC GUIDE (MAJOR, INTERMEDIATE, AND LOW)
WHAT ARE THE MAJOR, INTERMEDIATE, AND MINOR PREDICTORS OF CLINICAL SURGICAL RISK? ACCORDING TO ACC?
MAJOR: UNSTABLE CORONARY SYNDROMES, DECOMPENSATED CHF, SIGNIFICANT ARRHYTHMIAS, SEVERE VALVULAR DISEASE
INTERMED: MILD ANGINA, COMPENSATED OR PRIOR CHF, DM, RENAL INSUFFICIENCY
MINOR: OLD, ABNORMAL EKG, HX OF STROKE, UNCONTROLLED HTN, LOW FUNCTIONAL CAPACITY.
WHAT IS METS? WHAT DOES IT MEASURE?
METABOLIC EQUIVALENT OF TASKS.
A RELIABLE PREDICTOR OF CARDIAC MORBIDITY.
BECOME CONCERNED AT <4 METS…THATS POOR FUNCTIONAL CAPACITY.
A PT WOULD NEED ADDITIONAL TESTING IF A PT HAD 2 OF THESE….?
2 OF: ANGINA, CHF, DM, PRIOR MI, HTN, CAD, DYSRHYTHMIAS, PVD, CVA, RENAL DISEASE, COPD.
OR ANY PT WITH METS 5YO ASYMPTOMATIC BUT UNDERGOING HIGH RISK PROCEDURE.
HOW LONG IS AN EKG “GOOD” FOR?
1 YR. IF PT REMAINS FUNCTIONAL WITH NO NEW CV EFFECTS.
WHAT DO YOU DO IF YOUR PT HAS JUST HAD A DRUG ELUTING STENT PLACED?
DELAY CASE 12 MO. PT IS AT MORE RISK. PT HAS TO BE ON ASA OR PLAVIX FOR 1YR AFTER STENT PLACED. IF SURGERY IS EMERGENT….D/C PO MEDS PUT ON IV TICLID….D/C DICLID 6HRS PRIOR TO SURG….PUT PT BACK ON PO POST SURG.
WHAT DO YOU DO IF YOUR PT HAS JUST HAD BARE METAL STENT PLACED?
WAIT 1 MONTH TO DO SURGERY. YOU CAN D/C PO MEDS BUT PT DONT REQUIRE BRIDGING WITH TICLID. RESTART PO.
SHOULD PT ON B BLOCKER CONT. DURING SURGERY?
YES! THEY KEEP HR LOW REDUCING O2 DEMAND. MAY REDUCE INFLAMMATION BY DECREASING SYMP TONE, AND STABILIZE CORONARY PLAQUES.
IF HR< 60 HOLD BB.
AVOID BB IN PT WITH BROCHOSPASM, ASTHMA, BRADY, OR CONDUCTION ABNORMALITIES.
DO YOU WANT PT TO CONT. THE STATIN PRIOR TO SURGERY?
YES. THEY HELP STABILIZE PLAQUES.
