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Cardiology - Dr Constable > Quiz 1 - The Cardiovascular Patient > Flashcards

Quiz 1 - The Cardiovascular Patient Flashcards

1
Q

With anesthesia, will you typically have increased or decreased SVR?

A

Decreased

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2
Q

With anesthesia will you typically have increased or decreased stroke volume?

A

Decreased

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3
Q

During induction, how much can anesthesia lower your systemic blood pressure?

A

20-30% decrease BUT tracheal intubation can increase systemic BP by 20-30 mmHg.

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4
Q

How much can anesthetic agents lower cardiac output?

A

15%

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5
Q

In addition to identifying potentially serious cardiac disorders during an initial history, what else should you know about the cardiac disorder?

A

disease severity, stability, and prior therapy

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6
Q

What factors can place a patient at higher cardiac risk during surgery?

A
  • Functional capacity
  • age
  • co-morbid conditions (i.e. DM, PVD,…)
  • type of surgery
  • ANEMIA
  • presence of CAD and CHF
  • Hx of CVA
  • Creatinine greater than 2 mg
  • IDDM
  • High risk surgery
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7
Q

What 4 things should you assess on every pt before anesthesia?

A
  • history
  • physical exam
  • diagnostic tests
  • knowledge of planned surgical procedure
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8
Q

in a pt with valvular heart disease, what should you know from their history?

A

Whether it is stenotic or regurgitant.

Also, whether they have dyspnea, orthopnea, PND, embolic events, hemoptysis, heart failure or palpitations

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9
Q

During the physical exam, what items should you pay attention to?

A

cyanosis, pallor, dyspnea during the conversation or with minimal activity, nutritional status, obesity, skeletal deformities, tremor and anxiousness.

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10
Q

During a detailed cardiac assessment, what items should you assess?

A
  • JVD or pedal edema
  • cap refill
  • displaced apical pulse (cardiomegaly)
  • S3 gallop (increased LVEDP)
  • S4 (decreased compliance)
  • presence of murmur
  • pulmonary edema
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11
Q

What does 1 metabolic equivalent or 1 MET represent?

A

Oygen consumption of a resting adult (3.5 ml/kg/min). Can be measured by persons ability to do normal ADL’s including walking around inside of house or 1 block on level ground.

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12
Q

What does 4 MET’s represent?

A

ability to climb stairs or walk up a hill. Run for short distances. Walk on level ground at 4mph.

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13
Q

What does 10 MET’s represent?

A

Ability to participate in strenuous sports like swimming, tennis, and football.

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14
Q

If patients reduce exertion because of cardiac symptoms but still meet a 4-MET threshold, will clinicians over or under estimate their risk?

A

Underestimate their risk

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15
Q

If a person in not able to meet a 4-MET activity level due to non-cardiac reasons, will a clinician tend to over or under estimate their cardiac risk?

A

Overestimate their risk.

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16
Q

How is Functional Capacity defined in terms of numbers of MET’s one can accomplish?

A
  • Poor (<4 METS)
  • Moderate (4-7 METS)
  • Good (7-10 METS)
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17
Q

What is the number 1 determinant of myocardial workload?

A

Heart Rate

18
Q

T/F: Conduction disturbances such as right bundle branch block or first degree AV block, may lead to concern but usually do not justify further workup.

A

True

19
Q

What is the risk indicies that assess the patient’s overall physical status and to predict morbidity and mortality?

A

ASA

20
Q

What is the risk indicies that risk stratification of medical patients with angina, but they have been adapted for use in surgical patients.

A

NYHA/CCS

21
Q

what is the risk indicies that identify 9 independent variables that correlated with advers perioperative events?

A

Cardiac Risk Index (CRI)

22
Q

what is the risk indicies identified risk factors for cardiac morbidity bet were very cumbersome to apply?

A

-Modified Cardiac Risk Index

23
Q

What are major perioperative cardiovascular risk?

A
  • Unstable coronary syndromes
  • Decompensated heart failure
  • Significant arrhythmias
  • Severe Valvular disease
24
Q

What are moderate perioperative cardiovascular risk factors?

A
  • mild angina
  • History of MI, Pathologic Q’s
  • Compensated or Prior CHF
  • Diabetes Mellitus
  • Renal Insufficiency (CKD)
25
Q

What are minor perioperative cardiovascular risk factors?

A
  • Advanced age
  • Abnormal ECG (LVG, LBBB, ST-T abnormalities)
  • Rhythm other than sinus
  • Low functional capacity
  • History of stroke
  • Uncontrolled systemic hypertension
26
Q

High risk surgeries have a greater than ___% of perioperative death or MI.

A

5

27
Q

Moderate risk surgeries have a _____ % risk of perioperative death or MI.

A

1-5

28
Q

Low risk surgeries have a less than _____% risk of perioperative death of MI.

A

1

29
Q

What are six noninvasive cardiac tests?

A
  1. Transthoracic ECHO
  2. Exercise tests and pharmacologic tests
  3. Exercise stress test
  4. Dobutamine stress Echo
  5. Adenosine stress test
  6. ambulatory ECG monitoring
30
Q

What are the risk reduction strategies for perioperative management for cardio?

A

a. Anesthetic “maneuvers”
* anesthesia, temperature regulation, invasive monitoring.
b. Surgical technique
* Laparoscopic vs. open, endovascular

31
Q

What are risk reduction strategies for medical management of cardio?

A
  • Medical management
  • beta blocker, antiischemic medication, lipid lowering agents
  • Preoperative coronary revascularization/valvuloplasty
32
Q

Evidence base practice parameters of class 1 are _________?

A

-benefits outweigh the risks

33
Q

Evidence base practice parameters of class 2a are _______?

A

-reasonable to consider

34
Q

Evidence base practice parameters of class 2b are ______?

A

-may be reasonable to consider

35
Q

Evidence base practice parameters of class 3 are -____?

A

-not indicated

36
Q

Evidence base practice parameters of level A are ______?

A

highest level of evidence

37
Q

Evidence base practice parameters of level C are _______?

A

lowest level of evidence.

38
Q

What patient will you see for coronary angiogram/coronary intervention for class 1.

A
  1. stable angina with significant LMCA stenosis
  2. stable angina who have 3 vessel disease
  3. stable angina who have 2 vessel disease with significant proximal LAD stenosis
  4. unstable angina or non-ST segment elevation MI
  5. Coronary revascularization before noncardiac surgery is recommended in patients with acute ST elevation MI.
39
Q

BONUS: What would be a thorough and detailed assessment of a cardiac patient?

A
  1. Thorough Hx
  2. Detailed physical examination
  3. Judicious use of tests
  4. Categorize patients into low, intermediate & high risk categories
  5. Combine preop assessment with periop risk reduction strategies to optimize medical treatment in order to improve outcome
40
Q

What is the risk indicies that Indentify 6 independent predictors of adverse cardiac outcomes in patients undergoing noncardiac surgery

A

Revised Cardiac risk Index (RCRI)

41
Q

What is the risk indicies the provied a framework for screening and identifying patietns who are at high risk for perioperative cardiac events (PCE)

A

ACC/AHA guidelines

Cardiology - Dr Constable (9 decks)

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