CV Assessment Flashcards

Question

12-Lead

Answer 1

Recommendations for Preoperative Resting 12-Lead ECG All vascular surgery patients CAD, PAD, CVD AND intermed. risk surgery Maybe 1 or more clinical risk factor plus intermed. risk surgery No- asymptomatic patients plus low risk surgery Reviewed For: 1) Acute Myocardial ischemia 2) Prior myocardial infarction 3) Rhythm or conduction disturbances 4) Cardiomegaly or ventricular hypertrophy 5) Other ECG abnormalities, Electrolyte imbalances

Answer 2

5 Principle Indicators: ST segment elevation , ≥1mm T wave inversion Development of Q waves ST segment depression, flat or downslope of ≥1mm Peaked T waves

Answer 3

Atleast 1 clinical risk factor having vascular surgery Known CAD, PVD, CVD having intermediate or high risk surgery Maybe, if--- No clinical risk but vascular surgery Atleast 1 clinical risk factor having intermediate or high risk surgery Not needed in asymptomatic patients having low risk surgery ACC/AHA recommends ECG within 30 days of surgery

Answer 4

``` To ascertain general medical condition related to comorbidities K+ BUN/ Cr ABG’s Hbg/ Hct INR/ PT ```

Answer 5

Simulates sympathetic nervous system stimulation by increasing BP and HR and therefore increasing myocardial O2 demand and consumption w/ exercise Look for ischemia by ECG changes Interpreted based on: a) Duration of exercise the patient can perform b) Max. HR achieved c) Time of onset of ST depression d) Degree of ST depression e) Time until resolution of the ST segment

Answer 6

ST-segment depression > 2.5mm ST-depression occurs early in test (first 3 minutes) Serious ventricular arrhythmias Prolonged duration of ST depression in post recovery period Non-ECG responses If increase in BP or HR occurs at time of ST-depression If hypotension occurs Hypotension an ominous sign

Answer 7

Useful in patients unable to exercise IV injection of gamma-emitting radiopharmaceutical (thallium) that permits the imaging of blood within the heart and lungs. Dipyridamole or adenosine administered as a vasodilator to increase coronary blood flow The area of decreased perfusion (cold spot) only during stress shows ischemia, whereas a constant perfusion defect suggests old MI. Areas of redistribution defects are at higher risk of ischemia and infarction Look for ischemia by perfusion imaging, not ECG changes

Answer 8

Active cardiac condition Unstable coronary syndromes Unstable or severe angina Recent MI Decompensated HF Significant arrhythmias Severe valvular disease 3 or more clinical risk factors and poor functional capacity having vascular surgery Maybe if: Atleast 1-2 clinical risk factors and poor functional capacity having intermediate risk surgery if it will change management Atleast 1-2 clinical risk factors and good functional capacity having vascular surgery

Answer 9

Measurement of the dimensions of cardiac chambers and vessels and the thickness of the myocardium Global ventricular systolic function: EF Regional wall motion abnormalities Valve structure and motion Can detect blood flow and measure gradients Chamber enlargement Detection of pericardial fluid

Answer 10

Look for regional wall motion abnormalities under stress. An abnormal result consists of new regional wall motion abnormalities or worsening of existing regional wall motion abnormalities during an infusion of dobutamine (exercise/stress) Highly predictive of adverse cardiac events

Answer 11

Current or prior heart failure with worsening dyspnea or other change in clinical status Dyspnea of unknown origin ?Aortic stenosis

Answer 12

Provides best method defining coronary anatomy Information obtained Diffuseness of obstructive disease Adequacy of any previous angioplasties or bypass grafts CA spasms LV pressures, volumes, and EF LV dysfunction: akinesis, dyskinesis, low EF, high LVEDP Valvular lumen area and valve gradients Pressure gradients across valves and shunts, as well as degree of regurgitation PA pressures CO and SVR Gold standard test for undergoing cardiac surgery

Answer 13

Stable angina with Left main CAD Stable angina with 3-vessel disease Stable angina 2-vessel disease with significant proximal LAD lesion and EF <50% or demonstrable ischemia on noninvasive stress testing High-risk unstable angina or non-ST elevation MI Acute ST-elevation MI

Answer 14

BALLOON ANGIOPLASTY – wait >14 days BARE-METAL STENT – wait > 30-45 days DRUG-ELUTING STENT – wait > 365 days

Answer 15

Magnetic resonance imaging Used to assess function and viability of myocardium Highly sensitive in detecting infarctions using gadolinium Also good at determining intracardiac tissue characterization

Answer 16

Guidelines updated in 2006 High-Risk Cardiac Conditions Prosthetic heart valves History of infective endocarditis Unrepaired cyanotic congenital heart disease Repaired congenital heart defect with prosthetic material or device, during the 1st 6 months after the procedure Repaired congenital heart disease with residual defects Cardiac transplantation recipients with cardiac valvular disease For patients with high cardiac risk, antibiotic prophylaxis is recommended for: All dental procedures that involve manipulation for gingival tissue, perforation of oral mucosa, or the periapical region of teeth Invasive respiratory tract procedures with incision or biopsy of respiratory mucosa NOT recommended in genitourinary or gastrointestinal tract surgery* Only if current UTI

Answer 17

``` All antimicrobial prophylaxis are administered as a single dose, given 30-60 min. before procedure Standard prophylaxis Ampicillin 2 gm IV Or Cefazolin 1 gm IV Or Ceftriaxone 1 gm IV If PCN allergic, Clindamycin 600 mg IV ```