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CV > CV1 - the cardiovascular surgical patient > Flashcards

CV1 - the cardiovascular surgical patient Flashcards

1
Q

High risk surgeries (>5%)

A

Aortic surgery

Major vascular surgery

Peripheral vascular surgery

Long surgical procedures with significant volume/blood loss

A-M-P-L

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2
Q

Intermediate Risk (1-5%)

A

Carotid endarterectomy

Peripheral artery angioplasty

Endovascular aneurysm repair

Head and neck surgery

Major neurologic/orthopedic

Intrathoracic

Intraperitoneal

Major urologic

Transplant

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3
Q

Low Risk (<1%)

A

Breast

Dental

Endoscopic

Superficial

Endocrine

Cataract

Gynecologic

Reconstructive

Minor orthopedic

Minor urologic

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4
Q

What is associated with the highest risk for perioperative MI?

A

Unstable angina

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5
Q

Revised Cardiac Risk Index

A

Another tool for predictor of CV morbidity and mortality

High Risk Surgery (aortic, major vascular)

Hx of ischemic heart disease (previous MI, previous positive stress test, use of nitroglycerine, unstable angina, previous PCI or CABG)

Hx CHF

HX cerebrovascular disease

Hx diabetes

Serum creatinine >2mg/dL

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6
Q

ACC/AHA recommend waiting at least ____ days after MI before patient undergoes elective surgery

A

60

Answer on test could be 1-2 months

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7
Q

If perioperative reinfarction does occur, mortality is approximately ____ %

A

50%

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8
Q

MI Risk in Patients with Previous MI

A

General Population = 0.3%
MI if > 6 months = 6%
MI 3-6 months = 15%
MI if < 3 months = 30%

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9
Q

What is a MET defined as?

A

MET is defined as the amount of oxygen consumed while sitting at rest and is defined as 3.5 ml oxygen/kg/min

Kg x 3.5 ml/consumption/minute

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10
Q

What is perhaps the best question to determine how someone will do under anesthesia?

A

Can you walk up a flight of stairs?

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11
Q

What are the two questions we ask regarding METS?

A
  1. Are you able to walk four blocks without stopping regardless of limiting symptoms?
  2. Are you able to climb two flights of stairs without stopping regardless of limiting symptoms?

Inability to perform this leads to an 82% increase in risk for cardiopulmonary complications postoperatively

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12
Q

Examples of 1 MET

A

1 MET – poor functional capacity

Self-care
Eating, dressing, using the toilet
Walking indoors and around the house
Walking one to two blocks on level ground at 2-3 mph

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13
Q

Examples of 4 METS

A

4 METs –good functional capacity

Light housework
Climbing a flight of stairs without stopping, or walking up a hill longer than 1 to 2 blocks
Walking on level ground at 4 mph
Running a short distance
Golf, dancing, throwing a baseball

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14
Q

Examples of 10 METS

A

Greater than 10 METs- excellent functional capacity

Strenuous sports

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15
Q

Different classes of CV disability

A

I - no limitations
II - slight functional limitations
III - comfortable at rest, but minimal activity causes fatigue
IV - symptoms present at rest

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16
Q

What is the predominant CV risk factor for pts undergoing noncardiac surgery?

A

Active LV failure

Severe aortic stenosis = valvular disorder that poses greatest patient risk for noncardiac surgery

17
Q

What are the two classes of LV failure?

A

Preserved EF (>50%)

Reduced EF (<50%)

18
Q

Heart failure is defined as any of the following:

A

Hx of CHF, pulmonary edema, paroxysmal dyspnea, BL rales, S3 gallop, CXR showing pulmonary vascular redistribution

19
Q

When is aortic stenosis especially bad?

A

Especially when cross sectional area of valve is less than 1 cm2

Associated with a fourteenfold greater incidence of periop sudden death

20
Q

True/False: In the absence of cardiac disease, benign ventricular arrhythmias do not carry increased surgical risk

A

True

21
Q

Pacemakers should be interrogated within _______ of elective surgery, and ICD’s within _____ months

A

12 months, 6 months

22
Q

Interoperative key point for pacemakers

A

Electromagnetic interference risk is LOW if the device is less than 10 years old and bipolar cautery is greater than 15 cm from the device lead or generator

23
Q

What is significant stenosis?

A

Significant stenosis = narrowing of major coronary artery by more than 70% or left main by more than 50%

24
Q

What can echocardiography detect?

A

provides a quantitative assessment of global ventricular function, or EF., small pericardial effusions and anatomic cardiac abnormalities, including atrial septal defects (ASDs) and ventricular septal defects (VSDs), aneurysms, and mural thrombi.

25
Q

What is considered the gold standard for diagnosis of cardiac pathology before most open-heart operations and for definitive lesions of the coronary vessels?

A

Cardiac catheterization

26
Q

Lesions that reduce vessel diameter by greater than _____ reducing the cross-sectional area by greater than _____, are considered significant.

A

Lesions that reduce vessel diameter by greater than 50%, reducing the cross-sectional area by greater than 70%, are considered significant.

27
Q

What is post-procedure therapy (Dual antiplatelet therapy)?

A

Aspirin: continue indefinitely

Clopidogrel: continue for minimum 6 months to prevent restenosis

28
Q

Elective noncardiac surgery should NOT be scheduled within _______ of bare metal stent placement or within ________ of drug eluting stent placement (Hensley)

A

Elective noncardiac surgery should NOT be scheduled within 1 month of bare metal stent placement or within 6 months of drug eluting stent placement (Hensley)

29
Q

How long prior to surgery should a patient on beta-blockers take their beta blocker?

A

24 hours

30
Q

Recommendations for beta-blocker use

A

Continue beta blockers in patients previously treated with beta-blockers

Institute between 30 days and at least 1 week before high-risk surgery

Avoid acute initiation of high-dose beta-blocker therapy

Continue beta blockers postoperatively for approximately a month –goal HR 60-65

31
Q

How are beta blockers cardio protective?

A

Restore the oxygen supply/demand mismatch

Reduce perioperative ischemia

Redistribute coronary blood flow to subendocardium

Stabilizes plaques

Increases v-fib threshold…makes it harder for v-fib to occur

32
Q

How are statins cardioprotective?

A

Enhance endothelial function

Improve atherosclerotic plaque stability

Reduce vascular inflammation

33
Q

Recommendations for statin use prior to surgery

A

Institute therapy between 30 days and at least 1 week before high-risk surgery

Continue statin therapy perioperatively

34
Q

True/False: we routinely have ACE inhibitors held for 1-2 days prior to surgery due to the extreme refractory hypotension that can be associated with ACE inhibitors and volatile anesthetics

A

True

35
Q

How long do we hold beta blockers prior to surgery?

A

we dont

36
Q

How long do we hold aspirin prior to surgery? (antiplatelet)

A

7 - 10 days

37
Q

How long do we hold plavix/brilinta prior to surgery? (antiplatelet)

A

5 days

38
Q

How long do we hold effient prior to surgery? (antiplatelet)

A

7 days

39
Q

How long do we hold anticoagulants for (pradaxa, xarelto, eliquis)?

A

1-2 days

CV (2 decks)

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