Cardiovascular pathophysiology Flashcards
Which surgical procedure presents the HIGHEST risk of cardiovascular morbidity and mortality for the patient with coronary artery disease?
a. open reduction and internal fixation of a femur fracture
b. video-assisted lung thoracoscopy
c. open abdominal aortic aneurysm repair
d. carotid endarterectomy
c. open abdominal aortic aneurysm repair
You can stratify cardiac risk with the patient’s
history & type of surgery
Surgical procedures associated with the highest cardiac risk include
emergency surgery
open aortic surgery
peripheral vascular surgery
long surgical procedures with significant volume shifts and blood loss
Patient-related conditions that increase cardiac risk include
a history of ischemic heart disease
CHF
cerebrovascular disease
DM
serum creatinine >2 mg/dL
If a patient had a recent MI, then the risk of reinfarction is greatest within
30 days of the event
After a recent MI, elective surgery should be delayed for
4-6 weeks
Cardiac risk is defined as
perioperative MI, CHF, and death
A patient with ____________ should be optimized before elective non-cardiac surgery.
unstable angina
The following surgeries put the patient at intermediate cardiac risk:
carotid endarterectomy
head & neck surgery
intrathoracic or intraperitoneal surgery
orthopedic surgery
prostate surgery
What is the NYHA classification of heart failure?
four classes that help to classify the extent of heart failure symptoms during activity
NYHA class 1 is
no symptoms with physical activity
NYHA class 2 is
symptoms appear during normal activity but no symptoms at rest
NYHA class 3 is
symptoms appear with less than normal activity but no symptoms at rest
NYHA class 4 is
symptoms appear with minimal activity or even at rest
What is the risk of perioperative MI if the patient had an MI <3 months ago?
30%
What is the risk of perioperative MI in the general population?
0.3%
Use the data set to calculate the coronary perfusion pressure.
HR= 50 bpm
Systolic BP= 100 mmHg
diastolic BP= 55 mmHg
pulmonary artery occlusion pressure= 15 mmHg
central venous pressure= 10 mmHg
40
CPP= Aortic diastolic pressure- LVEDP or in this case DBP- PAOP
Most MIs occur within ________ after surgery
48 hours
Which lead is best for monitoring dysrhythmias?
II
The treatment for intraoperative myocardial ischemia should focus on
interventions that make the heart slower, smaller, and better perfused
Myocardial oxygen balance is determined by the ratio of
oxygen supply relative to demand
The myocardium is at risk when the
supply is less than the demand