Anesthetic implications of cardiovascular disease. objectives. To identify the patients at risk for peri -op cardiac complications.
1) risk factors
2) active cardiac condition
3) previous MI, prior cardiac evaluation
4) past interventions – CABG,PTCA
5) functional capacity (NYHA)
6) co-morbid conditions
Rate of major cardiac complications-
0 – 0.5 % 1- 1.3%
2 – 4% >3 – 9 %
"Low risk": if 0 factors, risk = 3.1%; no additional pre-op testing needed
"Intermediate risk: if 1-2 factors, risk = 15%; noninvasive testing with angio if inducible ischemia.
"High risk: if > 2 factors, risk = 50%; go straight to angiography.
Dipyridamole/adenosine thallium scintigraphy
Pharm stress echo: Unable to exercise or Inability to achieve target heart rate during exercise because of therapy with High dose beta-blocker or calcium channel blocker
-To detect or exclude serious CAD i.e. left main or 3 vsds.
-chronic stable angina pts who are severely symptomatic despite medical therapy
-Pts with ventricular dysfxn
-In young patients with VHD to rule out assoc. CAD before cardiac surgery.
-patients being considered for revascularization -Helps to decide how many bypass grafts should be performed
- for definitive diagnosis of CAD individuals whose occupations could place others life in danger( pilots)