Scoring Systems and equations

Question 1

What is a MET?
Can you give examples of what you would expect for each MET?

Answer 1

1 MET - 3.5ml/kg/min at rest, fasted
= 1Kcal/kg/hr

look this up and come back to on Peri-op day tomorrow

Question 1

What are the components of Lee’s revised cardiac index?

Answer 1

One point for each of:
- IHD/CAD
- CVA
- Renal impairment >177 creat
- Insulin dependant diabetes
- Heart failure
- High Risk Surgery

Scores correlate as follows:
0 = 0.4%
1 = 0.9%
2 = 7.0%
3 = 11.0% …. risk of MACE

Question 2

Pulmonary HTN:
- definition of mild/mod/severe (mPAP)
- Measurement of mPAP (2)
- Measurement of Tricuspid Jet

Answer 2

Mild = 20-40mmHg
Moderate = 41-55mmHg
Severe = > 55mmHg

mPAP: (RVSP x 0.6) + 2 or
PVR x CO +LAP

RVSP is measured from TR Jet and CVP:
TR Jet: sPAP= 4V2 + CVP

Question 3

Aortic Stenosis
- normal valve area
- mild/mod/severe mean and peak gradients, and AVAcm2, Vmax

Answer 3

Normal Valve area: >2.5cm2

Mean values:
Mild: <20mmHg
Mod: 20-40mmhg
Severe: >40mmhg

VMAX:
Mild: 2.6-2.9ms
Mod: 3-4 ms
Severe: >4ms

AVAcm2:
Mild: >1.5cm2
Mod: 1-1.5cm2
Severe: <1cm2

Indexed AVA:
Mild: >0.85cm2/M2
Mod: 0.6-0.85cm2/m2
Severe: <0.6cm2/M2

Question 4

Mitral Stenosis:
Normal AVA
AVA same as AS
What are the mean gradients for Mild, Mod, Severe

Answer 4

Normal AVA: >4cm2

Mean Gradient:
Mild: <5mmHG
Mod: 6-10mmHg
Severe: >10mmHg

Question 5

Mitral Regurgitation Severity
How is this measured?
What is the effect called?

Answer 5

Fraction:
Mild: <30%
Mod: 30-50%
Severe: >50%

Volume:
mild: <30mls
Mod: 30-60mls
Severe: >60mls

Orifice:
Mild: <0.2cm2
Mod: 0.2-0.4cm2
Severe: >0.4cm2

Coanda effect, like the DYSON

Question 6

Liver function test notes

Answer 6

Alcoholic liver disease: AST>ALT
Hepatitis/Para: ALT>AST
AST:ALT=1 means ischaemia, hepatitis
AST:ALT=>2.5 alcohol
AST:ALT= <1 variable check other markers

ALP primarily stones, cancer, bone, pregnancy