Perioperative Cardiovascular Risk Assessment Flashcards
Cardiac risk: general factors associated with increased risk
High risk surgery
History of ischemic heart disease
History of CHF
History of cerebrovascular disease
Diabetes
Serum creatinine >2 mg/dL
History of what condition is associated with the greatest cardiac risk
Unstable angina
Unstable angina definition
Angina at rest
New onset angina (<2 months)
Increasing symptoms
Duration >30 minutes
Symptoms becoming less responsive to medical therapy
Risk of perioperative MI in the general population
~0.3%
Perioperative risk of MI if pt had MI >6 months ago
6%
Perioperative risk of MI if pt had MI 3-6 months ago
15%
Perioperative risk of MI if pt had MI <3 months ago
30%
What is the recommended minimum to wait for elective surgery after an MI?
4-6 weeks
High cardiac risk surgical procedures (>5% risk)
Emergency surgery (especially in the elderly)
Open aortic surgery
Peripheral vascular surgery
Long surgical procedures with significant volume shift and/ or blood loss
Intermediate cardiac risk surgical procedures (1-5% risk)
Carotid endarterectomy
Head and neck surgery
Intrathoracic or intraperitoneal surgery
Orthopedic surgery
Prostate surgery
Low cardiac risk surgical procedures (<1%)
Endoscopic procedures
Cataract surgery
Superficial procedures
Breast surgery
Ambulatory procedures
Classifies extent of heart failure based on activity tolerance
NYHA classification
NYHA classification: no symptoms with physical activity
1
NYHA classification: symptoms appear with minimal activity or even at rest
4
NYHA classification: symptoms appear during normal activity; none at rest
2
