Quiz 1 - The Cardiovascular Patient Flashcards
(41 cards)
With anesthesia, will you typically have increased or decreased SVR?
Decreased
With anesthesia will you typically have increased or decreased stroke volume?
Decreased
During induction, how much can anesthesia lower your systemic blood pressure?
20-30% decrease BUT tracheal intubation can increase systemic BP by 20-30 mmHg.
How much can anesthetic agents lower cardiac output?
15%
In addition to identifying potentially serious cardiac disorders during an initial history, what else should you know about the cardiac disorder?
disease severity, stability, and prior therapy
What factors can place a patient at higher cardiac risk during surgery?
- Functional capacity
- age
- co-morbid conditions (i.e. DM, PVD,…)
- type of surgery
- ANEMIA
- presence of CAD and CHF
- Hx of CVA
- Creatinine greater than 2 mg
- IDDM
- High risk surgery
What 4 things should you assess on every pt before anesthesia?
- history
- physical exam
- diagnostic tests
- knowledge of planned surgical procedure
in a pt with valvular heart disease, what should you know from their history?
Whether it is stenotic or regurgitant.
Also, whether they have dyspnea, orthopnea, PND, embolic events, hemoptysis, heart failure or palpitations
During the physical exam, what items should you pay attention to?
cyanosis, pallor, dyspnea during the conversation or with minimal activity, nutritional status, obesity, skeletal deformities, tremor and anxiousness.
During a detailed cardiac assessment, what items should you assess?
- JVD or pedal edema
- cap refill
- displaced apical pulse (cardiomegaly)
- S3 gallop (increased LVEDP)
- S4 (decreased compliance)
- presence of murmur
- pulmonary edema
What does 1 metabolic equivalent or 1 MET represent?
Oygen consumption of a resting adult (3.5 ml/kg/min). Can be measured by persons ability to do normal ADL’s including walking around inside of house or 1 block on level ground.
What does 4 MET’s represent?
ability to climb stairs or walk up a hill. Run for short distances. Walk on level ground at 4mph.
What does 10 MET’s represent?
Ability to participate in strenuous sports like swimming, tennis, and football.
If patients reduce exertion because of cardiac symptoms but still meet a 4-MET threshold, will clinicians over or under estimate their risk?
Underestimate their risk
If a person in not able to meet a 4-MET activity level due to non-cardiac reasons, will a clinician tend to over or under estimate their cardiac risk?
Overestimate their risk.
How is Functional Capacity defined in terms of numbers of MET’s one can accomplish?
- Poor (<4 METS)
- Moderate (4-7 METS)
- Good (7-10 METS)
What is the number 1 determinant of myocardial workload?
Heart Rate
T/F: Conduction disturbances such as right bundle branch block or first degree AV block, may lead to concern but usually do not justify further workup.
True
What is the risk indicies that assess the patient’s overall physical status and to predict morbidity and mortality?
ASA
What is the risk indicies that risk stratification of medical patients with angina, but they have been adapted for use in surgical patients.
NYHA/CCS
what is the risk indicies that identify 9 independent variables that correlated with advers perioperative events?
Cardiac Risk Index (CRI)
what is the risk indicies identified risk factors for cardiac morbidity bet were very cumbersome to apply?
-Modified Cardiac Risk Index
What are major perioperative cardiovascular risk?
- Unstable coronary syndromes
- Decompensated heart failure
- Significant arrhythmias
- Severe Valvular disease
What are moderate perioperative cardiovascular risk factors?
- mild angina
- History of MI, Pathologic Q’s
- Compensated or Prior CHF
- Diabetes Mellitus
- Renal Insufficiency (CKD)
