The Cardiac Surgical Patient week 1 Flashcards
What is the simplest and single most useful risk index for patients undergoing most general and cardiac surgeries?
The patient’s functional status, or exercise tolerance.
What procedure is considered the Gold Standard for diagnosis of cardiac pathology?
Cardiac Catheterization is the Gold Standard to diagnose pathology before most open heart operations for definition of lesions of the coronary vessels.
The Cornerstones of Preoperative Cardiac evaluation includes: - - - -
- review of history
- physical exam
- diagnostic tests
- knowledge of the planned surgical procedure.
In addition to identifying the presence of pre-existing heart disease, it is essential to determine the disease ____,_____, and _______
- Severity
- Stability
- Prior treatments/therapy.
What are 3 risks of anesthesia to a cardiac patient?
- decreased systemic vascular resistance
- decreased stroke volume
- Induction of general anesthesia lowers systemic arterial pressure by 20-30%
T/F: The presence of pre-operative anemia is NOT an independent risk factor.
False.
Any PreOp anemia is an independent risk factor.
Define the levels of Surgical Risk. (High, Moderate, Low risk surgeries)
High Risk >5% risk of perioperative death or MI
Moderate Risk 1-5% risk of perioperative death or MI
Low risk <1% risk of perioperative death or MI
What types of surgeries are considered High, Moderate and Low risk?
High: Emergent major surgery, peripheral vascular or aortic surgery, prolonged surgery involving excessive blood loss.
Moderate: Carotid endarterectomy, urologic, orthopedic, uncomplicated abdominal, head, neck, and thoracic operations.
Low: cataract removal, endoscopy, superficial procedure, cosmetic procedures, and breast surgery.
What are considered MAJOR clinical predictors of increased perioperative cardiovascular events (PCE)? (MI, Heart Failure, Death)
Major risk factors:
- Unstable coronary syndromes (acute or recent MI, or unstable/severe angina)
- Decompensated heart failure
- Significant arrhythmias: High-grade AV block, symptomatic ventricular arrythmias, SVT, Afib RVR
- Severe valvular disease
What are considered INTERMEDIATE clinical predictors of increased perioperative cardiovascular events (PCE)? (MI, Heart Failure, Death)
Intermediate risk factors:
- Mild angina
- Hx of MI with pathologic Q waves
- Compensated or prior CHF
- DM
- Renal Insufficiency (CKD)
What are considered MINOR clinical predictors of increased perioperative cardiovascular events (PCE)? (MI, Heart Failure, Death)
Minor risk factors:
- Advanced age
- abnormal EKG (LVH, LBBB, ST-T abnormalities)
- Rhythm other than sinus (Afib)
- Low functional capacity (inability to climb 1 flight of stairs)
- Hx of stroke
- Uncontrolled systemic HTN
All oral BP meds should be continued on the day with the exception of which 2 classes?
- ACE Inhibitors
- Angiotensin II receptor blockers
These can cause significant perioperative hypotension. Hold them the morning of surgery, but re-start them as soon as the patient is euvolemic postoperatively.
How long is it recommended for a patient post placement of bare metal stents (BMS) to wait before scheduling an elective surgery requiring interruption of anti-platelet therapy?
1 month
How long is it recommended for a patient post placement of drug eluting stents (DES) to wait before scheduling an elective surgery requiring interruption of anti-platelet therapy?
12 months
Silent ischemia is more common in which 2 groups of patients, with 15-35% of all MIs occurring as silent events?
The elderly
Diabetics
