HTN and Ischemic Heart Disease

Question 1

4 CV Conditions requiring eval before surgery?

Answer 1

1. ACS/Unstable Angina
2. Decompensated HF
3. Arrhythmias
4. Severe Valvular Disease

Question 2

Do you revascularize patients prior to surgery?

Answer 2

1. Decision for coronary intervention made INDEPENDENTLY from surgical procedure
2. Can they be on DAPT for surgery?

Question 3

Classes of HTN

Answer 3

Stage 1 - 150/90
Stage 2 - 160/100
Stage 3 - 200/110
Stage 4 - Higher

Question 4

Chronic increases in afterload

Answer 4

results in chronic wall tension –> hypertrophy of the ventricle and diastolic dysfunction

Question 5

What causes ischemic heart disease?

Answer 5

1. Marked increase in myocardial metabolic demand

2. Reduction in myocardial oxygen supply

Question 6

Conditions that cause ischemic?

Answer 6

1. Atherosclerosis
2. Severe HTN
3. Severe tachycardia
4. Hypotension, hypoxia, anemia
5. Valvular Disease (AS)

Question 7

Arrhythmia most likely following ACS?

Answer 7

V-Fib!!! First 4 hours

Question 8

How does nitrate treat ACS?

Answer 8

1. reduces wall tension afterload of LV
   
   • reduces myocardial O2 consumption
2. Dilates coronaries
   
   • increases myocardial O2 supply

Question 9

Best way to treat ACS in OR?

Answer 9

Maintain the supply/demand relationship

1. aggressively treat tachycardia and HTN and analgesia
2. Increase FiO2, avoid hypotension