Risk assessment in noncardiac surgery
•Download as PPTX, PDF•
4 likes•358 views
This document provides guidelines for perioperative cardiovascular risk assessment and management. It outlines various cardiac conditions and procedures that confer low, intermediate, and high risk. It recommends evaluation and treatment of active cardiac conditions prior to elective surgery. For intermediate and high risk patients, it suggests assessing functional capacity and proceeding with surgery if >4 METs without symptoms. If risk is unclear, it recommends noninvasive testing if results could change management. The document provides testing and management guidelines for various cardiac conditions like hypertension, valvular disease, and prior stents/CABG. It emphasizes continued beta-blocker use for patients with coronary artery disease.
Report
Share
Report
Share
Recommended
Tachyarrhythmia's
There are two main types of tachyarrhythmias: supraventricular tachycardia (SVT) originating above the ventricles, and ventricular tachycardia (VT) originating in the ventricles. VT is more serious and can lead to cardiac death, while SVT is usually not lethal. The electrocardiogram (ECG) is used to distinguish between SVT and VT based on whether the QRS complex is narrow or wide. Tachyarrhythmias can cause symptoms like palpitations, dizziness, and chest pain. Diagnostic tests are needed to fully evaluate tachyarrhythmias.
Using External Pacemaker
This document discusses transcutaneous pacing, which is used to treat bradycardia and heart block when the heart rate is too slow and the patient is hemodynamically unstable. It indicates transcutaneous pacing can be used for conditions like third-degree heart block, Mobitz type II second-degree heart block, asystole, and pediatric bradycardia. The document reviews how to perform transcutaneous pacing using external pads placed on the chest connected to a pacemaker, and notes potential complications like failure to pace or capture and skin burns.
Tachyarrhythmias
The document discusses tachyarrhythmias and provides details about various types. It begins by defining tachyarrhythmia as an abnormal cardiac rhythm with a heart rate over 100 beats per minute. There are three main causes of tachyarrhythmia: abnormal automaticity, triggered activity, and re-entry. Several types of tachyarrhythmia are then described in detail, including sinus tachycardia, atrial tachycardia, ventricular ectopic beats, and supraventricular tachyarrhythmias. Diagnosis involves analyzing features of the electrocardiogram such as heart rate, rhythm, QRS width, and P wave morphology.
Tachyarrhythmia Management
This document discusses various types of tachyarrhythmias categorized by their anatomical location and electrophysiological mechanisms. It describes atrial arrhythmias including sinus tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. It also discusses atrioventricular node reentrant tachycardia, atrioventricular reentrant tachycardia, junctional tachycardia, and ventricular arrhythmias including monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. Key features and mechanisms of each type are outlined to aid in diagnosis and classification.
Tachyarrhythmia
This document provides an overview of evaluating and treating different types of tachycardia, including:
1) It discusses evaluating the patient's hemodynamic stability, history, and ECG to determine the characteristics and cause of the tachycardia.
2) It describes differentiating between narrow and wide complex tachycardias, and the differential diagnoses for each, including sinus tachycardia, atrial fibrillation, AV nodal reentrant tachycardia, and ventricular tachycardia.
3) It provides guidance on therapies for different tachycardias, such as electrical or chemical cardioversion, rate control, and ablation. The importance of correctly diagnosing wide complex tachycard
Tachyarrhythmias
This document provides guidance on the assessment and treatment of arrhythmias presenting in the emergency department. It outlines an approach of first determining hemodynamic stability, then distinguishing between narrow and wide complex tachycardias, and finally determining the specific arrhythmia and appropriate treatment. For unstable patients with any arrhythmia, synchronized direct current cardioversion is recommended. Further treatment is tailored based on whether the arrhythmia has narrow or wide QRS complexes and is regular or irregular.
Ductus Arteriosus
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
Tachyarrythmia
This document discusses various types of tachycardia and arrhythmias. It defines tachycardia as a heart rate over 100 bpm and describes the main mechanisms that can cause arrhythmias. Common types are discussed including sinus tachycardia, supraventricular arrhythmias like atrial fibrillation and flutter, and ventricular arrhythmias. Diagnosis is typically with ECG and treatment depends on whether the patient is stable or unstable and may involve rate control, cardioversion, ablation, or addressing underlying causes. Complications like thromboembolism from atrial fibrillation are also outlined.
Recommended
Tachyarrhythmia's
There are two main types of tachyarrhythmias: supraventricular tachycardia (SVT) originating above the ventricles, and ventricular tachycardia (VT) originating in the ventricles. VT is more serious and can lead to cardiac death, while SVT is usually not lethal. The electrocardiogram (ECG) is used to distinguish between SVT and VT based on whether the QRS complex is narrow or wide. Tachyarrhythmias can cause symptoms like palpitations, dizziness, and chest pain. Diagnostic tests are needed to fully evaluate tachyarrhythmias.
Using External Pacemaker
This document discusses transcutaneous pacing, which is used to treat bradycardia and heart block when the heart rate is too slow and the patient is hemodynamically unstable. It indicates transcutaneous pacing can be used for conditions like third-degree heart block, Mobitz type II second-degree heart block, asystole, and pediatric bradycardia. The document reviews how to perform transcutaneous pacing using external pads placed on the chest connected to a pacemaker, and notes potential complications like failure to pace or capture and skin burns.
Tachyarrhythmias
The document discusses tachyarrhythmias and provides details about various types. It begins by defining tachyarrhythmia as an abnormal cardiac rhythm with a heart rate over 100 beats per minute. There are three main causes of tachyarrhythmia: abnormal automaticity, triggered activity, and re-entry. Several types of tachyarrhythmia are then described in detail, including sinus tachycardia, atrial tachycardia, ventricular ectopic beats, and supraventricular tachyarrhythmias. Diagnosis involves analyzing features of the electrocardiogram such as heart rate, rhythm, QRS width, and P wave morphology.
Tachyarrhythmia Management
This document discusses various types of tachyarrhythmias categorized by their anatomical location and electrophysiological mechanisms. It describes atrial arrhythmias including sinus tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. It also discusses atrioventricular node reentrant tachycardia, atrioventricular reentrant tachycardia, junctional tachycardia, and ventricular arrhythmias including monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. Key features and mechanisms of each type are outlined to aid in diagnosis and classification.
Tachyarrhythmia
This document provides an overview of evaluating and treating different types of tachycardia, including:
1) It discusses evaluating the patient's hemodynamic stability, history, and ECG to determine the characteristics and cause of the tachycardia.
2) It describes differentiating between narrow and wide complex tachycardias, and the differential diagnoses for each, including sinus tachycardia, atrial fibrillation, AV nodal reentrant tachycardia, and ventricular tachycardia.
3) It provides guidance on therapies for different tachycardias, such as electrical or chemical cardioversion, rate control, and ablation. The importance of correctly diagnosing wide complex tachycard
Tachyarrhythmias
This document provides guidance on the assessment and treatment of arrhythmias presenting in the emergency department. It outlines an approach of first determining hemodynamic stability, then distinguishing between narrow and wide complex tachycardias, and finally determining the specific arrhythmia and appropriate treatment. For unstable patients with any arrhythmia, synchronized direct current cardioversion is recommended. Further treatment is tailored based on whether the arrhythmia has narrow or wide QRS complexes and is regular or irregular.
Ductus Arteriosus
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
Tachyarrythmia
This document discusses various types of tachycardia and arrhythmias. It defines tachycardia as a heart rate over 100 bpm and describes the main mechanisms that can cause arrhythmias. Common types are discussed including sinus tachycardia, supraventricular arrhythmias like atrial fibrillation and flutter, and ventricular arrhythmias. Diagnosis is typically with ECG and treatment depends on whether the patient is stable or unstable and may involve rate control, cardioversion, ablation, or addressing underlying causes. Complications like thromboembolism from atrial fibrillation are also outlined.
pediatrics.Cardiac arrhythmias.(dr.hader)
This document discusses different types of cardiac arrhythmias, including tachyarrhythmias (fast heart rhythms) and bradyarrhythmias (slow heart rhythms). It describes various supraventricular tachycardias such as sinus tachycardia, paroxysmal supraventricular tachycardia, atrial flutter, and atrial fibrillation. It also discusses ventricular tachycardias including ventricular tachycardia and ventricular fibrillation. Treatment options are provided for each type of arrhythmia. The document additionally covers normal heart rate ranges by age and types of bradyarrhythmias such as sinus bradycardia.
Supra ventricular tachycardia
This document discusses various types of supraventricular tachycardias (SVTs), including their causes, mechanisms, diagnosis, and treatment. It covers atrial fibrillation, atrial flutter, atrial tachycardia, and AV nodal reentrant tachycardia. For each type, it discusses epidemiology, mechanisms, classification, evaluation with tests like ECG and echocardiogram, anticoagulation measures, and treatment options like medications, cardioversion, and catheter ablation. Rate control is emphasized as usually preferable to rhythm control for atrial fibrillation.
Cardiac arrythmia in children
This document discusses pediatric cardiac arrhythmias. Some key points:
- Arrhythmias are classified based on site of origin such as the sinus node, atria, AV node or ventricles. Common arrhythmias include sinus tachycardia, supraventricular tachycardia, and ventricular tachycardia.
- Presentation of arrhythmias in children varies by age. Neonates may experience atrial flutter or ectopic atrial tachycardia. Older children may experience WPW syndrome or AV nodal re-entrant tachycardia.
- Diagnosis involves analyzing the ECG for heart rate, QRS width, and P wave relationship to the
Approach to chest pain
This document provides guidance on evaluating and managing patients presenting with chest pain. It outlines the general approach which includes ensuring patient stability, providing oxygen and analgesia. It describes performing a focused history and physical exam, as well as relevant investigations. It discusses life-threatening causes of chest pain including acute coronary syndrome, cardiac tamponade, pulmonary embolism, tension pneumothorax, and aortic dissection. For each condition, it details symptoms, signs, diagnostic tests, and general treatment approaches.
Evaluation & Management Of Child With Arrhythmias
1. The document discusses evaluation and management of pediatric arrhythmias. It defines arrhythmias and classifies them into categories like tachycardia, bradycardia, and irregular rhythms.
2. Causes, symptoms, physical exam findings, and evaluation for different arrhythmias are described. Evaluation involves ECG, holter monitoring, and identifying any underlying structural heart defects or acquired conditions.
3. Management algorithms for bradycardic rhythms like various types of heart block and tachycardic rhythms are provided. Treatment depends on severity and involves supporting circulation, addressing reversible causes, medications, and pacemaker placement if needed.
Bradyarrhythmia Management
This document discusses different types of bradyarrhythmias which are heart rates less than 60 beats per minute. The types include sinus bradycardia, sick sinus syndrome, and AV blocks of varying degrees. Causes include drugs, ischemia, structural issues, and electrolyte imbalances. Treatment depends on whether the bradycardia is stable or unstable. For stable patients, no treatment may be needed but unstable patients require treatment of the underlying cause if known and use of drugs like atropine, epinephrine, or isoproterenol to increase heart rate. Pacing may also be used through temporary or permanent pacemakers.
Pediatric dysrhythmias
The causes listed are all potential causes for syncope in children. The most common causes are neurocardiogenic syncope, breath-holding spells, and seizures. Other important considerations include cardiac causes like long QT syndrome, hypertrophic cardiomyopathy, and aortic stenosis.
Adult tachycardia
1) When encountering a patient with tachycardia, first check if they have a pulse and if they are stable or unstable. Then treat according to the ACLS tachycardia algorithm.
2) For stable tachycardia, further assess if the QRS is narrow or wide, regular or irregular to determine the likely rhythm and appropriate treatment.
3) Unstable tachycardia requires immediate synchronized cardioversion without delay.
ALS Algorithm lecture
The document discusses treatment algorithms for cardiac arrest caused by ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity, and asystole. It outlines the principles of cardiopulmonary resuscitation including the importance of minimizing interruptions to chest compressions. Treatment algorithms are provided for defibrillation, drug administration, and management of tachycardias and bradycardias. Effective advanced life support requires high quality cardiopulmonary resuscitation and treatment of underlying causes and arrhythmias to maximize chances of survival.
Presentation2
The 62-year-old man presented with chest pain, difficulty breathing, palpitations, and fever for 4 weeks. Tests showed signs of a prior heart attack and severely reduced heart function. He was admitted to the intensive care unit for treatment of heart failure due to ischemic cardiomyopathy with an ejection fraction of 20%, borderline shock, and arrhythmia risks as an early complication of his heart attack.
The ECG as a Diagnostic Tool: A Clinical Case Study of Supraventricular Tachy...
This document presents a case study of a patient presenting with supraventricular tachycardia (SVT). It describes the patient's history and symptoms, analysis of the electrocardiogram (ECG) showing SVT, and treatment and monitoring based on the ECG diagnosis. Adenosine was administered, returning the rhythm to normal sinus rhythm on the ECG. The patient's heart rate and symptoms improved, and they were discharged in normal sinus rhythm.
Approach to tachyarrhythmia
This presentation describes the emergency department management of sinus tachycardia, supraventricular tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia and ventricular ectopic
Svt and vm
This document discusses supraventricular tachycardia (SVT) and the role of vagal maneuvers in treating SVT. It defines SVT and describes how a rapid heart rate from SVT can reduce cardiac output and cause symptoms. It explains the mechanisms of two common types of SVT - AV nodal reentrant tachycardia and orthodromic AV reentrant tachycardia. The document then describes how vagal stimulation through maneuvers like carotid sinus massage, Valsalva maneuver, and cold water immersion can help terminate SVT by slowing AV node conduction. It notes that while generally safe, vagal maneuvers can rarely cause complications like prolonged pauses or arrhythmias.
Patent ductus arteriosus A long case presentation
The document discusses the history, diagnosis, and management of patent ductus arteriosus (PDA), including the timeline of surgical and transcatheter closure techniques. PDA is a persistent opening between the aorta and pulmonary artery that normally closes shortly after birth; if it remains open, closure may be recommended depending on the size of the shunt. Transcatheter closure has largely replaced surgery as the treatment of choice, with high success rates using devices designed to occlude the opening in the PDA.
Tachyarrhythmias
This document discusses various tachyarrhythmias, including:
- Supraventricular tachycardias like atrial flutter, AV nodal reentrant tachycardia, and AV reentrant tachycardia.
- Ventricular arrhythmias including ventricular tachycardia and ventricular flutter.
- Irregular rhythms such as atrial fibrillation.
It provides details on characteristics like rate, morphology, underlying causes, and treatment approaches for each type of tachycardia. Emphasis is placed on distinguishing ventricular tachycardia from supraventricular tachycardia with aberrancy in clinical evaluation.
Dysrhythmias april 2013
This document provides guidance on treating various cardiac arrhythmias. It recommends treating wide complex tachycardia with electricity or procainamide and cardioverting WPW with synchronized electricity. For ventricular fibrillation it recommends unsynchronized shocks followed by CPR, adrenaline, and amiodarone. It also provides guidance on treating sinus tachycardia, SVT, narrow complex tachycardia, bradycardia, hyperkalemia, and TCA overdose.
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
Differential diagnosis and treatment of ventricular tachycardia, flutter, and ventricular fibrillation
Pediatric arrhythmia
The document discusses various pediatric arrhythmias including tachycardias and bradycardias. It provides details on normal heart rates at different ages and describes common supraventricular tachycardias like AV nodal reentrant tachycardia, accessory pathway mediated tachycardias. It also discusses idiopathic ventricular tachycardia and management strategies for different arrhythmias including medication and ablation. Congenital complete heart block is described along with its association with maternal autoimmune conditions.
Dr somani
In patients with acute myocardial infarction (AMI), arrhythmias are common. 90% will develop some form of cardiac arrhythmia, with 25% occurring within the first 24 hours. Arrhythmias can be classified as tachyarrhythmias (ventricular, supraventricular) or bradyarrhythmias (bradycardias, heart blocks). Life-threatening ventricular arrhythmias like ventricular fibrillation and ventricular tachycardia are treated with defibrillation or antiarrhythmic drugs like amiodarone. Other arrhythmias seen in AMI include atrial fibrillation, sinus tachycardia, and various heart blocks. Temporary pacing may be needed for symptomatic bradyarrhythmias
Patent Ductus Arteriosus: Clinical manifestation and Diagnosis
Descriptive and informative facts about Patent Ductus Arteriosus focusing on its clinical features, physical findings, natural course and diagnostic work up. The diagnostic work up does not include Echocardiography in this presentation.
Fattore umano in chirurgia
Medical errors are common, resulting in thousands of unnecessary deaths each year in the US and other countries. Errors often stem from systemic issues rather than individual failings, such as complex systems, lack of training and oversight. To improve patient safety, healthcare systems must focus on system design and policies that reduce complexity, automate processes, and establish a culture of reporting and learning from errors without blame.
Cardiac patient for non cardiac surgery
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.
More Related Content
What's hot
pediatrics.Cardiac arrhythmias.(dr.hader)
This document discusses different types of cardiac arrhythmias, including tachyarrhythmias (fast heart rhythms) and bradyarrhythmias (slow heart rhythms). It describes various supraventricular tachycardias such as sinus tachycardia, paroxysmal supraventricular tachycardia, atrial flutter, and atrial fibrillation. It also discusses ventricular tachycardias including ventricular tachycardia and ventricular fibrillation. Treatment options are provided for each type of arrhythmia. The document additionally covers normal heart rate ranges by age and types of bradyarrhythmias such as sinus bradycardia.
Supra ventricular tachycardia
This document discusses various types of supraventricular tachycardias (SVTs), including their causes, mechanisms, diagnosis, and treatment. It covers atrial fibrillation, atrial flutter, atrial tachycardia, and AV nodal reentrant tachycardia. For each type, it discusses epidemiology, mechanisms, classification, evaluation with tests like ECG and echocardiogram, anticoagulation measures, and treatment options like medications, cardioversion, and catheter ablation. Rate control is emphasized as usually preferable to rhythm control for atrial fibrillation.
Cardiac arrythmia in children
This document discusses pediatric cardiac arrhythmias. Some key points:
- Arrhythmias are classified based on site of origin such as the sinus node, atria, AV node or ventricles. Common arrhythmias include sinus tachycardia, supraventricular tachycardia, and ventricular tachycardia.
- Presentation of arrhythmias in children varies by age. Neonates may experience atrial flutter or ectopic atrial tachycardia. Older children may experience WPW syndrome or AV nodal re-entrant tachycardia.
- Diagnosis involves analyzing the ECG for heart rate, QRS width, and P wave relationship to the
Approach to chest pain
This document provides guidance on evaluating and managing patients presenting with chest pain. It outlines the general approach which includes ensuring patient stability, providing oxygen and analgesia. It describes performing a focused history and physical exam, as well as relevant investigations. It discusses life-threatening causes of chest pain including acute coronary syndrome, cardiac tamponade, pulmonary embolism, tension pneumothorax, and aortic dissection. For each condition, it details symptoms, signs, diagnostic tests, and general treatment approaches.
Evaluation & Management Of Child With Arrhythmias
1. The document discusses evaluation and management of pediatric arrhythmias. It defines arrhythmias and classifies them into categories like tachycardia, bradycardia, and irregular rhythms.
2. Causes, symptoms, physical exam findings, and evaluation for different arrhythmias are described. Evaluation involves ECG, holter monitoring, and identifying any underlying structural heart defects or acquired conditions.
3. Management algorithms for bradycardic rhythms like various types of heart block and tachycardic rhythms are provided. Treatment depends on severity and involves supporting circulation, addressing reversible causes, medications, and pacemaker placement if needed.
Bradyarrhythmia Management
This document discusses different types of bradyarrhythmias which are heart rates less than 60 beats per minute. The types include sinus bradycardia, sick sinus syndrome, and AV blocks of varying degrees. Causes include drugs, ischemia, structural issues, and electrolyte imbalances. Treatment depends on whether the bradycardia is stable or unstable. For stable patients, no treatment may be needed but unstable patients require treatment of the underlying cause if known and use of drugs like atropine, epinephrine, or isoproterenol to increase heart rate. Pacing may also be used through temporary or permanent pacemakers.
Pediatric dysrhythmias
The causes listed are all potential causes for syncope in children. The most common causes are neurocardiogenic syncope, breath-holding spells, and seizures. Other important considerations include cardiac causes like long QT syndrome, hypertrophic cardiomyopathy, and aortic stenosis.
Adult tachycardia
1) When encountering a patient with tachycardia, first check if they have a pulse and if they are stable or unstable. Then treat according to the ACLS tachycardia algorithm.
2) For stable tachycardia, further assess if the QRS is narrow or wide, regular or irregular to determine the likely rhythm and appropriate treatment.
3) Unstable tachycardia requires immediate synchronized cardioversion without delay.
ALS Algorithm lecture
The document discusses treatment algorithms for cardiac arrest caused by ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity, and asystole. It outlines the principles of cardiopulmonary resuscitation including the importance of minimizing interruptions to chest compressions. Treatment algorithms are provided for defibrillation, drug administration, and management of tachycardias and bradycardias. Effective advanced life support requires high quality cardiopulmonary resuscitation and treatment of underlying causes and arrhythmias to maximize chances of survival.
Presentation2
The 62-year-old man presented with chest pain, difficulty breathing, palpitations, and fever for 4 weeks. Tests showed signs of a prior heart attack and severely reduced heart function. He was admitted to the intensive care unit for treatment of heart failure due to ischemic cardiomyopathy with an ejection fraction of 20%, borderline shock, and arrhythmia risks as an early complication of his heart attack.
The ECG as a Diagnostic Tool: A Clinical Case Study of Supraventricular Tachy...
This document presents a case study of a patient presenting with supraventricular tachycardia (SVT). It describes the patient's history and symptoms, analysis of the electrocardiogram (ECG) showing SVT, and treatment and monitoring based on the ECG diagnosis. Adenosine was administered, returning the rhythm to normal sinus rhythm on the ECG. The patient's heart rate and symptoms improved, and they were discharged in normal sinus rhythm.
Approach to tachyarrhythmia
This presentation describes the emergency department management of sinus tachycardia, supraventricular tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia and ventricular ectopic
Svt and vm
This document discusses supraventricular tachycardia (SVT) and the role of vagal maneuvers in treating SVT. It defines SVT and describes how a rapid heart rate from SVT can reduce cardiac output and cause symptoms. It explains the mechanisms of two common types of SVT - AV nodal reentrant tachycardia and orthodromic AV reentrant tachycardia. The document then describes how vagal stimulation through maneuvers like carotid sinus massage, Valsalva maneuver, and cold water immersion can help terminate SVT by slowing AV node conduction. It notes that while generally safe, vagal maneuvers can rarely cause complications like prolonged pauses or arrhythmias.
Patent ductus arteriosus A long case presentation
The document discusses the history, diagnosis, and management of patent ductus arteriosus (PDA), including the timeline of surgical and transcatheter closure techniques. PDA is a persistent opening between the aorta and pulmonary artery that normally closes shortly after birth; if it remains open, closure may be recommended depending on the size of the shunt. Transcatheter closure has largely replaced surgery as the treatment of choice, with high success rates using devices designed to occlude the opening in the PDA.
Tachyarrhythmias
This document discusses various tachyarrhythmias, including:
- Supraventricular tachycardias like atrial flutter, AV nodal reentrant tachycardia, and AV reentrant tachycardia.
- Ventricular arrhythmias including ventricular tachycardia and ventricular flutter.
- Irregular rhythms such as atrial fibrillation.
It provides details on characteristics like rate, morphology, underlying causes, and treatment approaches for each type of tachycardia. Emphasis is placed on distinguishing ventricular tachycardia from supraventricular tachycardia with aberrancy in clinical evaluation.
Dysrhythmias april 2013
This document provides guidance on treating various cardiac arrhythmias. It recommends treating wide complex tachycardia with electricity or procainamide and cardioverting WPW with synchronized electricity. For ventricular fibrillation it recommends unsynchronized shocks followed by CPR, adrenaline, and amiodarone. It also provides guidance on treating sinus tachycardia, SVT, narrow complex tachycardia, bradycardia, hyperkalemia, and TCA overdose.
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
Differential diagnosis and treatment of ventricular tachycardia, flutter, and ventricular fibrillation
Pediatric arrhythmia
The document discusses various pediatric arrhythmias including tachycardias and bradycardias. It provides details on normal heart rates at different ages and describes common supraventricular tachycardias like AV nodal reentrant tachycardia, accessory pathway mediated tachycardias. It also discusses idiopathic ventricular tachycardia and management strategies for different arrhythmias including medication and ablation. Congenital complete heart block is described along with its association with maternal autoimmune conditions.
Dr somani
In patients with acute myocardial infarction (AMI), arrhythmias are common. 90% will develop some form of cardiac arrhythmia, with 25% occurring within the first 24 hours. Arrhythmias can be classified as tachyarrhythmias (ventricular, supraventricular) or bradyarrhythmias (bradycardias, heart blocks). Life-threatening ventricular arrhythmias like ventricular fibrillation and ventricular tachycardia are treated with defibrillation or antiarrhythmic drugs like amiodarone. Other arrhythmias seen in AMI include atrial fibrillation, sinus tachycardia, and various heart blocks. Temporary pacing may be needed for symptomatic bradyarrhythmias
Patent Ductus Arteriosus: Clinical manifestation and Diagnosis
Descriptive and informative facts about Patent Ductus Arteriosus focusing on its clinical features, physical findings, natural course and diagnostic work up. The diagnostic work up does not include Echocardiography in this presentation.
What's hot (20)
The ECG as a Diagnostic Tool: A Clinical Case Study of Supraventricular Tachy...
The ECG as a Diagnostic Tool: A Clinical Case Study of Supraventricular Tachy...
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
Patent Ductus Arteriosus: Clinical manifestation and Diagnosis
Patent Ductus Arteriosus: Clinical manifestation and Diagnosis
Viewers also liked
Fattore umano in chirurgia
Medical errors are common, resulting in thousands of unnecessary deaths each year in the US and other countries. Errors often stem from systemic issues rather than individual failings, such as complex systems, lack of training and oversight. To improve patient safety, healthcare systems must focus on system design and policies that reduce complexity, automate processes, and establish a culture of reporting and learning from errors without blame.
Cardiac patient for non cardiac surgery
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.
Cardiac risk stratification
The document discusses various methods of assessing cardiac risk for patients undergoing surgery. It describes several cardiac risk indices, including the Goldman Multifactorial Cardiac Risk Index, Eagle's Cardiac Risk Index, Detsky's Cardiac Risk Index, and the Revised Cardiac Risk Index. It also discusses the American College of Cardiology Cardiac Risk Classification and factors that can affect cardiac risk, such as coronary artery disease, diabetes, hypertension, and the type of surgery. The document provides guidelines for stratifying cardiac risk based on the invasiveness and risk level of the surgical procedure. It further discusses ways to minimize risk, such as through the use of beta blockers, lipid-lowering agents, and a2-adre
Preventing Heart Disease - Statistics, Risk Factors and Prevention Guidelines
The document contains 30 lines that are all identical copyright notices from 2012 attributed to MapsofWorld.com. It does not contain any other substantive information.
Risk factors of cardiovascular
This document discusses risk factors of cardiovascular diseases. It begins by defining cardiovascular diseases and coronary heart disease. It then discusses the global burden of cardiovascular diseases, providing statistics on deaths and prevalence rates in various parts of the world. The major risk factors discussed include smoking, high blood pressure, diabetes, obesity, physical inactivity, and stress. Strategies for prevention and intervention at the population level, high-risk level, and secondary prevention level are described. Clinical trials investigating risk factor modification are also summarized.
Ischemic heart diseases..
Ischemic heart disease is usually caused by atherosclerosis in the coronary arteries which limits blood supply to the heart. It has a spectrum of clinical manifestations from mild angina to myocardial infarction depending on the severity of ischemia. Angina pectoris is recurrent chest pain due to transient ischemia while a myocardial infarction occurs when ischemia is prolonged leading to cell death and scarring of heart muscle. Atherosclerosis develops from childhood and lifestyle factors influence its progression, with plaques vulnerable to rupture typically containing inflammatory cells, lipids, and a thin fibrous cap.
Cardiac assessment ppt
The document provides information on assessing cardiovascular health. It defines key terms like systolic and diastolic blood pressure. It describes how to inspect the eyes, skin, chest and edema during assessment. Methods of assessment include measuring blood pressure, taking a health history, and auscultating the heart to identify sounds like S1, S2, murmurs or gallops. A thorough assessment can help identify risk factors for cardiovascular disease.
Coronary Artery Disease (CAD)
Coronary artery disease occurs when plaque builds up in the coronary arteries, narrowing them and reducing blood flow to the heart. It is the most common type of heart disease and leading cause of death in the US. Risk factors include age, family history, smoking, high cholesterol, diabetes, and physical inactivity. Over time, plaque buildup can severely block coronary arteries and cause chest pain, heart attack, or death. Diagnosis involves ECG, cardiac catheterization, and blood tests. Treatment focuses on lifestyle changes like diet, exercise, and quitting smoking as well as cholesterol-lowering drugs, angioplasty, stents, or bypass surgery to improve blood flow.
Coronary heart diseases ppt
This document summarizes a seminar on coronary artery disease presented by Ms. Umadevi. K. It defines coronary artery disease as a narrowing of the coronary arteries that limits blood supply to the heart muscle. Risk factors include high cholesterol, smoking, hypertension, diabetes, and family history. Signs and symptoms include chest pain. Diagnosis involves ECGs, cardiac enzymes tests, echocardiograms, stress tests, and angiography. Treatment includes medications, angioplasty, stents, and bypass surgery to restore blood flow.
Cardiovascular Disease.ppt
The document discusses various diseases of the heart and blood vessels. It describes the structure of the heart and how diseases can affect the heart's chambers, valves, arteries and muscle. Some of the most common heart diseases mentioned are coronary artery disease, heart attacks, heart failure, arrhythmias, and congenital heart defects. It also discusses various diseases that can affect the blood vessels, such as atherosclerosis, hypertension, aneurysms, and peripheral arterial disease. Finally, it provides an overview of several common heart scanning techniques used to diagnose heart conditions, such as echocardiograms, stress tests, angiograms, CT scans, MRI and PET scans.
Ischemic heart disease
The document discusses ischemic heart disease (IHD), including its causes, symptoms, types (such as stable angina, unstable angina, and myocardial infarction), risk factors, diagnosis, and management. IHD is caused by reduced blood flow to the heart muscle, usually due to coronary artery disease. It presents with chest pain and other symptoms and is diagnosed through electrocardiograms, exercise tolerance tests, echocardiograms, isotope scans, and coronary angiography. Investigation aims to determine the severity and location of arterial blockages for guiding revascularization procedures.
Cardiac Evaluation Ppt!
The document discusses guidelines for pre-operative cardiac evaluation to identify patients at risk of peri-operative complications and determine the need for interventions. It outlines goals of evaluating a patient's history, physical exam, and tests to determine cardiac risk. Non-invasive tests include ECG, stress testing, and echocardiogram. Surgical risk is stratified as high, moderate, low. Guidelines provide a framework to screen patients. The evaluation involves assessing risk factors, functional capacity, surgical risk to categorize patients and guide management through anesthesia, medical optimization, or possible revascularization.
Ischemic Heart Disease
1. Ischaemic heart disease is caused by an imbalance between myocardial oxygen supply and demand, usually due to atherosclerosis limiting blood flow in the coronary arteries.
2. The main types of ischaemic heart disease are stable angina, unstable angina, myocardial infarction (STEMI and NSTEMI), and sudden cardiac death. Clinical presentation and ECG/biomarker findings are used to distinguish these conditions.
3. Treatment involves lifestyle modifications and medications like nitrates, beta-blockers, and calcium channel blockers to reduce oxygen demand and increase supply. Revascularization procedures like PCI or CABG may also be used in certain patients.
Viewers also liked (13)
Preventing Heart Disease - Statistics, Risk Factors and Prevention Guidelines
Preventing Heart Disease - Statistics, Risk Factors and Prevention Guidelines
Similar to Risk assessment in noncardiac surgery
Congenital Cardiac Disease types and pathophysiology .ppt
This document discusses congenital heart disease (CHD) and provides details on various types of defects including left-right and right-left shunts. It covers the prevalence, etiology, clinical features, diagnosis, and treatment of atrial septal defects, ventricular septal defects, patent ductus arteriosus, atrioventricular septal defects, and other conditions. Preoperative evaluation and management of patients with CHD is also summarized.
Medicine 5th year, 11th lecture/part one (Dr. Sabir)
Venous thrombosis can arise from damage to or pressure on veins, or from changes in blood components. Risk factors include age over 40, obesity, previous DVT, pregnancy, medications, immobility, surgery, medical illnesses, hematological disorders, coagulation deficiencies, and antiphospholipid syndrome. Diagnostic tests include ultrasound, venography, MRI, CT, D-dimer, and Wells Criteria. Treatment involves anticoagulants like heparin and warfarin to prevent clots from worsening and recurring. Prevention strategies consist of compression stockings, early mobilization, and anticoagulation in high risk patients.
Approach to Pediatric Cardiovascular diseases.pptx
Approach to Pediatric cardiovascular diseases:
Congenital heart diseases
ASD
VSD
PDA
Coarctation of the Aorta
PS
AS
TOF
TGA
Tricuspid atresia
Truncus arteriosus
Total Pulmonary venous return
Hypoplastic left Heart Syndrome
Acute rheumatic fever (ARF)
Chronic Rheumatic Disease
Infective endocarditis (IE)
Venous Thrombosis Emboli disease and how to manage it
Venous thromboembolism (VTE) includes pulmonary embolism (PE) and deep vein thrombosis (DVT). VTE results from Virchow's triad of stasis, endothelial injury, and hypercoagulability. Clinical diagnosis of PE is difficult due to vague symptoms in most patients. Wells criteria and D-dimer testing are used to determine pre-test probability before confirmatory tests like CT angiography (CTA) or ventilation-perfusion (V/Q) scanning. Treatment involves anticoagulation with heparin or low molecular weight heparin initially, followed by vitamin K antagonist therapy. Fibrinolytics or embolectomy may be used for high-
Right ventricular infarction & posterior extension by dr salim
1. The document describes a case of a 60-year-old diabetic and hypertensive woman who presented with chest tightness, nausea, and shortness of breath following breast cancer surgery.
2. On examination, the patient was tachycardic with low blood pressure and an elevated jugular venous pressure. The ECG showed ST elevations in the inferior leads suggestive of an inferior myocardial infarction.
3. Detection of right ventricular infarction is important as it presents differently clinically and requires different management than an isolated inferior MI. Fluid challenges, inotropic support, and afterload reduction may be needed to support the right ventricle.
Deep Vein Thrombosis.pptx
This document provides an overview of deep vein thrombosis (DVT) and pulmonary embolism (PE). It covers the definition, epidemiology, risk factors, clinical features, investigations, management including prevention, treatment and anticoagulation. DVT occurs when a blood clot forms in a deep vein, usually in the legs, while PE is a complication that can occur when part of the clot breaks off and travels to the lungs. The document outlines Virchow's triad of factors that contribute to clot formation and discusses various diagnostic tests and therapeutic approaches for DVT and PE.
principles of preoperative evaluation and preparation.pptx
The importance of preoperative assessment and evaluation to prepare the patient to surgical procedure is directly proportional with the degree of successful of any surgical procedure.
So, good preoperative assessment and evolution is necessary to avoid the morbidity and mortality that expected to the surgical procedures.
MANIKANDAN RATHNAM
This document describes the case of a 55-year-old diabetic and hypertensive female patient who presented with weakness in her left side and a history of palpitations and sweating. She was diagnosed with an acute cerebrovascular disease involving the right middle cerebral artery territory, as well as an acute coronary syndrome with lesions in the LAD artery, which were treated with double stenting. Post-procedure, the patient developed a tentorial brain hemorrhage. She was treated with anticoagulant reversal therapies and improved clinically before being discharged. The case highlights the risks of intracranial hemorrhage from anticoagulation or antiplatelet therapies in patients with multiple vascular risk factors.
Atrial fibrillation (af)
Atrial fibrillation is a common arrhythmia characterized by irregular conduction through the atria and ventricles. It is caused by various conditions and risk factors. Treatment involves rate or rhythm control with medications, cardioversion, or ablation, as well as anticoagulation to prevent strokes. Direct oral anticoagulants are now preferred over warfarin for most patients due to similar efficacy and improved safety profile.
Vsd,Asd &Anaesthesia
This document provides an overview of the classification, pathophysiology, preoperative evaluation, and anesthetic management considerations for patients undergoing surgery with congenital heart defects such as atrial septal defects (ASD) and ventricular septal defects (VSD). It discusses the pathophysiology of left-to-right and right-to-left shunting, preoperative assessment including history, examination, investigations, and risk factors. It also outlines goals and techniques for anesthesia including bubble avoidance, optimizing oxygen delivery and ventilation, and avoiding hypovolemia and increases in left-to-right shunting. Specific considerations for inhalational and intravenous induction agents, central neuraxial blockade, pregnancy, and Eisenmenger
Ventricular septal defect
This document discusses ventricular septal defects (VSDs), which are defects in the wall separating the ventricles of the heart. VSDs are the most common type of congenital heart defect, occurring in around 2.5 per 1000 live births. The document describes the different types of VSDs based on their location, size, whether they are isolated or part of other heart defects. Treatment depends on the size of the VSD, with small defects monitored, moderate defects possibly closed between 9-12 months, and large defects closed by 4-5 months to prevent complications like pulmonary arterial hypertension.
Pediatric Arrythmias
This presentation is a simplified version of the various types of cardiac arrythmias seen in pediatric age groups. We have discussed supraventricular tachycarsias and prolonged QT syndrome in details here. Hope everyone finds it useful.
Heart disease in pregnancy
1. Patients with heart disease require careful intrapartum management including monitoring of vital signs, fluid balance, and fetal heart rate. Epidural analgesia is preferred to avoid hemodynamic changes from pain. Vaginal delivery is preferred for most, and antibiotics are given before procedures to prevent endocarditis.
2. NYHA classification stratifies heart disease severity from Class I (no limitation) to Class IV (severe limitation even at rest).
Pulmonary embolism
The document discusses acute pulmonary embolism (PE). PE is common but difficult to diagnose, with nonspecific symptoms. It describes a case of a 48-year-old woman presenting with sudden dyspnea, tachycardia, and leg swelling who may have PE. Risk factors for PE include recent surgery or trauma, prolonged immobilization, and inherited or acquired hypercoagulable states. Diagnosis involves clinical scoring, D-dimer, imaging like CTPA, and treatment includes anticoagulation with heparin or warfarin.
Adult congrnital heart disease
The document discusses various aspects of congenital heart disease in adults, including definitions, categories, complications, implications for non-cardiac surgery and anesthesia, and considerations for pregnancy. It covers topics such as increased risk for patients with prior cardiac surgery, importance of consulting cardiologists at regional centers for moderate to complex CHD, non-cardiac implications like pulmonary, renal and neurological issues, and challenges specific to different congenital heart defects.
Approach to chest pain recording
This document provides guidance on evaluating and managing chest pain. It lists common cardiac, pulmonary, aortic, chest wall, and esophageal causes of chest pain. It describes typical versus atypical chest pain characteristics and provides the Modified Wells Criteria for evaluating pulmonary embolism risk. Evaluation steps are outlined including EKG, labs, and imaging. Specific cases are presented and addressed, including acute coronary syndrome, pulmonary embolism, aortic dissection, and pericarditis.
Approach to chest pain 3 17- 2020
This document provides guidance on evaluating and managing chest pain. It lists common cardiac, pulmonary, aortic, chest wall, and esophageal causes of chest pain. It describes typical versus atypical chest pain characteristics and provides the Modified Wells Criteria for evaluating pulmonary embolism risk. Evaluation involves history, physical exam, EKG, and lab tests. The document reviews two case studies of patients presenting with chest pain and outlines diagnostic and treatment approaches.
cardiac emergencice im pediatrics
A 2-day-old infant presented with shock and was found to have severe coarctation of the aorta. After discharge from the hospital following delivery, the infant collapsed at home. Examination showed poor perfusion and enlarged liver. Echocardiogram revealed severe coarctation, and the infant went into shock once the ductus arteriosus closed, obstructing left heart outflow. Management involved prostaglandin infusion to keep the ductus patent and stabilize the infant until surgery.
Management of cyanotic congenital heart diseae3
1) The document discusses the management of various cyanotic congenital heart diseases that present in newborns including Tetralogy of Fallot (TOF), Transposition of the Great Arteries (TGA), Tricuspid Atresia (TA), Total Anomalous Pulmonary Venous Return (TAPVR), and Truncus Arteriosus.
2) It outlines the initial management of life-threatening presentations including shock, cyanosis, and heart failure as well as treatments for cyanosis including prostaglandin E1.
3) The long-term medical and surgical management strategies for each condition are described, including palliative procedures and definitive repairs. Shunt operations,
Neonatal Cardiology
This document summarizes the diagnosis and management of critical congenital heart disease in neonates. It discusses prenatal evaluation, initial evaluation and stabilization, confirmation of diagnosis, preoperative evaluation of other organ systems, and lesion-specific surgical management. Key lesions discussed in detail include hypoplastic left heart syndrome, transposition of the great arteries, and total anomalous pulmonary venous connection.
Similar to Risk assessment in noncardiac surgery (20)
Congenital Cardiac Disease types and pathophysiology .ppt
Congenital Cardiac Disease types and pathophysiology .ppt
Medicine 5th year, 11th lecture/part one (Dr. Sabir)
Medicine 5th year, 11th lecture/part one (Dr. Sabir)
Approach to Pediatric Cardiovascular diseases.pptx
Approach to Pediatric Cardiovascular diseases.pptx
Venous Thrombosis Emboli disease and how to manage it
Venous Thrombosis Emboli disease and how to manage it
Right ventricular infarction & posterior extension by dr salim
Right ventricular infarction & posterior extension by dr salim
principles of preoperative evaluation and preparation.pptx
principles of preoperative evaluation and preparation.pptx
Recently uploaded
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
It includes regulation of combination products and medical devices. FDA and industry liaisons.
Identifying Major Symptoms of Slip Disc.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
All info about Diabetes and how to control it.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Efficacy of Avartana Sneha in Ayurveda
Avartana Sneha is a unique method of Preparation of Sneha Kalpana in Ayurveda, mainly it is indicated for the Vataja rogas.
Role of Mukta Pishti in the Management of Hyperthyroidism
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
This document outlines policies and procedures for handling narcotic and controlled drugs in NABH accredited hospitals.
Recently uploaded (20)
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
Risk assessment in noncardiac surgery
- 2. High risk surgery h/o IHD h/o CHF h/o CVA Preop insulin tmt Creat >2 Some include age also. Zero- low One or two –intermediate Three or more- high
- 3. Aortic, major vascular, peri. vascular- high Intraperitoneal,intrathoracic, carotid endarterectomy, head&neck, orthopedic, prostate- intermediate Endoscopy, superficial, cataract, breast, ambulatory- low.
- 4. Emergency Sx Op.room Periop surveillance, postop risk stratification & mmt.
- 5. Elective yes Active cardiac conditions Evaluate & treat, consider OR
- 6. Acute MI / Recent MI Unstable angina, recent MI Decompensated HF Significant arrhythmias Severe valve d/s- severe AS, severe MS High grade AV block Symtomatic ventricular A SVT HR > 100 Symptomatic brady
- 7. No ACC Low risk surgery Proceed with sx
- 8. Intermediate or high risk Functional capacity > 4 mets without symptoms yes proceed
- 9. 1 met: taking care of self, eat, dress, use toilet, indoor walking. 4 met: light work, climb a flight of stairs, golf, dancing. >10 met: strenuous sports.
- 10. No or unsure of functional capacity No clinical risk factors proceed
- 11. No clinical risk factors Proceed with planned surgery 1 or 2 RF(vascular / intermediate risk sx) Proceed with HR control or consider noninvasive testing If it will change mmt.
- 12. 3 or more RF intermediate Proceed with HR control or noninvasive testing If it will change mmt. High Testing if it change mmt
- 13. Cancellation of sx for prohibitive risk Delay of sx for further medical mmt. Coronary interventions before sx. Use of ICU. Changes in monitoring.
- 14. Exercise ECG Phamacologic stress imaging Stress echocardiography Role of MRI, multislice CT, coronary calcium scores, PET is rapidly evolving.
- 15. ACS & decompensated HF of ischaemic origin high risk of periprocedural further worsening. Highest risk cohort: within 30 days of MI.
- 16. Htve crisis postop: DBP>120 and end organ damage- papilloedema, myocardial ischaemia,ARF. Withdrawal of antiHTve tmt may ppt.
- 17. SX need not be postponed in uncomplicated mild to moderate HTN. Severe HTN DBP >110, benefits of delaying sx Vs risk of delaying sx. IV drugs may be used.
- 18. Assessment help to adjust periop fluid & vasopressor mmt. HOCM: thought to be high risk, but major sx under GA– low risk. RelativeC.I for SA
- 19. Aortic systolic murmurs require full eva’n. MV d/s less risk. Prosthetic heart valve: I.E. pxis. Stop OralAntiCoagulants 5 days prior, INR < 1.5, restart pop day 1. Conversion to heparin periop period. LMWH cost effective, residual anticoagulant effect in two thirds.
- 20. Heparin in only •Mechanical MV/TV. •Mechanical AV with AF Prev. thromboembolism Hypercoagulable state Older gen. valve EF < 30% > 1 mech. valve
- 21. Presence of PHT & Eisenmenger Avoid regional anasthesia, sympathetic blockade , worsening R to L shunt.
- 22. Class 1 1. Stable angina with LMCA d/s. 2. SA withTVD esp. if EF < 50 3. SA, DVD with prox. LAD d/s & either EF < 50% or demonstrable ischaemia 4. High risk UA or NSTEMI 5. Acute STEMI
- 23. CABG in last 5 yrs- sent for sx without delay Bare Metal Stent- minimum of 6 wks, optimum of 3 mths. Drug Eluting Stent- one yr. Balloon Angioplasty- 2 wks
- 24. Balloon Angioplasty < 14 days- delay for elective sx. > 14 days- proceed with asp.
- 25. BMS >30-45 days : proceed with asp. < 30-45 days : delay sx
- 26. DES < 1 yr : delay sx > 1 yr : proceed with asp.
- 27. Continuation of BB : class 1 Use of BB titrated to HR & BP : class 11-A in Vascular sx with CAD Ishaemia on preop testing. Routine high dose BB without dose titration maybe harmful.