Cardiac Questions For Anesthesia

Cardiac Rotation Question Review

1) What percent of adult patients undergoing surgery are estimated to have, or be at risk for, coronary artery disease? It is estimated that 40% of adult patients who undergo surgery annually are either have or are at risk for coronary artery disease. Stoelting, Basics of Anesthesia, 5th Edition, pg. 365

2) What are some components of a routine preoperativecardiac evaluation? What are some more specialized methods of cardiac evaluation? What is the ultimate purpose of a preoperative cardiac evaluation?

Some components of a routine preoperative cardiac evaluation include the history and physical examination with specific attention to cardiac and pulmonary disease and risks, as well as evaluation of the patient’s electrocardiogram. Some morespecialized methods of cardiac evaluation include ambulatory ECG monitoring (Holter monitoring), exercise stress testing, transthoracic or transesophageal echocardiography, radionuclide ventriculography (determination of ejection fraction), dipyridamole-thallium scintigraphy (mimics the coronary vasodilator response but not the heart rate response associated with exercise), cardiac catheterization,and angiography. Ultimately, the purpose of the history and physical examination with specific attention to signs and symptoms of new onset of angina, change in angina pattern, unstable angina, recent myocardial infarction, congestive heart failure, or aortic stenosis is to determine whether patients are in the best medical condition possible before elective cardiac or noncardiac surgery.Stoelting, Basics of Anesthesia, 5th edition, pgs. 365-366

3) What are some important aspects of the preoperative history taken from patients with coronary artery disease with respect to their cardiac status?

Important aspects of the history taken from patients with coronary artery disease before noncardiac surgery include (1) evaluation of cardiac reserve (exercise tolerance), (2)characteristics of their angina pectoris, (3) previous occurrence of myocardial infarction, and (4) medical, interventional cardiology, and cardiac surgical therapy for these conditions. Potential interactions of medications used in the treatment of coronary artery disease with drugs used to produce anesthesia must also be considered. Coronary angiography is the gold standard for defining coronary anatomy.Stoelting, Basics of Anesthesia, 5th edition, pg. 366

4) What are some co-existing noncardiac diseases that are frequently present m patients with coronary artery disease? Coexisting noncardiac diseases that are often present in patients with CAD include systemic hypertension, peripheral vascular disease, chronic obstructive pulmonary disease from cigarette smoking, renal dysfunction associatedwith chronic hypertension, and diabetes mellitus. Stoelting, Basics of Anesthesia, 5th edition, pg. 366

5) What are some co-existing noncardiac diseases that are frequently present m patients with coronary artery disease?

Symptoms are generally absent until the atherosclerotic lesions cause 50-75% occlusions in the coronary circulation. Morgan & Mikhail, Clinical Anesthesiology, 4thedition, pg. 453 Patients with atherosclerotic coronary disease become symptomatic when 75% of the coronary vessel is occluded, resulting in a decrease in coronary blood flow. Nagelhout, Nurse Anesthesia, 3rd edition, pg. 461

6) What is the best indicator for a patient's cardiac reserve?

Limited exercise tolerance in the absence of significant pulmonary disease is the best indicator ofdecreased cardiac reserve. If a patient can climb two to three flights of stairs without symptoms, cardiac reserve is probably adequate. Stoelting, Basics of Anesthesia, 5th edition, p. 366
7) When is angina pectoris considered "stable"?
Angina pectoris is considered to be stable when no change in precipitating factors, frequency, and duration has occurred for at least sixty days....