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Anaesthesiology > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

What is the definition of Ischaemic Heart Disease?

A

It is a syndrome resulting from myocardial ischamia because of the imbalance between supply and demand of oxygen in the heart

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2
Q

What percentage of patients above 35 years old have asymptotic ischemia?

A

5%

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3
Q

What is the most commonest form of arrhythmia?

A

Ventricular fibrillation morning

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4
Q

What are some risk factors for developing IHD?

A
  1. Male
  2. Age
  3. Smoking
  4. Family history
  5. Genetic predisposition
  6. Diabetes
  7. High cholesterol
  8. Obesity
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5
Q

What does DO2 mean?

A

It is defined as the oxygen delivery

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6
Q

What does VO2 mean?

A

It is defined as the consumption of oxygen

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7
Q

What causes an increase in oxygen consumption?

A
  1. Tachycardia
  2. Increased preload/afterload
  3. Increased contractility
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8
Q

What causes a decreases in oxygen consumption?

A
  1. Anaemia(low Hb), hypoxia, decreases temperature, increased pH(more alkaline), decreased 2,3 DPG
  2. Decreased coronary blood flow:
    Tachycardia
    Diastolic hypotension
    Increased hypotension
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9
Q

What are the characteristics of an unstable angina?

A
  1. Angina at rest
  2. Sudden increase in the severity, duration and frequency
  3. New onset: occurring in less than 2 months
  4. Associates with ST changes if there’s severe disease
  5. May occur after myocardial infarction
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10
Q

What are the characteristics of chronic stable angina?

A
  1. Usually substernal
  2. Radiates to the neck and arm
  3. Gets better with Rest
  4. Gets worse of exertion
  5. 50% of the time presents with some sort of occlusion
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11
Q

Which surgery has a high peri-operative mortality?

A
  1. Vascular surgery- it automatically becomes more than 5%
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12
Q

What types of surgeries are between 1-5% mortality rate?

A
  1. Intraperitoneal
  2. Intrathoracic
  3. Orthopedic
  4. Prostate
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13
Q

How do we treat ischaemic heart disease?

A
  1. lifestyle modifications
  2. correct the risk factors as far as possible
  3. medication
  4. correct the coronary lesions CABG/PCA
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14
Q

What do nitrates do?

A
  1. dilate the coronary arteries

2. causes relaxation of the vascular smooth muscles

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15
Q

What treatment can we give to treat IHD?

A
  1. Nitrates
  2. Calcium channel blockers
  3. B-blockers
  4. ACE-inhibitors
  5. Combination therapy
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16
Q

In which two cases would we stop aspirin pre-operatively?

A
  • prostate surgery

- neurosurgery

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17
Q

Why do we stop ACE-inhibitors before surgery?

A

Has a high likelihood of causing hypotension

18
Q

How do we diagnose myocardial infarction peri-operatively?

A
  1. monitor with ECG
  2. Monitor patients symptoms
  3. Check troponins every 6 hours
19
Q

What is the treatment for myocardial infarction peri-operatively?

A
  1. oxygen
  2. aspirin
  3. morphine
  4. refer to cardiology for definitive treatment
20
Q

What does the NYHA-New York Heart Association classification entail?

A

-It is a classification of heart failure from 1 until 4

21
Q

What is heart failure?

A

-The inability to meet the oxygen demand of the heart

22
Q

What kind of blood flow is in coronary blood vessels?

A

-low flow high oxygen extraction this is why when some patients exercise they exercise angina, and dyspnea

23
Q

What is the single most important risk factor for peri-operative myocardial ischaemia and infarction?

A

Tachycardia because it causes shortened diastole which leads to decreased perfusion of the left ventricle

24
Q

How can we manage the patients peri-operative risk for myocardial ischaemia?

A

By offering beta-adrenergic receptor blockers

25
Q

Why should we monitor patients post-operatively for 3 days?

A

-they have to catch up on REM sleep and this leads to hypoxia , hypertension, breath holding, and tachycardia which can precipitate myocardial ischaemia and infarction

26
Q

Why is aspirin important in myocardial ischaemia and infarction patients?

A

-it washes out the platelet plug that develops

27
Q

What is the risk for having peri-operative infarction if the patient had an infarction 3 months, 3-6 months back and more than 6 months back?

A
  • less than 3 months-30% risk
  • between 3-6 months-11% risk
  • more than 6 months-5% risk
28
Q

What premeds would you make sure you give the ischaemic heart disease patient?

A
  1. Benzodiazepines to treat the anxiety

2. Chronic medication: aspirin, simvastatin, BBlockers

29
Q

What is the first thing that we should do pre-operatively in a patient with ischaemic heart disease?

A

-give the patient beta-adrenergic blockers to prevent tachycardia

30
Q

Why do local anaesthetic procedures have an advantage to a patient with myocardial infarction?

A

-Nerve blocks, epidural and spinal have advantage because they reduce afterload and preload and can prevent pain

31
Q

Which induction agent can use?

A

Etomidate and sometimes propofol

32
Q

Which induction drug should we avoid?

A

Ketamine

33
Q

What muscle relaxants are we permitted to use?

A

-vecuronium and rocuronium

34
Q

Which muscle relaxant should we avoid?

A

-pancuronium

35
Q

Why should I avoid pancuronium?

A
  • Because it is going to block the re-uptake of noradrenaline and cause tachycardia
  • this can be avoided by giving a dose of beta adrenergic blocker beforehand
36
Q

Which gas should be avoided in myocardial ischaemia?

A

-nitrous oxide

37
Q

Which drugs IAA help with preconditioning?

A

Halothan and sevoflurane

38
Q

How do sevoflurane and halothane cause protection the heart intra-operatively?

A

They have antiplatelet effects and this protects the heart from an unstable angina

39
Q

Why can we not see when a patient is shaving an ischaemic event intra-operatively?

A

-the clinical sign being an angina cannot be picked up and the 5 lead ECG used intra-op is not as effective as the 12 lead

40
Q

How much supplemental oxygen do we give the patient post-operatively?

A

40%

41
Q

What are some of the strange/atypical ways that myocardial ischaemia can present?

A
  1. Lung oedema
  2. Arrhythmia
  3. Cardiovascular instability
42
Q

If the patient presents for an emergency surgery with IHD what is the NB thing to do?

A
  1. History and examination
  2. Quantify the angina and the exercise tolerance
  3. Local anaesthetic, nerve blocks or epidural considered

Anaesthesiology (25 decks)

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