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Periop CV evaluation Flashcards

1
Q

what are considered “active cardiac conditions” for preop?

A

ACS
Decompensated CHF
Significant Valvular dz
Significant arrhythmias

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2
Q

High risk surgeries; what is the % cardiac risk?

A

Vascular; > 5%

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3
Q

Intermediate risk surgeries and % cardiac risk

A 
CEA
Intraperitoneal/intrathoracic
head and neck
orthopedic
prostate
1-5% risk
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4
Q

Low risk surgeries and % cardiac risk

A

breast
endoscopic
cataract
<1%

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5
Q

examples of 4 METS

A

light housework (wash dishes)
flight of stairs/walk uphill
walk on level ground at 4mph

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6
Q

how many METS is strenuous sports like singles tenis, skiing, football)?

A

10 METS

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7
Q

What are the 5 risk factors for patients undergoing noncardiac surgery?

A 
h/o MI or Q waves
DM
renal insufficiency
h/o cerebrovascular dz
h/o CHF
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8
Q

what is the only heart sound that does not increase on inspiration?

A

pulmonic ejection click

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9
Q

5 categories in Revised Cardiac Index

A
  • high risk Sx (intraperitoneal/intrathoracic/suprainguinal vasc)
  • ischemic heart dz
  • cerebrovasc dz
  • Cr > 2
  • CHF
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10
Q

what is your risk of major cardiac event w/ surgery and Revised Cardiac Risk Index of 0,1,2,3 points (class I, II, III, IV)?

A

0 and 1 are < 1%
2 - 6.6 %
3- 11%

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11
Q

2 Class I indications for preop ECG

A
  • vasc Sx and 1 or more clinical risk factors

- intermediate Sx + known CHD, PAD or cerebrovasc dz

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12
Q

Class I indicatios for periop assessment of LV fxn

A

none

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13
Q

what stress test is Class I indication for LBBB?

A

pharmacologic nuclear

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14
Q

high risk features on imaging stress test

A

EF 2segments WMA at low dose dobuta (<120

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15
Q

If pt is preop Vasc Sx and has 3 or more cardiac risk factors, what to do?

A

Stress test if it will change management

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16
Q

What do you do for a pt going to low risk Sx

A

Always send to OR (unless active cardiac condition)

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17
Q

According to periop cardiac risk assessment table from mayo interventional review,when is the only time you send pt to stress test preop?

A

3 or more risk factors with unknown fxn capacity having vascular Sx.

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18
Q

according to DECREASE V study, what was the difference in 30d and 1yr MI/death in high risk pt’s with significant CAD undergoing vasc sx b/w OMT or PCI?

A

no difference

19
Q

besides ACS, what are the 3 Class I indications for pre-op revascularization?

A
  • stable angina with sig LM stenosis
  • stable angina with 3VD
  • stable angina and 2VD, pLAD, AND EF < 50% or +stress test (ischemia)
20
Q

what to do for a pt who just had a DES and needs urgent Sx?

A

hold plavix, cont. ASA if possible. restart plavix ASAP.

21
Q

3 factors that reduce LV volume and make HOCM worse

A

hemorrhage
decreased SVR
increased venous capacitance

22
Q

2 drug classes to avoid in HOCM

A

diuretics

beta agonists

23
Q

in general, do you delay elective surgery for symptomatic/severe valvular stenosis or regurgitation?

A

stenosis

24
Q

algorithm for pt w/ AS that needs Sx

A

mild/mod –> OR
Sev: sxs- AVR before OR
no sxs- make sure echo within past yr

25
Q

mortality risk in pt’s w/ severe AS going to OR w/o AVR

A

10%

26
Q

what class of meds to avoid in AR (esp. prior to Sx)?

A

BB

27
Q

is bridging with heparin needed preoperatively for bileafleat mech AVR and no other thromboembolic risk factors?

A

no

28
Q

risk factors for thromboembolism preoperatively?

A 
afib
previous thromboembolism
LV dysfxn
hypercoagulable
older prosthetic valve
mech. TV
> 1  mech valve
29
Q

which prosthetic valves have a high risk of thrombosis?

A

any mech MVR

mech AVR w/ a risk factor

30
Q

if A/C for prosthetic valve needs to be reversed, what is preferred method?

A

FFP (not Vit K)

31
Q

what type of electrosurgery causes electromagnetic interferon with a PPM/ICD?

A

monopolar (minimize bursts to <5sec)

32
Q

when should you re-program a PPM to asynchronous mode for a Sx?

A

Sx above the umbilicus

PPM dependent patients

33
Q

for pt’s undergoing elective surgery; what are the guidelines for when PPM and ICD should have been interrogated?

A

PPM- within 1 yr

ICD- within 6 mo

34
Q

when do you have to inactivate an ICD preop?

A

mono polar electrosurgery or RF ablation above umbilicus

35
Q

will a magnet placed over ICD force asynchronous pacing?

A

no

36
Q

what do you for a pt. that is PPM dependent with an ICD going for supra-umbilical Sx?

A

reprogram it (magnet will not cause asynchronous pacing, it will just deactivate ICD arrhythmia detection)

37
Q

when is it OK to give a BB for preop vasc Sx?

A

+ischemia on stress
or
2+ risk factors

38
Q

5 q’s to ask for preop eval

A
  • what is the procedure?
  • Sx elective or emergent
  • any active cardiac conditions
  • what is pt’s functional capacity
  • will test change anything?
39
Q

According to POISE, what is the lesson for BB preop?

A

Don’t use them routinely preop and if you have to, start well in advance of Sx with careful titration.
Always continue for pt’s already on BB

40
Q

Which OHT pt’s need abx ppx?

A

ones with valvular regurgitation

41
Q

Class III rec for abx ppx

A

Solely to prevent endocarditis if undergoing GU, GI procedures (incld EGD, colonoscopy)

42
Q

What med to avoid intraop for severe AS and HTN?

A

NTG

43
Q

What rec do you give for pt intraop with severe AS and low BP/low SVR?

A

Poorly tolerated, give phenylephrine

44
Q

When is it appropriate to do stress nuclear preop?

A

Intermediate Sx with 1 or more risk factors AND poor functional capacity

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