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ARCHIVED: Assessment > Exam 2: Cardiac > Flashcards

Exam 2: Cardiac Flashcards

1
Q

Clinical predictors of minor CV risk:

A 
Uncontrolled HTN (>160/>100)
EKG: LBBB, L/R hypertrophy, non-sinus rhythm
Low functional capacity
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2
Q

Clinical predictors of moderate CV risk:

A 
CAD
Mild and stable angina
MI > 1 month ago with Q waves
Compensated LVF/CHF
DMI/DMII
Chronic renal insufficiency (Cr > 2.0)
Stroke/TIA
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3
Q

Clinical predictors of major CV risk:

A

Unstable coronary syndrome
Unstable angina
Acute or recent MI (

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4
Q

Incidences of periop infarction by previous MI timeframe:

A

> 6 mo: 6%
3-6 mo: 10%
Within 3 mo: 30%

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5
Q

Mortality rate for periop re-infarction:

A

50%

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6
Q

ACC/AHA guidelines recommend waiting this long after MI for elective surgery:

A

4-6 weeks

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7
Q

High-risk surgeries:

A

Intraperitoneal
Intrathoracic
Aortic surgery or other major vascular surgery
Emergent major operations (especially elderly)
Prolonged procedures with large fluid shifts/blood loss

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8
Q

Intermediate risk surgeries:

A 
Carotid endarterectomy
Peripheral vascular surgery
Head & neck
Neurologic/orthopedic
Endovascular aneurysm repair
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9
Q

Low risk surgeries:

A 
Endoscopic procedures
Superficial procedures
Biopsies
Cataracts
Breast surgery
GYN
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10
Q

Gold standard exam for coronary anatomy:

A

Coronary angiography

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11
Q

Goal of cardiac history is to elicit:

A

Severity
Progression of condition
Functional limitation

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12
Q

Examples of 1-4 MET activities:

A

ADL’s, eating, dressing, walking around house, dishwashing

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13
Q

1 MET = ____

A

3.5 mL of O2/kg/min

Basal metabolic rate

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14
Q

Examples of 4-10 MET activities:

A

Climbing stairs, walk in neighborhood, heavy housework, golf, bowl, dance

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15
Q

Examples of > 10 MET activities:

A

Strenuous sports i.e. swimming, tennis, running, football, basketball, stress test

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16
Q

Angina is a sign of:

A

Imbalance between myocardial O2 supply and demand

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17
Q

Angina may be experienced in patients with ______ & ______ despite normal coronaries.

A

Aortic stenosis

Prinzmetal angina

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18
Q

Non-coronary condition that can cause angina-like pain and be relieved by NTG:

A

Esophageal spasms

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19
Q

Prinzmetal angina is:

A

Vasospastic angina that occurs at rest

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20
Q

Patients with Prinzmetal angina have ↑ risk of:

A

Reynaud’s

Migraines

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21
Q

Tx for Prinzmetal angina:

A

Nitrates

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22
Q

Five things to know about a patient’s pacemaker/ICD:

A 
The indication 
The underlying rhythm/rate
The type (demand, fixed, RF)
The chamber paced
The chamber sensed
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23
Q

Pacemaker/ICD should be evaluated within:

A

3-6 months prior to surgery

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24
Q

Effect of magnet on pacemaker/ICD:

A

Converts to a fixed asynchronous rate

EXCEPT tachyarrythmia ICDs - need to be turned off manually

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25
Q

Safety with cautery and pacemakers/ICDs:

A

Grounding pads as far away as possible from device
Use bipolar, not monopolar cautery
Have external pacing available
Monitor blood flow (pulse ox, a-line) not just EKG

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26
Q

Treat HTN when greater than:

A

160 systolic

90 diastolic

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27
Q

Worse in the OR: hypo or hypertension?

A

Hypotension

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28
Q

Labs for long-standing severe or uncontrolled HTN:

A

EKG
BUN/Cr
Chemistry if on diuretics

29
Q

β-blockers and surgery:

A

If on, continue - discontinuation may ↑ CV morbidity

Start β-blockers on high risk patients having vascular surgery or having 3+ risk factors

If starting, start DAYS before surgery, NOT day of!

30
Q

S/s of heart failure:

A 
Orthopnea
Nocturnal coughing
Fatigue
Peripheral edema
3rd/4th heart sound
Resting tachycardia
Rales
JVD
Ascites
31
Q

EKG sign of heart failure:

A

LVH
↑ R wave in I, aVF, V4-6
↑ S wave in III, aVR, V1-3

32
Q

Labs for heart failure:

A

EKG
Chemistry
BUN/Cr
BNP (want

33
Q

Cardiac medications to hold pre-op:

A

ACEIs
ARBs
(Hold for one day)

34
Q

Greatest-risk valvular disorder:

A

Severe aortic stenosis

If symptomatic, postpone surgery!

35
Q

Diastolic murmurs are always:

A

Pathologic and requiring investigation

36
Q

Medication considerations for prosthetic heart valves:

A

May need anticoag bridge and/or endocarditis prophylaxis

37
Q

Arrhythmias associated with periop risk:

A

SVT

Ventricular arrythmias

38
Q

Arrythmia strongly associated with CAD:

39
Q

Postpone surgery for these rhythms:

A 
Uncontrolled atrial fibrillation
Ventricular tachycardia
New-onset atrial fibrillation
Symptomatic bradycardia
High-grade or 3rd degree HB
40
Q

Statins and surgery:

A

Continue them and start vascular surgery patients on them

41
Q

Aspirin and surgery:

A

Weigh risks/benefits, esp. patients at high risk (CAD/CVD)

If holding - hold 7-10 days prior to surgery

Do not D/C ASA in patients with DES until 12 months of dual therapy, or bare metal stents until 1 month dual therapy, and in general try not to d/c it at all in stented pts

42
Q

Anticoagulants and surgery:

A

D/c coumadin 3-5 days prior (aim for INR

43
Q

CXR can show us r/t heart function:

A

Cardiomegaly
Pulmonary vascular congestion/pulmonary edema (CHF)
Pleural effusions

44
Q

Order CXR preop for anyone who is:

A

75y/o +
CHF history
Symptomatic CV disease

45
Q

Definite EKG for patients who:

A

Are having vascular surgery

CAD/PAD/CVD and intermediate risk procedure

46
Q

Maybe EKG for patients who:

A

1+ risk factor having intermediate risk surgery

47
Q

Review EKGs for:

A

Acute or prior MI
Rhythm/conduction disturbance
Cardiomegaly/VH
Electrolyte imbalances

48
Q

On EKG, hypocalcemia causes:

A

Prolonged QT

49
Q

On EKG, hypercalcemia causes:

A

Shortened QT

50
Q

On EKG, hypokalemia causes:

A

Flat or inverted T waves

51
Q

On EKG, hyperkalemia causes:

A

Peaked T waves

52
Q

Inferior EKG leads and associated artery:

A

II, III, aVF

Right coronary artery

53
Q

Lateral wall EKG leads and associated artery:

A

I, aVL, V5-6

Circumflex branch of LCA

54
Q

Anterior wall EKG leads and associated artery:

A

I, aVL, V1-4

Left coronary artery

55
Q

Anteroseptal EKG leads and associated artery:

A

V1-4

Left anterior descending

56
Q

Sufficient stress criteria for stress testing:

A

5+ minutes at HR > 120

57
Q

Positive ECG criteria during stress testing:

A

ST segment depression >2.5 mm especially early in test (first 3 minutes)
Serious ventricular arrhythmias
Prolonged duration of ST depression in post recovery period

58
Q

Positive non-ECG responses during stress testing:

A

↑ in BP or HR at time of ST-depression
Hypotension (ominous)
Achieved HR of

59
Q

Drugs used to elicit stress in pharmacologic stress testing:

A

Dipyridamole or adenosine (vasodilators)

60
Q

Interpreting “cold” spots in pharmacologic stress testing:

A

Only during stress: ischemia

Constant perfusion deficit: old MI/scarring

61
Q

When to request stress testing:

A

Active cardiac condition
3+ risk factors, poor functional capacity, vascular surgery

Maybe for less if it will change management

62
Q

Drug used to elicit stress in stress echocardiography:

A

Dobutamine

63
Q

Abnormal result in stress echo:

A

New regional wall motion abnormalities or worsening of existing regional wall motion abnormalities during an infusion of dobutamine

64
Q

When to order a pre-op echo:

A

Current/prior heart failure
Dyspnea of unknown origin
Possible aortic stenosis
Re-do if past echo > 1 year old

65
Q

When to order pre-op cath:

A

Stable angina with:

  • L main CAD
  • 3-vessel disease
  • 2-vessel disease including proximal LAD and EF
66
Q

Time to wait after PCI interventions before surgery:

A

Balloon angioplasty: 14+ days
Bare-metal stent: 30-45+ days
DES: 365+ days (so anticoag can be stopped)

67
Q

High-risk conditions for SBE:

A

Prosthetic heart valves
Hx of infective endocarditis
Unrepaired cyanogenic congenital heart disease
Post defect repair with prosthetic material for 6 mo
Repaired defect with residual defect
Transplant recipients with valve disease

68
Q

SBE prophylaxis indicated in high-risk patients when:

A

Dental procedures involving gums/oral mucosa/periapical teeth area
Invasive/incising/biopsy respiratory tract procedures

69
Q

Drugs used for SBE prophylaxis:

A

Ampicillin 2gm IV
Ancef (Cefazolin) 1gm IV
Ceftriaxone (Rocephin) 1gm IV

PCN allergy: clindamycin 600mg IV

ARCHIVED: Assessment (11 decks)

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