Complications of a MI
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What is a complication noted in patients with inferior wall MI?
also common with 2nd or 3rd degree AV heart blocks
What occurs in 10-15% of patients post MI that can be confused with recurrent angina??
Describe the pain associated with pericarditis
- pain is worse when inspiring or lying down.
- patients will frequently change positions to relieve pain.
What may be evident on an EKG with pericarditis??
Diffuse ST segment or T wave changes.
how do you treat pericarditis??
ASA or indomethacin
What is dresslers syndrome??
It is a form of pericarditis that develops several weeks to months following an MI.. it is related to an immune response.
Mitral regurg occurs more often with what kind of MI?
inferior wall MI
What are the results of mitral regurg from an inferior wall MI?
- cardiogenic shock or pulmonary edema
- total muscle rupture
Ventricular septal rupture is more likely seen with an ____ MI.
anterior wall MI
A MI is often complicated by some degree of _____.
Left ventricular dysfunction.
how would you assess for L ventricular dysfunction??
3rd heart sound or decreased PaO2 will be evident.
What is the clinical triad of symptoms associated with right ventricular infarct?/?
- increased jugular pressure
- clear lung field in patients with inferior wall MI
what is undesirable in the treatment of R ventricular infarction??
vasodilation and diuretics
Most perioperative Mi's occur within ___ after surgery.
What symptoms often precede a perioperative MI?
Tachycardia and ST depression
SILENT MI.. presents as NSTEMI
What are the 2 hypothesis for the causes of perioperative MI's?
increase myocardial oxygen demand and sudden development of clot due to a vulnerable plaque rupture.
What are some post operative changes that can create a prothrombotic state that can lead to perioperative MI's??
changes in blood viscosity, catecholamine concentrations, cortisol levels, tissue plasminogen activator concentrations and plasminogen activator inhibitor levels
What changes occur after surgery that can lead to an increased amount of endothelial damage that could cause a perioperative MI?
changes in HR and BP
can lead to plaque rupture
If a patient suspected of a silent MI they should always be referred to a cardiologist!!
Dyspnea after the onset of angina suggests ______.
left ventricular dysfunction
Elective noncardiac surgery should be delayed for ___ after coronary angioplasty.
Elective surgery should be delayed ___ after PCI with bare metal stent placement and as long as ____ in patients with drug electing stent placement.
Renal insufficiency or a creatitine of _____ puts patients at increased risk of perioperative cardiac events.
What are the 6 independent predictors of cardiac complications post operatively ....
- 1. High risk surgery
- 2. HF
- 3. cerebrovascular disease
- 4. IDDM
- 5. Ischemic Heart Disease
- 6. Creatinine >2
PREOPERATIVE TESTING SHOULD BE PERFORMED ONLY IF IT IS LIKELY TO INFLUENCE PERIOPERATIVE MANAGEMENT.
What are the 3 steps used to determine if a patient needs further eval before surgery??
- 1. Urgency of surgery (need for emergency surgery takes precedence over additional workup).
- 2. Has the patient undergone revascularization before??
- 3. Has the patient undergone non invasive cardiac testing?
If the patient has underwent revascularization within the past 5 years or has had appropriate intervention in 2 years with no deterioration --- further eval is unwarranted.
Name some conditions that are considered major clinical risk factors for surgery...
- unstable coronary syndrome
- decompensated HF
- severe valvular heart disease
Name some conditions that are considered intermediate clinical risk factors for surgery...
- previous MI (in hx)
- compensated or previous HF
- Renal failure
Name some conditions that are considered minor clinical risk factors for surgery...
- nonspecific ST changes
Functional Capacity is expressed in _________.
metabolic equivalent of the task (METs)
aka... or exercise tolerance
What is 4 METS equal to??
climbing a flight of stairs
If a patient has a METS of 4.... they are considered to ??
have good functioning capacity
risk of complications low
Patients with two of the following three factors
should be considered for further cardiac eval.
- 1. high risk surgery
- 2. low exercise tolerance
- 3. moderate clinical risk factors.
List some high risk surgeries..
These surgeries have >5% chance of cardiac events.
- emergency major surgery
- aortic or major vascular surgery
- prolonged surgery
- surgeries with large fluid shifts or blood loss
List some intermediate risk surgeries...
These surgeries have <5% risk of cardiac events....
- CEA (Carotid endarterectomy)
- head and neck surgerys
- intraperitoneal surgeries
- orthopedic surgeries
- and prostate surgeries
List some low risk surgeries...
These surgeries are suggested to have <1% chance of cardiac events
- endoscopic procedures
- superficial procedures
- breast surgeries
For a CABG surgery to be beneficial, the risk of the noncardiac operation should be greater than the combined risk of the heart cath and CABG.
in book page 21 (stoelings)
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