Surgical Eval of the Cardio System

Question 1

Are diabetics considered at high cardiac risk for surgery?

Answer 1

Yes

Question 2

What are the major risk factors for peri-op MI?

Answer 2

• Recent MI
• Unstable angina
• Uncontrolled CHF
• Severe valvular disease
• Uncontrolled HTN

Question 3

What are the moderate factors for peri-op MI?

Answer 3

• Chronic stable CHF
• Arrhythmia
• History of ischemic heart dz.
• History of stroke, MI

Question 4

What testing should be done if METS < 4 or status is unknown prior to surgery?

Answer 4

Stress Testing

Question 5

What are the options for stress testing?

Answer 5

• Exercise stress testing (EKG)
• Pharmacologic stress testing (EKG)
• Dobutamine stress ECHO

Question 6

What constitutes as a positive stress test?

Answer 6

• ST depression (>1mm in multiple leads)
• New bundle branch block
• New high grade AV block
• Sustained VT or ventricular fibrilation
• New or increasing frequency of PVCs
• Supraventricular tachyarrhythmia

Question 7

If stress testing demonstrates ischemia what should be considered?

When is it indicated?

Answer 7

Coronary angiography

Only indicated if will change surgical treatment

Question 8

What biomarkers can be ordered as part of CV testing?

Should BNP and Troponin be ordered on everyone?

Answer 8

• BNP, Troponins

No, consider in symptomatic patients

Question 9

Do Beta Blockers have a mortality benefit in the peri-op period?

Should they be continued through surgery?

Answer 9

Yes!

Yes, have mortality benefit

Can hold a dose if hypotensive after surgey but otherwise should be continued

Question 10

Are ACE/ARBs continued during surgery?

Answer 10

No, they are typically held AM of surgery due to risk for significant hypotension

Also have a risk for peri-op renal injury

Question 11

What are the risks of diuretics in the peri-op period?

What are the guidelines for surgery?

Answer 11

• Hypotension
• Hypokalemia
• Renal Injury

Hold AM of surgery, unless CHF and hard to control fluid status

Question 12

Should cholesterol-lowering medications (except statins) be held day before and day of surgical procedures?

Answer 12

Yes, due to risk for myopathy and rhabdo

Can resume post-op

Question 13

A 55-year old patient underwent stent placement 2-months ago but now requires an elective orthopedic procedure, are they eligible for surgery?

Answer 13

No, surgery should be delayed 12 months after drug-eluting stent

< 3 months = complete contraindication