Clinical Med Final Flashcards
Define Functional Capacity
The ability to perform activities of daily living
Requires aerobic metabolism
Reflects the pulmonary, cardiac, skeletal muscle health of PT
Define MET
Metabolic Equivalent
3.5ml/kg/minute is the amount of O2 consumption ofa 70kg 40 year old man in the resting state
Cardiac risks in NONCARDIAC procedures are increased if the PT cannot meet a 4-MET demand
What are some things that are included in a 4MET
Climb a flight of stairs
walk up a hill
walk on level ground at 4mph
run a short distance
do heavy work (scrub floors, move furniture)
Moderate exercise (golf, bowling, throwing a ball)
Why is functional capacity important for dentists?
it essentially represents the cardiovascular health of the PT
you can use it to assess the PT’s ability to tolerate stresses associated with dental care
3 things go into the “funnel” to define functional capacity
- disease and medical therapy risks
- comorbidity risks
- dental therapy risks
what are some MAJOR predictors of increased CV risk in NONCARDIAC procedures
unstable coronary syndrome (recent MI 7-30 days) unstable angina decompensated HF severe valvular disease significant arrhythmias
what are some INTERMEDIATE predictors of increased CV risk in NONCARDIAC procedures
Stable angina pectoris Previous MI Compensated HF Diabetes mellitus (particularly Type-1) Renal insufficiency
what are some MINOR predictors of increased CV risk in NONCARDIAC procedures
Advanced age Atrial fibrillation History of stroke Low functional capacity Uncontrolled HTN (>180/110)
Things that increase your BP from most to least
attending a meeting (most) commuting to work getting dressed walking eating desk work (least)
What are some dental considerations for CVD?
minimize stress (avoid long appts) make sure there is good pain control
Describe the controversy of vasoconstrictors
Benefit of vasoconstrictor use appears to outweigh risk
Comprehensive care is okay in a CVD pt if…
Minor/intermeidate predictor of CV risk
BP is 4 METs
When do you give limited care to the CVD patient?
Minor/intermeidate predictor of CV risk
BP is < 4 METs
what is the max epi you can give to a CVD patient?
0.04 mg
What calls for emergency care only of the CVD patient?
Minor/intermeidate predictor of CV risk
BP is > 180/110
