Pro Operative Cardiac Clearence For Non Cardiac Surgery
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1. The document discusses guidelines for assessing cardiac risk and obtaining clearance for patients undergoing non-cardiac surgery, which is important as cardiac complications are common in such procedures. 2. It outlines evaluating a patient's history, examination, and selecting appropriate investigations to determine their cardiac risk level. 3. Specific high-risk cardiac conditions like coronary artery disease, heart failure, arrhythmias and valvular diseases warrant detailed assessment of prognosis and management during the perioperative period.
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Perioperative cardiovascular assessment of patients undergoing noncardiac sur...
Perioperative cardiovascular assessment is necessary for patients undergoing noncardiac surgery to evaluate medical status, cardiac risks, and recommend strategies to improve short and long term outcomes. Surgeries are stratified as low, intermediate, or high risk depending on the procedure. For patients at elevated risk, further testing like stress testing may be considered to guide management. Guidelines recommend continuing medications like beta blockers and statins perioperatively, as well as delaying surgery for patients with stents based on type. The timing and risks of surgery must be weighed based on a patient's cardiovascular condition and procedure.
pre op evaluation of cardiac pts for non-cardiac surgery
This document discusses the preoperative evaluation of cardiac patients undergoing non-cardiac surgery. It notes that 1-5% of unselected patients experience perioperative cardiac morbidity, and outlines the goals of pre-op evaluation as defining risks, determining if further testing is beneficial, planning anesthesia appropriately, and considering peri-op beta blockade or other therapies. It discusses evaluating patients' history, symptoms, physical exam findings, and using risk indices to stratify cardiac risk. Higher risk factors include recent MI, heart failure, significant arrhythmias or valvular disease. The document provides recommendations for further testing and treatment based on a patient's functional status and cardiac conditions.
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This document discusses pre-operative evaluation and preparation of cardiac patients for non-cardiac surgeries. It outlines that patients with coronary artery disease undergoing non-cardiac surgery are at increased risk of complications. A thorough pre-operative evaluation including history, physical exam, diagnostic tests, and knowledge of the planned surgery is important to assess risk factors and develop a management plan. Tests like ECG, stress testing, echocardiogram and in some cases angiography help evaluate cardiac status. Medical optimization including management of angina, heart failure, diabetes, etc. can help reduce perioperative risk. Timing of surgery depends on the clinical status and risk of delay. Intraoperative management focuses on preventing ischemia.
Anaesthesia in Cardiac Patients for Non-cardiac Surgery
The reader should be able to:
(1) identify factors which will lead to increased cardiovascular risk for patients undergoing non-cardiac surgery
(2) decide which patients require further cardiovascular testing
(3) make optimization plan for such patients
(4) understand the principles of anaesthesia for patients with cardiac disease
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Perioperative cardiovascular assessment of patients undergoing noncardiac sur...
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Anaesthesia in Cardiac Patients for Non-cardiac Surgery
The reader should be able to:
(1) identify factors which will lead to increased cardiovascular risk for patients undergoing non-cardiac surgery
(2) decide which patients require further cardiovascular testing
(3) make optimization plan for such patients
(4) understand the principles of anaesthesia for patients with cardiac disease
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The document provides guidelines for perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. It was developed by an expert panel representing multiple medical societies. The guidelines include recommendations on preoperative risk assessment, management of valvular heart disease and pulmonary hypertension, use of cardiovascular implantable electronic devices, and approaches to predicting and reducing perioperative cardiac risk. A stepwise approach to preoperative cardiac assessment and management is presented based on urgency of surgery and estimated risk of major adverse cardiac events.
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1. The document discusses preoperative cardiac evaluation and risk stratification of patients undergoing non-cardiac surgery based on ACC/AHA guidelines.
2. It outlines 5 factors to consider for risk stratification: recency of cardiac procedures or evaluation, clinical predictors of risk, functional status, and risk of the planned surgery.
3. Based on risk assessment, the document recommends different preoperative testing like ECG, stress testing, echocardiogram or angiogram and outlines perioperative therapies like beta blockers to optimize patient condition and reduce cardiac risk during surgery.
Cardiomyopathy and anesthetic concern
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Laporan Kasus Cardiac Assessment in Non Cardiac Surgery (Sabrina Erriyanti)
1. Many patients undergoing major noncardiac surgery are at risk for cardiovascular events due to changes in cardiac physiology during anesthesia and surgery and the patient's underlying cardiovascular status.
2. A preoperative evaluation involves assessing the urgency of surgery, active cardiac conditions, risk of the planned procedure, and patient's functional capacity.
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2. It can be acute, caused by things like infective endocarditis or aortic dissection, or chronic, caused by conditions like bicuspid aortic valve or hypertension.
3. Chronic AR is often well-tolerated for years as the left ventricle dilates and hypertrophies to accommodate the increased volume, but acute AR can rapidly lead to heart failure and shock if not emergently treated.
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This document discusses anaesthetic management considerations for adults with congenital heart disease undergoing non-cardiac surgery. It outlines common congenital heart defects seen in adults and their long-term consequences, including pulmonary hypertension, bleeding/thrombosis risk, heart failure, and dysrhythmias. It provides guidance on preoperative evaluation, intraoperative monitoring tailored to specific defects, management strategies for defects like Fontan circulation, and postoperative care focused on preventing complications in the ICU.
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The document discusses the approach to anesthesia for patients with cardiac disease undergoing non-cardiac surgery. It emphasizes the importance of preoperative evaluation and risk stratification to determine the safest anesthetic plan. During surgery, careful monitoring is recommended to detect any deterioration in cardiac function. The appropriate selection of anesthetic drugs and techniques can help minimize stress on the heart. Overall, the key is choosing an anesthetic that provides stability for the patient's cardiac condition.
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Perioperative myocardial infarction is a common cause of morbidity and mortality in patients undergoing noncardiac surgery. It can occur through acute coronary syndrome or prolonged myocardial ischemia in patients with stable coronary artery disease. Diagnosis is difficult as symptoms often do not present in anesthetized patients. Risk is determined by patient clinical factors, exercise capacity, and surgery risk. Management may include beta blockers, statins, aspirin, and evaluating need for revascularization based on standard criteria.
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The document discusses the importance of preoperative evaluation in anesthesia. It notes that anesthesiologists now perform many roles beyond just anesthesia in the operating room, including focused clinical exams, medical optimization, reducing patient anxiety, and informed consent. A thorough preoperative evaluation can reduce surgical risks, delays and cancellations. Key aspects of the evaluation include assessing medical history and physical exam findings, laboratory tests, EKG, and risk classification using the ASA system. The goals are to identify health risks, heart conditions, optimize medical issues, and modify perioperative risk.
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Renjith George is an experienced cardiac operation room nurse seeking a position that utilizes his knowledge and experience. He has over 6 years of experience as a senior cardiac operation room nurse and nursing incharge in hospitals in New Delhi, Punjab, and Odisha. His responsibilities include receiving patients, assisting in surgeries, ensuring accurate instrument and supply counts, and anticipating the needs of surgical teams. He is proficient in many cardiac, vascular and general surgery procedures.
Ihd and anaesth
1) The document discusses the anaesthetic management of patients with ischemic heart disease undergoing non-cardiac surgery. It covers preoperative evaluation and risk stratification, intraoperative management focusing on preventing myocardial ischemia, and postoperative monitoring and care.
2) Key points addressed include identifying risk factors for ischemic heart disease, evaluating functional capacity and surgical risk, optimizing hemodynamics under anesthesia, using regional anesthesia when possible, and monitoring for signs of perioperative myocardial ischemia.
3) Perioperative myocardial ischemia is often silent, but can be detected by ECG changes, hemodynamic instability, or elevated cardiac enzymes. Careful management is needed to minimize the risk of perioperative cardiac events in these high-risk patients.
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Preop cardiovascular evaluation
Dr. Brijesh Savidhan discusses strategies for evaluating cardiac risk in patients undergoing non-cardiac surgery. The goals are to identify patients at risk, evaluate the severity of underlying heart disease, and stratify surgical risk. A thorough history, physical exam, electrocardiogram, and assessment of functional capacity are recommended. For higher-risk patients, stress testing and evaluation of left ventricular function may be considered to guide management and minimize perioperative complications. Overall, a multidisciplinary approach is important to optimize cardiac status, determine the safest location and timing of surgery, and develop an anesthesia plan tailored to each patient's cardiac condition.
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1. The document discusses preoperative cardiac evaluation and risk stratification of patients undergoing non-cardiac surgery based on ACC/AHA guidelines.
2. It outlines 5 factors to consider for risk stratification: recency of cardiac procedures or evaluation, clinical predictors of risk, functional status, and risk of the planned surgery.
3. Based on risk assessment, the document recommends different preoperative testing like ECG, stress testing, echocardiogram or angiogram and outlines perioperative therapies like beta blockers to optimize patient condition and reduce cardiac risk during surgery.
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Cardiomyopathies are diseases of the heart muscle that cause it to be structurally and functionally abnormal without other known causes like coronary artery disease. There are several types including dilated, hypertrophic, restrictive, arrhythmogenic right ventricular, and Takotsubo cardiomyopathy. Anesthesia management aims to minimize negative inotropic effects, maintain appropriate preload and afterload, and prevent hypotension, arrhythmias, and tachycardia. Goals depend on the type of cardiomyopathy and whether systolic or diastolic dysfunction predominates. Close monitoring is important due to potential hemodynamic instability from anesthesia and surgery.
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1. Many patients undergoing major noncardiac surgery are at risk for cardiovascular events due to changes in cardiac physiology during anesthesia and surgery and the patient's underlying cardiovascular status.
2. A preoperative evaluation involves assessing the urgency of surgery, active cardiac conditions, risk of the planned procedure, and patient's functional capacity.
3. For a planned bipolar hemiarthroplasty, a 80-year-old woman with an uncontrolled type 2 diabetes and hip fracture underwent further cardiac, pulmonary, and anesthesia assessments due to her age and medical conditions which increased her risk for perioperative cardiovascular complications.
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The ACC/AHA guidelines provide recommendations for preoperative cardiac risk assessment and perioperative management of noncardiac surgery patients. The guidelines classify patients into different risk levels based on 5 factors, including coronary history, prior cardiac testing, comorbidities, functional status, and surgery risk. They provide a 9 step algorithm to determine which patients need further cardiac testing or optimization of medical therapy prior to surgery based on their risk level. The guidelines aim to identify patients at high risk for cardiac complications from surgery and make recommendations to reduce surgical risk and improve outcomes.
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2. It can be acute, caused by things like infective endocarditis or aortic dissection, or chronic, caused by conditions like bicuspid aortic valve or hypertension.
3. Chronic AR is often well-tolerated for years as the left ventricle dilates and hypertrophies to accommodate the increased volume, but acute AR can rapidly lead to heart failure and shock if not emergently treated.
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This document discusses myocardial ischemia and infarction in the surgical population. It defines myocardial ischemia as insufficient blood flow to the heart muscle and myocardial infarction as death of heart muscle cells due to prolonged ischemia. The document notes that myocardial ischemia can lead to infarction and is a major cause of short and long term morbidity and mortality in surgical patients. It provides details on the pathophysiology, diagnosis, incidence, risk factors, and strategies for prevention and management of perioperative myocardial ischemia.
2014 accaha guideline on perioperative cardiovascular evaluation and manageme...
This document summarizes guidelines for perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. It defines levels of surgical risk and urgency, and provides recommendations for evaluating and managing active cardiac conditions, clinical risk factors, valvular heart disease, arrhythmias, and pulmonary vascular disease before surgery. A stepwise approach is outlined to estimate perioperative risk based on clinical risk factors, surgical risk level, and objective measures of functional capacity. Further testing is only recommended if it could impact decision-making about proceeding with the planned surgery.
Pre-Anesthetic Checkup
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
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The document discusses strategies for preventing secondary strokes or TIAs, including evaluating the mechanism of the initial event, localizing symptoms to determine if they are anterior or posterior circulation, and initiating the best medical, surgical, or endovascular treatment based on findings; it also stresses the importance of aggressively controlling modifiable risk factors like hypertension, smoking, diabetes, and hyperlipidemia to reduce long-term risk of recurrence.
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1005 Desai - Hypertrophic Cardiomyopathy Update.pdf
1. Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy that is often in the septum and anterior wall. It has an autosomal dominant inheritance pattern.
2. Diagnosis involves multimodality imaging like echocardiogram and cardiac MRI to phenotype HCM and rule out other causes of hypertrophy.
3. Treatment is tailored and may involve medications, invasive therapies like septal reduction procedures, or implantable cardioverter defibrillators depending on risk stratification. Experience and coordinated care at specialized centers is important for management.
Fitness for non cardiac surgery 2
This document discusses preoperative evaluation and risk assessment for non-cardiac surgery. It outlines how to evaluate patients' surgical risk based on their medical history, functional status, and type of surgery. Factors like age, diabetes, kidney function, and cardiovascular health can increase surgical risk. The document provides guidelines on optimizing high-risk patients medically before elective surgery through measures like controlling blood sugar, hypertension, and anemia. It also reviews strategies to reduce risks like pulmonary complications through breathing exercises.
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Preoperative managment
The document discusses preoperative evaluation and management. It aims to identify any medical comorbidities that could affect surgical outcomes rather than broadly screening for disease. A thorough history and physical exam are important to understand preexisting conditions and risks. Investigations should be ordered selectively based on medical history. Preoperative preparation includes securing IV access, emptying bowels if needed, and providing thromboprophylaxis or antibiotics if required. Special considerations depend on the surgery and any cardiovascular, respiratory, or other system involvement.
vkaspre-opforcardiac-141226102841-conversion-gate02 (1).pdf
This document discusses the preoperative evaluation of cardiac patients undergoing non-cardiac surgery. It notes that 1-5% of unselected patients experience perioperative cardiac morbidity, and outlines the goals of pre-op evaluation as defining risks, determining if further testing is beneficial, planning anesthesia appropriately, and considering peri-op beta blockade or other therapies. It discusses evaluating patients based on history, physical exam, risk stratification tools like Goldman and Detsky cardiac risk indices, and determining functional capacity. Specific cardiac conditions like coronary artery disease, heart failure, valvular issues and their peri-op implications are also reviewed.
2. Preoperative evaluation.pptx
This document provides an overview of preoperative evaluation and preparation. It discusses taking a thorough patient history and conducting a physical exam, with a focus on assessing the airway and risk factors. Preoperative tests and investigations are recommended based on patient age and type of surgery. Risk stratification tools like the ASA classification and cardiac risk indices are presented. Guidelines are provided for medication management and NPO restrictions prior to surgery. The goals of preoperative evaluation are identified as optimizing patient health and reducing perioperative risks.
ANESTHESIA PREOPERATIVE EVALUATION.pptx
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TIA and stroke prevention
1. A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with symptoms typically lasting less than one hour without evidence of acute infarction.
2. The risk of stroke is highest in the first few days after a TIA, with about a 10% risk of stroke in the first week and 15% risk within the first 90 days.
3. Evaluation of patients with suspected TIA involves detailed history, neurological exam, prognostic testing like the ABCD2 score, and investigations including blood tests, brain and vascular imaging to identify the cause and risk of future stroke.
Myocarditis
1. Myocarditis is an inflammatory disease of the myocardium diagnosed using histological, immunological and immunohistochemical criteria, with an abnormal inflammatory infiltrate defined as ā„14 leucocytes/mm including up to 4 monocytes/mm and ā„7 CD3 positive T-lymphocytes/mm.
2. Causes of myocarditis include infectious agents like viruses, bacteria, and parasites; immune-mediated reactions to drugs, vaccines or transplants; and toxic effects of drugs, heavy metals, and other toxins.
3. Diagnosis involves clinical presentations like chest pain and heart failure, as well as diagnostic criteria including ECG/imaging abnormalities, elevated cardiac biomarkers, and endomyocardial biopsy showing
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DELIVER delivered 2022.pptx
#flozins
š«DAPA šplacebo in HFpEF
Now we have a positive trial!
ā¬ļø18% in CVā ļø death or
worsening HF among LVEF>40%
ā¬ļø 21%heart failure
š„Results same for LVEF> 60% šLVEF<60%
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