Periop CV evaluation Flashcards
what are considered “active cardiac conditions” for preop?
ACS
Decompensated CHF
Significant Valvular dz
Significant arrhythmias
High risk surgeries; what is the % cardiac risk?
Vascular; > 5%
Intermediate risk surgeries and % cardiac risk
CEA Intraperitoneal/intrathoracic head and neck orthopedic prostate 1-5% risk
Low risk surgeries and % cardiac risk
breast
endoscopic
cataract
<1%
examples of 4 METS
light housework (wash dishes)
flight of stairs/walk uphill
walk on level ground at 4mph
how many METS is strenuous sports like singles tenis, skiing, football)?
10 METS
What are the 5 risk factors for patients undergoing noncardiac surgery?
h/o MI or Q waves DM renal insufficiency h/o cerebrovascular dz h/o CHF
what is the only heart sound that does not increase on inspiration?
pulmonic ejection click
5 categories in Revised Cardiac Index
- high risk Sx (intraperitoneal/intrathoracic/suprainguinal vasc)
- ischemic heart dz
- cerebrovasc dz
- Cr > 2
- CHF
what is your risk of major cardiac event w/ surgery and Revised Cardiac Risk Index of 0,1,2,3 points (class I, II, III, IV)?
0 and 1 are < 1%
2 - 6.6 %
3- 11%
2 Class I indications for preop ECG
- vasc Sx and 1 or more clinical risk factors
- intermediate Sx + known CHD, PAD or cerebrovasc dz
Class I indicatios for periop assessment of LV fxn
none
what stress test is Class I indication for LBBB?
pharmacologic nuclear
high risk features on imaging stress test
EF 2segments WMA at low dose dobuta (<120
If pt is preop Vasc Sx and has 3 or more cardiac risk factors, what to do?
Stress test if it will change management
What do you do for a pt going to low risk Sx
Always send to OR (unless active cardiac condition)
According to periop cardiac risk assessment table from mayo interventional review,when is the only time you send pt to stress test preop?
3 or more risk factors with unknown fxn capacity having vascular Sx.