Pharmacology 2: Exam 3 (Cardiac) –
Nagelhout |139 Questions and Answers
Major Risk Factors - -Unstable Coronary Syndromes
Decompensated Heart Failure
Significant Arrhythmias
Severe Valvular Disease
- What is the number one morbidity for anesthesia? - -Decompensated
Heart Failure
- Unstable coronary syndromes - -Acute or recent MI
Unstable or Severe Angina
- What significant arrhythmia's are considered as major risk factors? - -High-
grade AV block
Mobitz II AV block
CHB
Symptomatic Ventricular arrhythmias
SVT, AFib w/ RVR
Symptomatic bradycardia
New VT
- What Severe Valve Diseases are considered as major risk factors? - -AS
with gradient >40 mmHg;
Aortic valve area <1cm2 or exhibiting symptoms
- Mild AS with Aortic Valve Area - -> 1.5 cm2
- Moderate AS with Aortic Valve Area - -1.0 - 1.5 cm2
- Severe AS with Aortic Valve Area - -< 1.0 cm2
- Mild AS with gradient - -< 20 mmHg
- Moderate AS with gradient - -20 - 40 mmHg
- Severe AS with gradient - ->40 mm Hg
- Intermediate Risk Factors - -Mild Angina (Canadian Class I or II)
Previous MI
Compensated or previous heart failure
IDDM
Renal Insufficiency
, - Minor Risk Factors - -Old Age
Abnormal ECG (LVH, LBBB, ST-T)
Afib
Low Mets
Hx CVA
Uncontrolled systemic HTN
- High (Very Elevated) Risk (Cardiac Index >5%) - -Major Vascular Surgery
Emergent major operations
Prolonged procedures with large fluid shifts or significant blood loss
- Intermediate Risk (Cardiac Risk 1 - 5%) - -CEA
Endovascular Aortic Aneurysm Repair
Head and Neck surgery
Intraperitoneal and Intrathoracic surgery
Orthopedic Surgery
Prostate Surgery
- Low Risk (Cardiac Risk <1%) - -Superficial Procedures
Cataract Surgery
Breast Surgery
Ambulatory Surgery
- Calcium effects what node? - -SA node
- Sodium leaks into what conduction system? - -Ventricular
- Class I antiarrhythmics - -Depression of phase 0 (delays depolarization) -
blocks Na+ channels (ventricular)
- Class I antiarrhythmic Common Drugs - -Lidocaine
Procainamide
Quinidine
Phenytoin
Flecainide
Propafenone
- Class II antiarrhythmics - -Beta-adrenergic blocking drugs
- Class II antiarrhythmic common drugs - -Metoprolol, Labetolol, Atenolol,
Carvedilol, Propranolol, Esmolol, Timolol
- Class III antiarrhythmics - -Prolongs repolarization - blocks K+ channels
- Class III antiarrhythmic common drugs - -Amiodarone, Sotalol, Ibutilide,
Nagelhout |139 Questions and Answers
Major Risk Factors - -Unstable Coronary Syndromes
Decompensated Heart Failure
Significant Arrhythmias
Severe Valvular Disease
- What is the number one morbidity for anesthesia? - -Decompensated
Heart Failure
- Unstable coronary syndromes - -Acute or recent MI
Unstable or Severe Angina
- What significant arrhythmia's are considered as major risk factors? - -High-
grade AV block
Mobitz II AV block
CHB
Symptomatic Ventricular arrhythmias
SVT, AFib w/ RVR
Symptomatic bradycardia
New VT
- What Severe Valve Diseases are considered as major risk factors? - -AS
with gradient >40 mmHg;
Aortic valve area <1cm2 or exhibiting symptoms
- Mild AS with Aortic Valve Area - -> 1.5 cm2
- Moderate AS with Aortic Valve Area - -1.0 - 1.5 cm2
- Severe AS with Aortic Valve Area - -< 1.0 cm2
- Mild AS with gradient - -< 20 mmHg
- Moderate AS with gradient - -20 - 40 mmHg
- Severe AS with gradient - ->40 mm Hg
- Intermediate Risk Factors - -Mild Angina (Canadian Class I or II)
Previous MI
Compensated or previous heart failure
IDDM
Renal Insufficiency
, - Minor Risk Factors - -Old Age
Abnormal ECG (LVH, LBBB, ST-T)
Afib
Low Mets
Hx CVA
Uncontrolled systemic HTN
- High (Very Elevated) Risk (Cardiac Index >5%) - -Major Vascular Surgery
Emergent major operations
Prolonged procedures with large fluid shifts or significant blood loss
- Intermediate Risk (Cardiac Risk 1 - 5%) - -CEA
Endovascular Aortic Aneurysm Repair
Head and Neck surgery
Intraperitoneal and Intrathoracic surgery
Orthopedic Surgery
Prostate Surgery
- Low Risk (Cardiac Risk <1%) - -Superficial Procedures
Cataract Surgery
Breast Surgery
Ambulatory Surgery
- Calcium effects what node? - -SA node
- Sodium leaks into what conduction system? - -Ventricular
- Class I antiarrhythmics - -Depression of phase 0 (delays depolarization) -
blocks Na+ channels (ventricular)
- Class I antiarrhythmic Common Drugs - -Lidocaine
Procainamide
Quinidine
Phenytoin
Flecainide
Propafenone
- Class II antiarrhythmics - -Beta-adrenergic blocking drugs
- Class II antiarrhythmic common drugs - -Metoprolol, Labetolol, Atenolol,
Carvedilol, Propranolol, Esmolol, Timolol
- Class III antiarrhythmics - -Prolongs repolarization - blocks K+ channels
- Class III antiarrhythmic common drugs - -Amiodarone, Sotalol, Ibutilide,
