logging in or signing up anaesthesia and IHD saaigun Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1233 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: October 29, 2008 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: dreeshwar (9 month(s) ago) please can u allow me to download Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Ischemic Heart Diseaseand Anesthesia : Ischemic Heart Diseaseand Anesthesia Dr. Jason Waechter Dec/2003 Objectives : Objectives Risk evaluation: Is this patient high risk or low risk? Are further investigations required? Is optimization required? Risk Predictors : Risk Predictors Are categorized according to the AHA as: Major risk patient factors (marked by M) Medium risk patient factors (marked by m) Fitness capacity Type of surgery These factors determine management! Major Patient Risks M : Major Patient Risks M ACS (Acute Coronary Syndrome) M CHF (Congestive Heart Failure) M Valvular disease M Arrhythmias M Medium Patient Risks m : Medium Patient Risks m Past History of: CHF m Previous MI m CRF m DM m Mild Angina (stable angina) m Case Presentation : Case Presentation 50 yr. old male with past history of chest pain presents for fem-pop bypass How do you evaluate this patient? General Approach : General Approach History Physical Exam Investigations Important Features in History : Important Features in History Risk factors for IHD: smoking, DM m, HTN, chol. previous MI m family history of heart disease Important Features in History : Important Features in History Acute Coronary Syndrome M unstable angina new onset angina acute MI Congestive Heart Failure (CHF) M orthopnea, ankle swelling, PND, diuretics Important Features in History : Important Features in History Presence of Valvular Disease M ask the patient about valves History of Arrhythmias M palpitations, dizziness, syncope Important Features in History : Important Features in History Functional Capacity < 4 mets: walk around house can do dishes slow walking on flat ground 1 block Important Features in History : Important Features in History Functional Capacity 4-6 mets: 1 flight stairs can walk 2 blocks normal speed can walk up slight hill, but slowly Important Features in History : Important Features in History Medications for CHF (diuretics, AT blocker, ACE I) for angina (beta blocker, NTG) for arrhythmia (sotalol, amiodarone) The medication profile often provides good information about the patient’s condition Physical Exam : Physical Exam Perform a thorough physical exam with a focus on airway, respiratory and cardiac systems Look for MAJOR patient risk factors: CHF: (crackles, S3, JVP, edema) M Valve disease (murmurs) M Investigations : Investigations Labs K from diuretic m Na from CHF m Cr from CRF m glucose (DM) m troponin M Hb to rule out as cause of ischemia Investigations : Investigations Chest X-Ray (CXR) Signs of CHF: M hilar fullness vascular redistribution Kerley B lines alveolar infiltrates (pulmonary edema) pleural effusions Investigations : Investigations ECG Acute MI M Old MI m Dysrhythmias M ventricular, 2nd or 3rd degree blocks, SVT Echocardiography : Echocardiography Look for: Valvular disease M Decreased EF (<35% is high risk) AHA Decision Making : AHA Decision Making The AHA has developed an algorithm for preop management of IHD 3 main factors are used: patient risk factors (major and minor) patient fitness level type of surgery (high risk, low risk) AHA IHD Preop Guidelines : AHA IHD Preop Guidelines No investigations required if: emergency surgery revascularized < 5 yrs and no symptoms recent angio or stress echo was ok AHA IHD Preop Guidelines : AHA IHD Preop Guidelines Angiography required if: presence of 1 major patient risk factor M AHA IHD Preop Guidelines : AHA IHD Preop Guidelines Non-invasive testing required if 2 out of 3 are present: presence of 1 medium patient risk factor m poor fitness level high risk surgery Back to the Case : Back to the Case 50 yr old man with chest pain for fem-pop bypass. Hx: stable angina and old MI (plasty 7 yrs ago) no CHF or valvular disease DM, HTN, smoker fitness level: walks 30 minutes ok Case Presentation : Case Presentation Physical Exam normal airway lungs clear to auscultation CVS: no cardiomegaly no S3 no murmurs Case Presentation : Case Presentation Meds beta blocker, ACE I, NTG Labs Cr is elevated all other values normal Case Presentation : Case Presentation Investigations: ECG shows Q waves anteriorly. Otherwise is normal sinus rhythm with borderline LVH Echo shows: EF 35% normal valves mild dilated cardiomyopathy How do you manage? : How do you manage? To be discussed next week … You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
anaesthesia and IHD saaigun Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1233 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: October 29, 2008 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: dreeshwar (9 month(s) ago) please can u allow me to download Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Ischemic Heart Diseaseand Anesthesia : Ischemic Heart Diseaseand Anesthesia Dr. Jason Waechter Dec/2003 Objectives : Objectives Risk evaluation: Is this patient high risk or low risk? Are further investigations required? Is optimization required? Risk Predictors : Risk Predictors Are categorized according to the AHA as: Major risk patient factors (marked by M) Medium risk patient factors (marked by m) Fitness capacity Type of surgery These factors determine management! Major Patient Risks M : Major Patient Risks M ACS (Acute Coronary Syndrome) M CHF (Congestive Heart Failure) M Valvular disease M Arrhythmias M Medium Patient Risks m : Medium Patient Risks m Past History of: CHF m Previous MI m CRF m DM m Mild Angina (stable angina) m Case Presentation : Case Presentation 50 yr. old male with past history of chest pain presents for fem-pop bypass How do you evaluate this patient? General Approach : General Approach History Physical Exam Investigations Important Features in History : Important Features in History Risk factors for IHD: smoking, DM m, HTN, chol. previous MI m family history of heart disease Important Features in History : Important Features in History Acute Coronary Syndrome M unstable angina new onset angina acute MI Congestive Heart Failure (CHF) M orthopnea, ankle swelling, PND, diuretics Important Features in History : Important Features in History Presence of Valvular Disease M ask the patient about valves History of Arrhythmias M palpitations, dizziness, syncope Important Features in History : Important Features in History Functional Capacity < 4 mets: walk around house can do dishes slow walking on flat ground 1 block Important Features in History : Important Features in History Functional Capacity 4-6 mets: 1 flight stairs can walk 2 blocks normal speed can walk up slight hill, but slowly Important Features in History : Important Features in History Medications for CHF (diuretics, AT blocker, ACE I) for angina (beta blocker, NTG) for arrhythmia (sotalol, amiodarone) The medication profile often provides good information about the patient’s condition Physical Exam : Physical Exam Perform a thorough physical exam with a focus on airway, respiratory and cardiac systems Look for MAJOR patient risk factors: CHF: (crackles, S3, JVP, edema) M Valve disease (murmurs) M Investigations : Investigations Labs K from diuretic m Na from CHF m Cr from CRF m glucose (DM) m troponin M Hb to rule out as cause of ischemia Investigations : Investigations Chest X-Ray (CXR) Signs of CHF: M hilar fullness vascular redistribution Kerley B lines alveolar infiltrates (pulmonary edema) pleural effusions Investigations : Investigations ECG Acute MI M Old MI m Dysrhythmias M ventricular, 2nd or 3rd degree blocks, SVT Echocardiography : Echocardiography Look for: Valvular disease M Decreased EF (<35% is high risk) AHA Decision Making : AHA Decision Making The AHA has developed an algorithm for preop management of IHD 3 main factors are used: patient risk factors (major and minor) patient fitness level type of surgery (high risk, low risk) AHA IHD Preop Guidelines : AHA IHD Preop Guidelines No investigations required if: emergency surgery revascularized < 5 yrs and no symptoms recent angio or stress echo was ok AHA IHD Preop Guidelines : AHA IHD Preop Guidelines Angiography required if: presence of 1 major patient risk factor M AHA IHD Preop Guidelines : AHA IHD Preop Guidelines Non-invasive testing required if 2 out of 3 are present: presence of 1 medium patient risk factor m poor fitness level high risk surgery Back to the Case : Back to the Case 50 yr old man with chest pain for fem-pop bypass. Hx: stable angina and old MI (plasty 7 yrs ago) no CHF or valvular disease DM, HTN, smoker fitness level: walks 30 minutes ok Case Presentation : Case Presentation Physical Exam normal airway lungs clear to auscultation CVS: no cardiomegaly no S3 no murmurs Case Presentation : Case Presentation Meds beta blocker, ACE I, NTG Labs Cr is elevated all other values normal Case Presentation : Case Presentation Investigations: ECG shows Q waves anteriorly. Otherwise is normal sinus rhythm with borderline LVH Echo shows: EF 35% normal valves mild dilated cardiomyopathy How do you manage? : How do you manage? To be discussed next week …