Final Exam Review Flashcards
(365 cards)
High risk (>5% morbidity) surgeries for patients with preexisting CV disease: ___ surgery; major ___ surgery; ___ vascular surgery
Aortic surgery; major vascular surgery; peripheral vascular surgery
These surgeries have higher rates of morbidity just based on the procedure alone (not even considering additional patient factors)
___ risk surgeries: intraperitoneal; transplant; carotid; peripheral artery angioplasty; endovascular aneurysm repair (open AAA repair would be HIGH risk); head/neck surgery; major neurologic/orthopedic surgery—i.e.: multi-level fusion surgery, hip repair; intrathoracic—i.e.: lung surgery; major urologic—i.e.: prostatectomy, nephrectomy
Intermediate risk (1-5% morbidity)
___ risk surgeries: breast; dental; endoscopic; superficial; endocrine; cataract; gynecological; reconstructive; minor orthopedic; minor urologic
Low risk (< 1% morbidity)
METs = ___, how we measure a patient’s ___ capacity
Metabolic equivalents, how we measure a patient’s functional capacity
Gold standard of evaluating a patient’s functional capacity (main question we ask patients when doing our pre-op assessment?)
“Are you able to climb two flights of stairs without stopping, regardless of limiting symptoms?”
Inability of patients to climb two flights of stairs without stopping, regardless of limiting symptoms, leads to a ___% increase in risk for cardiopulmonary complications postoperatively
82% increase in risk
1 MET = ___ functional capacity
Poor
Examples = self-care, eating, dressing, using the toilet, walking indoors/around the house, walking 1-2 blocks on level ground at 2-3 mph
4 METs = ___ functional capacity
Good
Examples = light housework; climbing a flight of stairs without stopping, or walking up a hill longer than 1 to 2 blocks; walking on level ground at 4 mph; running a short distance; golf; dancing; throwing a baseball
Greater than 10 METs = ___ functional capacity
Excellent
Example = strenuous sports
8 clinical risk factors for CV surgery: poor ___ (right/left) ventricular function; ___ heart failure; ___ angina or MI within the past ___ months; age > ___; severe ___ity; reoperation (i.e.: redo CABG); ___ surgery; severe uncontrolled ___ illness (i.e.: COPD or diabetes + noncompliance)
Poor LV function; congestive heart failure; unstable angina or MI within the past 6 months; age > 65; severe obesity; reoperation (i.e.: redo CABG); emergency surgery; severe uncontrolled systemic illness (i.e.: COPD or diabetes + noncompliance)
___ = highest risk factor for perioperative MI
Unstable angina—chest pain that doesn’t go away with nitroglycerin or by stopping activity; unpredictable
Patient with history of MI—MI in the past > ___ months increase periop risk of infarction 6%
> 6 months
Patient with history of MI—MI in the past ___-___ months increase periop risk of infarction 15%
3-6 months
Patient with history of MI—MI in the past ___ months increase periop risk of infarction 30%
3 months
Patient with history of MI—highest at risk period for perioperative infarction is within ___ days after an acute MI
30 days
Patient with history of MI—AHA guidelines recommend waiting at least ___-___ weeks after an MI before undergoing elective surgery
4-6 weeks
Elective non-cardiac surgery should NOT be scheduled within ___ weeks after bare metal stent placement
6 weeks
Elective non-cardiac surgery should NOT be scheduled within ___ months after drug eluting stent placement
12 months
Which valvular disorder poses the greatest patient risk for non-cardiac surgery?
Severe aortic stenosis
Aortic stenosis is the greatest risk for non-cardiac surgery, especially when the cross sectional area of the valve is less than ___ cm ^ 2
< 1 cm ^ 2–indicates severe aortic stenosis
Electromagnetic interference risk is low as long as cautery is > ___ cm away from the pacemaker device (~ distance from pacemaker to ___)
> 15 cm away from the pacemaker device (~distance from pacemaker to belly button)
Typically do not need to disable the AICD in these cases because the chance of interference is so low
This class of medications enhances endothelial function; improves atherosclerotic plaque stability; and reduces vascular inflammation
Statins
Statin therapy should be continued perioperatively—T/F?
True
This medication class restores oxygen supply/demand mismatch; reduces perioperative ischemia; redistributes coronary blood flow to subendocardium; stabilizes plaques; increases V Fib threshold
Beta blockers